Topic Overview
What is cerebral palsy?
Cerebral palsy is a group
of problems that affect body movement and posture. It is related to a brain
injury or to problems with brain development. It is one of the most common causes of
lasting disability in children.
Cerebral palsy causes
reflex movements that a person can't control and muscle tightness that may
affect parts or all of the body. These problems can range from mild to severe.
Intellectual disability,
seizures, and vision and hearing problems can
occur.
What causes cerebral palsy?
Cerebral palsy is
caused by a brain injury or problem that occurs during pregnancy or birth or
within the first 2 to 3 years of a child's life. It can be caused
by:
- Problems from being born too early (premature
birth).
- Not getting enough blood, oxygen, or other nutrients
before or during birth.
- A serious head injury.
- A
serious infection that can affect the brain, such as
meningitis.
- Some problems passed from
parent to child (genetic conditions) that affect brain
development.
In many cases, the exact cause of cerebral palsy is not
known.
What are the symptoms?
Everyone with cerebral
palsy has problems with body movement and posture. But the physical problems
are worse for some people than for others.
Some people who have cerebral palsy have
a slight limp or a hard time walking. Other people have little or no
control over their arms and legs or other parts of the body, such as the mouth
and tongue, which can cause problems with eating and speaking. People who have
severe forms of cerebral palsy are more likely to have other problems, such as
seizures or intellectual disability.
Babies with severe cerebral palsy
often have problems with their posture. Their bodies may be either very floppy
or very stiff. Birth defects sometimes occur along with cerebral
palsy. Examples of birth defects include a spine that doesn't have the normal
shape, a small jawbone, or a small head.
The brain injury or problem that causes cerebral palsy
doesn't get worse over time. But new symptoms may appear, or symptoms may
change or get worse as your child gets older. This is why some babies born with
cerebral palsy don't show clear signs of it right away.
How is cerebral palsy diagnosed?
Your child's doctor will do a physical exam and ask you about your child's medical history. He or she will ask about your child's growth and about any problems you may have
noticed. The doctor may also ask about your child's development.
Tests, such as a
CT scan or an
MRI of your child's head, may also be done. Or the
doctor may look at
ultrasound pictures of the brain. These tests can sometimes help
the doctor find the cause of cerebral palsy.
If
your child has a severe form of cerebral palsy, a doctor may be able to
pinpoint the problem within the first few weeks of your child's life. But
parents are often the first to notice that their baby does not have the
abilities and skills that are common in other children in the same age group.
These
developmental delays can be early signs of cerebral
palsy.
Even when the condition is present at birth,
the signs of
cerebral palsy may not be noticed until a child
is 1 to 3 years old.
How is it treated?
Even though cerebral palsy can't be cured, you and your child can do things to help
deal with symptoms, prevent problems, and make the most of your child's
abilities. Physical therapy is one of the most important treatments. Medicines,
surgery, and special equipment such as a walker can also help.
What can you do to cope?
Meeting the daily needs
of a family member with cerebral palsy isn't easy. If your child has
cerebral palsy, seek family and community support. It may help to join a
support group or talk with other parents who have a child with special needs,
so you don't feel alone.
You may also find counseling useful. It may help you
understand and deal with the wide range of emotions you may feel. Your child will need help too. Providing emotional
support for your child can help him or her cope with having cerebral
palsy.
Learning that your child has cerebral palsy isn't easy,
and raising a child who has it can be hard. But the more you know, the
better you can care for and provide for your child.
Frequently Asked Questions
Learning about cerebral palsy: | |
Being diagnosed: | |
Getting treatment: | |
Living with cerebral palsy: | |
Cause
Cerebral palsy
(CP) is a result of an injury to the brain or abnormal development of the brain. In many
cases, the exact cause isn't known. The damage or abnormality may occur
during pregnancy or birth or within the first 2 to 3 years of life.
- Possible causes of CP during pregnancy or birth can include
genetic problems, infections or health problems in the
mother or baby during pregnancy, or problems related to labor and
delivery. Health problems in a newborn,
such as untreated low blood sugar, can also cause brain damage that leads to
CP.
- Possible causes of CP related to an early birth (premature birth) are related to the brain's development. For example, babies born too early are
at risk for bleeding in the brain.
- Possible causes of CP within the first 2 or 3 years of life are usually related to brain
damage from a serious illness, injury, or lack of oxygen to the brain.
Symptoms
When cerebral palsy (CP) is severe, signs are often noticed at birth or shortly
after birth. But some early signs of severe CP vary depending on the
specific type of CP.
