Cerebral Palsy Information

What is Cerebral Palsy?
The term cerebral palsy refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination but don’t worsen over time. Even though cerebral palsy affects muscle movement, it isn’t caused by problems in the muscles or nerves.  It is caused by abnormalities in parts of the brain that control muscle movements.  The majority of children with cerebral palsy are born with it, although it may not be detected until months or years later. The early signs of cerebral palsy usually appear before a child reaches 3 years of age.  The most common are a lack of muscle coordination when performing voluntary movements (ataxia); stiff or tight muscles and exaggerated reflexes (spasticity); walking with one foot or leg dragging; walking on the toes, a crouched gait, or a “scissored” gait; and muscle tone that is either too stiff or too floppy.  A small number of children have cerebral palsy as the result of brain damage in the first few months or years of life, brain infections such as bacterial meningitis or viral encephalitis, or head injury from a motor vehicle accident, a fall, or child abuse.

How do you get Cerebral Palsy?
Cerebral palsy is caused by an injury to the brain before, during, or shortly after birth. In many cases, no one knows for sure what caused the brain injury or what may have been done to prevent the injury. Sometimes injuries to a baby's brain happen while the baby is still in the mother's womb (before birth). The injury might be caused by an infection or by an accident in which the mother is hurt. If a mother has a medical problem such as high blood pressure or diabetes, this can also cause problems in the baby. There may be problems during birth such as the baby not getting enough oxygen, or a difficult delivery in which the baby's brain is injured. Problems after birth may happen when a baby is born too soon (premature delivery) and his body is not ready to live outside his mother's womb. Even babies born at the right time can have infections, or bleeding in their brain which causes a brain injury because the brain is still developing even after birth. The most important thing to remember is that you do not "catch" CP from another person, and you do not develop CP later in life. It is caused by an injury to the brain near the time of birth.

Are there different types of cerebral palsy?
Children with CP have damage to the area of their brain that controls muscle tone. Depending on where their brain injury is and how big it is, their muscle tone may be too tight, too loose, or a combination of too tight and loose. Muscle tone is what lets us keep our bodies in a certain position, like sitting with our heads up to look at the teacher in class. Changes in muscle tone let us move.
Try this:
Bend your arm to move your hand up to touch your nose. To do that, you must shorten, or increase the tone in the muscle in the front of the upper part of your arm (biceps muscle) while you lengthen, or decrease the tone in the back of the upper part of your arm (triceps muscle). To move your arm smoothly without jerks and without hitting yourself in the nose, the tone in muscles used to make that movement must change in a way that is just right---an even change to tighten one while loosening the other. Children with CP are not able to change their muscle tone in a smooth and even way, so their movements may be jerky or wobbly.
Spastic Cerebral Palsy
If muscle tone is too high or too tight, the term spastic is used to describe the type of cerebral palsy. Children with spastic CP have stiff and jerky movements because their muscles are too tight. They often have a hard time moving from one position to another or letting go of something in their hand. This is the most common type of CP. About half of all people with CP have spastic CP.
Ataxic Cerebral Palsy
Low muscle tone and poor coordination of movements is described as ataxic (a-tax-ick) CP. Kids with ataxic CP look very unsteady and shaky. They have alot of shakiness, like a tremor you might have seen in a very old person, especially when they are trying to do something like write or turn a page or cut with scissors. They also often have very poor balance and may be very unsteady when they walk. Because of the shaky movements and problems coordinating their muscles, kids with ataxic CP may take longer to finish writing or art projects.
Athetoid Cerebral Palsy
The term athetoid is used to describe the type of cerebral palsy when muscle tone is mixed - sometimes too high and sometimes too low. Children with athetoid CP have trouble holding themselves in an upright, steady position for sitting or walking, and often show lots of movements of their face, arms and upper body that they don't mean to make (random, involuntary movements). These movements are usually big. For some kids with athetoid CP, it takes a lot of work and concentration to get their hand to a certain spot (like to scratch their nose or reach for a cup). Because of their mixed tone and trouble keeping a position, they may not be able to hold onto things (like a toothbrush or fork or pencil). About one-fourth of all people with CP have athetoid CP.
Mixed Cerebral Palsy
When muscle tone is too low in some muscles and too high in other muscles, the type of cerebral palsy is called mixed. About one-fourth of all people with CP have mixed CP.

Besides different kinds of muscle tone, kids with CP also show different parts of their bodies that are affected by the CP. This is also due to what part of their brain was hurt and how big the injury was.

Quadriplegia
When a child shows CP in all four of their limbs--both arms and both legs, it is called quadriplegia. Quad means four. Usually kids with quadriplegia have trouble moving all the parts of their bodies, their face and trunk as well as their arms and legs, and may need a wheelchair to get around. Because of the problems controlling the muscles in their face and upper body, they also have trouble talking and eating.
Hemiplegia
Hemiplegia means that the CP affect one side of the child's body. Hemi means half, so the right arm and leg or the left arm and leg are affected. The other side of the child's body works just fine. Many kids with hemiplegia are able to walk and run, although they may look a little awkward or have a limp.
Diplegia
Some children have CP just in their legs or much more severe in their legs than in their arms. This is called diplegia. Di means two, so in diplegia only the two lower limbs are affected. As you probably can guess, the difficulty for children with diplegia is using their legs, so walking and running may be hard for them. Because their upper bodies are usually not affected they have good ability to hold themselves upright and good use of their arms and hands. You may wonder whether anyone ever has CP in their arms but not their legs. This happens sometimes, but it is very, very rare.

