Cerebral Palsy

A look at the types, symptoms, and complications associated with cerebral palsy.

What is Cerebral Palsy?

Cerebral palsy is a term used to describe a group of chronic disorders impairing control of movement. These disorders appear within the first few years of life and generally do not worsen over time. The term cerebral refers to the brain’s two halves and palsy describes any disorder that impairs control of body movement. Thus, these disorders are not caused by problems in the muscles or nerves. Instead, faulty development or damage to motor areas in the brain disrupts the brain’s ability to control movement and posture.

Symptoms of cerebral palsy lie along a spectrum of varying severity, and may include:

  • Difficulty with fine motor tasks, such as writing or cutting with scissors
  • Difficulty maintaining balance and walking
  • Involuntary movements, such as uncontrollable writhing or drooling.
  • Some people with cerebral palsy are also affected by other medical disorders, including seizures or mental impairment

The symptoms differ from one person to the next, and may even change over time in the individual. Contrary to common belief, however, cerebral palsy does not always cause profound handicap. While a child with severe cerebral palsy might be unable to walk and need extensive, lifelong care, a child with mild cerebral palsy might only be slightly awkward and require no special assistance.

What Are the Different Forms?

Doctors classify cerebral palsy into four broad categories—spastic, athetoid, ataxic, and mixed forms—according to the type of movement disturbance.

Spastic

In this form of cerebral palsy, which affects 70–80 percent of patients, the muscles are stiffly and permanently contracted. When both legs are affected by spasticity, they may turn in and cross at the knees. As these individuals walk, their legs move awkwardly and stiffly and nearly touch at the knees. This causes a characteristic walking rhythm, known as the scissors gait.

Individuals with spastic hemiparesis may also experience hemiparetic tremors, in which uncontrollable shaking affects the limbs on one side of the body. If these tremors are severe, they can seriously impair movement.

Athetoid

Also known as “dyskinetic,” this form of cerebral palsy is characterized by uncontrolled, slow, writhing movements. These movements usually affect the hands, feet, arms, or legs and, in some cases, the muscles of the face and tongue, causing grimacing or drooling. The movements often increase during periods of emotional stress and disappear during sleep. Patients may also have problems coordinating the muscle movements needed for speech, a condition known as dysarthria. Athetoid cerebral palsy affects about 10–20 percent of patients.

Ataxic

This rare form affects the sense of balance and depth perception. Affected persons often have poor coordination; walk unsteadily with a wide-based gait, placing their feet unusually far apart; and experience difficulty when attempting quick or precise movements, such as writing or buttoning a shirt. The ataxic form affects an estimated 5–10 percent of cerebral palsy patients.

Mixed Forms.

It is common for patients to have symptoms of more than one of these forms. The most common mixed form includes spasticity and athetoid movements but other combinations are also possible.
 
What Other Medical Disorders Are Associated With Cerebral Palsy?

Many individuals who have cerebral palsy have no associated medical disorders. However, disorders that involve the brain and impair its motor function can also cause seizures and impair an individual’s intellectual development, attentiveness, activity and behavior, and vision and hearing. Medical disorders associated with cerebral palsy include:

  • Mental impairment. About one-third of children who have cerebral palsy are mildly intellectually impaired, one-third are moderately or severely impaired, and the remaining third are intellectually normal.
  • Seizures or epilepsy. As many as half of all children with cerebral palsy have seizures.
  • Growth problems. A syndrome called failure to thrive is common in children with moderate-to-severe cerebral palsy. Failure to thrive is a general term used to describe children who seem to lag behind in growth and development despite having enough food.
  • Impaired vision or hearing. A large number of children with cerebral palsy have strabismus, a condition in which the eyes are not aligned because of differences in the left and right eye muscles. In an adult, this condition causes double vision. In children, the brain often adapts to the condition by ignoring signals from one of the misaligned eyes. Untreated, this can lead to very poor vision in one eye and can interfere with certain visual skills.
  • Abnormal sensation and perception. Some children with cerebral palsy have impaired ability to feel simple sensations like touch and pain. They may also have stereognosia, or difficulty perceiving and identifying objects using the sense of touch.

What Other Problems Are Associated with Cerebral Palsy?

Poor control of the muscles of the throat, mouth and tongue sometimes leads to drooling. Drooling can cause severe skin irritation and lead to further isolation of affected persons. Although numerous treatments for drooling have been tested, there is no one treatment that always helps.

  • Drugs called anticholinergics can reduce the flow of saliva but may cause side effects, such as mouth dryness and poor digestion.
  • Surgery, while sometimes effective, carries the risk of complications, including worsening of swallowing problems.
  • Some patients benefit from a technique called biofeedback that can tell them when they are drooling or having difficulty controlling muscles that close the mouth.

Difficulty with eating and swallowing—also triggered by motor problems in the mouth—can cause poor nutrition. Poor nutrition, in turn, may make the individual more vulnerable to infections and cause or aggravate “failure to thrive.”

To help with swallowing problems, consider the following suggestions:

  • Prepare semisolid, easier-to-swallow food, such as strained vegetables and fruits.
  • Proper position, such as sitting up while eating or drinking will reduce the risk of choking.
  • Sitting with the neck extended away from the body while eating can also reduce the risk of choking and make swallowing easier.
  • In severe cases, physicians may recommend tube feeding, in which a tube delivers food down the throat and into the stomach, or gastrostomy, in which a surgical opening allows a tube to be placed directly into the stomach.

A common complication is incontinence, caused by faulty control over the muscles that keep the bladder closed. Incontinence can take the form of bed-wetting (also known as enuresis), uncontrolled urination during physical activities (or stress incontinence), or slow leaking of urine from the bladder. Possible medical treatments for incontinence include special exercises, biofeedback, prescription drugs, surgery, or surgically implanted devices to replace or aid muscles. Specially designed undergarments are also available.

© Copyright FamilyCare America, Inc. All Rights Reserved.

Adapted from “Cerebral Palsy—Hope Through Research,” by the National Institute of Neurological Disorders and Stroke, National Institutes of Health.

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