What are other problems associated with CP?
In addition to problems controlling their muscle movement, children with CP may have some other problems too. Most of these are caused by the same brain injury that caused the CP.
Talking and Eating
Just as CP can affect the way a person moves their arms and legs, it can also affect the way they move their mouth, face and head. This can make it hard for the person to talk clearly and to bite, chew and swallow food. If you meet a girl with CP you may notice that her speech is hard to understand or that she seems to work very hard just to get out a few words. This is because she is not able to make her lips, jaw and tongue move as quickly as you can. She may also have trouble controlling her breath flow to make her voice work. All of these parts of your body are very important in talking.
Try this:
Make a "g" sound (say "guh"). To do that, you must pull your tongue back and touch the back of your tongue to the back part of the roof of your mouth (your palate). Then, you must breathe out a little but not let the breath through until you are ready to make the sound. When you say "guh," you let your tongue drop while letting the breath out and turning on your voice. Whew! That's a lot of stuff to do just to make one sound. Just think of all the movements you must put together to say a whole word, or a sentence. Now imagine what it would be like to make sounds and words if you had trouble controlling your tongue. lips and breathing! The speech problem most children with CP have is called dysarthria (dis-are-three-a). That means it is hard for them to control and coordinate the muscles needed to talk. Their speech may sound very slow and slurred and their faces may look a little funny when they are trying to talk. Some kids' voices may sound different too. If too much air comes through your nose when you talk you sound hypernasal (hyper means too much), like Erkel from the old TV show "Family Matters". If not enough air comes through your nose you sound hyponasal (hypo means not enough), like when you have a bad cold and can't breathe through your nose. If you meet someone with CP who has speech problems, try hard to listen carefully when they are talking, and don't be afraid to tell them when you can't understand something they've said. Most people would rather say it again or find a different way to communicate (maybe writing or pointing) than have you pretend you understood them when you did not. Many of the same muscles involved in talking are also used when you eat. Some kids with CP might not be able to bite and chew foods like a hotdog or a peanut butter sandwich. They may also have trouble sucking through a straw or licking an ice cream cone.
Learning Problems
About one-fourth to one-half of children with CP also have some type of learning problem. It may be a learning disability so that they have trouble with one or two subjects in school but learn other things pretty well, or may be a more severe learning problem like mental retardation in which they learn everything at a slower rate. There are many different levels of mental retardation so that people with mild mental retardation may learn to read and write and do math, but people with more severe mental retardation probably will not. This does not mean that children with severe mental retardation can't learn. It means that they learn at a slower pace than most other kids, and that they will need some special learning help in school.
Seizures
About half of all children wih CP have seizures. This means that they have times when there is some abnormal activity in their brains that interrupts what they are doing. Often, the abnormal brain activity happens in the same place as the brain injury which caused the CP. Your brain is constantly sending messages out to your body - to breathe, to move, to keep your heart pumping. A seizure is a series of abnormal messages being sent out very close together. These abnormal messages may cause someone to stare and stop moving during a seizure, or may cause them to loose control of their body and fall down. Some people show shaking movements all over when they are having a seizure. Seizures usually last a few seconds to a few minutes, and in most case are not dangerous. Many children take special medicine to help prevent seizures or reduce the number of seizures they have.

What type of therapy is available for CP?
Children with CP often go to different kinds of therapy to help them improve their motor skills for things like walking, talking and using their hands. Some kids get therapy at school and some kids go to a special clinic to see their therapists. Therapists are special teachers who are trained to work with people on learning better or easier ways to do things. Just like a coach who helps you learn and practice new skills to make you a better soccer or basketball player, therapists "coach" people to help them learn and practice new skills.
Physical Therapy
Physical therapists help children learn better ways to move and balance. They may help children with CP learn to walk, use their wheelchair, stand by themselves, or go up and down stairs safely. Kids may also work on fun skills in physical therapy like running, kicking and throwing a ball, or learning to ride a bike. Physical therapy is usually called "PT" for short.
Speech and Language Therapy
Speech therapists work with children on communication skills. Communication skills may mean talking, using sign language, or using a communication aid. Children who are able to talk may work with a speech therapist on making their speech clearer (easier to understand) or on building their language skills by learning new words, learning to speak in sentences, or improving their listening skills. Children who are not able to talk because of their difficulty controlling the muscles needed for speech may learn sign language or use some kind of communication aid. A communication aid might be a book or poster with pictures that show things the person might want, or an alphabet board that the person can use to spell out their message. There are also computers that are used as communication aids that actually talk for the person!
Occupational Therapy
Occupational therapists usually work with children on better ways to use their arms, hands, and upper body. They may teach children better or easier ways to write, draw, cut with scissors, brush their teeth, dress and feed themselves, or control their wheelchair. Occupational therapists also help children find the right special equipment to make some everyday jobs a little easier.
Recreational Therapy
Recreational therapists help kids with CP have fun! They work with children on sports skills or other leisure activities. In recreational therapy kids may work on dance, swimming or horseback riding. They may also work on art or horticulture (growing and taking care of plants) or almost any other hobby they are interested in.

Is there any treatment?
Cerebral palsy can’t be cured, but treatment will often improve a child's capabilities.   Many children go on to enjoy near-normal adult lives if their disabilities are properly managed. In general, the earlier treatment begins the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them.   Treatment may include physical and occupational therapy, speech therapy, drugs to control seizures, relax muscle spasms, and alleviate pain; surgery to correct anatomical abnormalities or release tight muscles; braces and other orthotic devices; wheelchairs and rolling walkers; and communication aids such as computers with attached voice synthesizers.

What is the prognosis?
Cerebral palsy doesn’t always cause profound disabilities.   While one child with severe cerebral palsy might be unable to walk and need extensive, lifelong care, another with mild cerebral palsy might be only slightly awkward and require no special assistance. Supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world.