Common signs
of severe CP that may be noticed shortly after birth include:
- Problems sucking and swallowing.
- A
weak or shrill cry.
- Seizures.
- Unusual positions. Often the baby's body is either
very relaxed and floppy or very stiff.
Even when the condition is present at birth,
the signs of
cerebral palsy may not be noticed until a child
is 1 to 3 years old. Doctors and parents may not see that a baby's movements are unusual until the movements become more obvious as the baby grows.
Signs that occur over time
Some problems related to CP become more clear over time. Or they may develop as a child grows. These may include:
- Smaller muscles in the affected arms or legs. Nervous
system problems prevent movement in the affected arms and legs. Not being active affects how the muscles grow.
- Abnormal sensations. Some people
who have CP feel pain when touched lightly. Even everyday activities, such as
brushing teeth, may hurt. Abnormal sensations can also make it hard to
identify common objects by touch.
- Skin irritation. Drooling is common when facial and
throat muscles are affected. Drooling irritates the skin, particularly around
the mouth, chin, and chest.
- Dental problems. Children who have trouble
brushing their teeth have a greater risk of getting cavities and gum disease
(gingivitis). Seizure medicines may also lead to gum
disease.
- Accidents. Falls and other accidents are a risk,
depending on muscle control, joint stiffness, and general physical strength.
And CP-related seizures can cause injuries.
What Happens
All people who have
cerebral palsy (CP) have some problems with body
movement and posture. But many babies don't show signs of CP at birth. Parents
and caregivers may notice the
first signs of CP. For example, the baby may not roll over,
sit, crawl, or walk at the expected ages.
Signs of CP
may become more obvious as the child grows. Some developmental problems may not
appear until after a baby's first year. The brain injury that causes CP doesn't get worse over time. But its effects can appear, change, or become more
severe as the child gets older.
How CP may affect your child
How much a child is able to move around and do things depends on the
type of CP the child has and how much of his or her body is affected. The way CP affects a child also depends
on the child's level of intellectual disability, if any, and whether he or she has other
complications or other medical conditions.
Most people who have CP have a type of
spastic cerebral palsy. This can affect the whole body
but may only affect parts of the body in some children. For example, a child
with spastic cerebral palsy may have symptoms mostly in one leg or on one side
of the body. Most children usually learn ways to adapt to their
movement problems, like using special devices and equipment to move around.
Total body cerebral palsy causes the most severe
problems. Many of those affected are not able to take care of themselves, either
because of severe physical disabilities or
intellectual disability. But some people can live on their
own with the help of family members, health care aides, or both.
Complications of CP
Some children with CP may have complications, such as seizures. Other medical conditions, such as vision or hearing
problems, are often associated with CP. Sometimes these conditions are known
right away. In other cases, they aren't found until a child gets
older.
Adults with CP
are at risk for heart and lung disease. For example, severe CP causes
problems with eating. If food is inhaled into the lungs, the risk of lung
infection (pneumonia) increases.
Living with CP
Just like people who have normal physical development,
people who have CP have
social and emotional concerns throughout their lives.
Because their physical limitations may add to these concerns, people who have CP
need the awareness and consideration of others.
Most adults with the mild or moderate
form—and some with the severe form—live independently and have jobs.
Others live and work with some level of assistance. Opportunities for independent living and employment for adults with CP have
improved, thanks to better home support services and
advances in technology, such as computers to assist with speech, powered
wheelchairs, and other devices.
What Increases Your Risk
Risk factors before birth
Babies born to teen mothers or to mothers age 35 and
older have a higher risk for cerebral palsy (CP).
Also, a baby's risk
for developing a brain abnormality or injury that leads to CP increases when
the mother has certain problems during her pregnancy. These problems may include:
- Infections, such as
rubella,
cytomegalovirus infection (CMV), chorioamnionitis, and
toxoplasmosis.
- Exposure to certain
medicines, such as thyroid hormones, estrogen, or methotrexate.
- Use of alcohol or
illegal drugs.
- Other problems, such as bleeding in the uterus
during the sixth to ninth month of pregnancy, large amounts of protein in the
urine (proteinuria), or high blood sugar levels.
Premature birth and low birth weight
About half of all children who have
cerebral palsy (CP) are born
prematurely.1 The risk of a
baby having CP increases as the birth weight decreases.
A baby who is born
prematurely usually has a low birth weight, less than
5.5 lb (2.5 kg). But full-term
babies can also have low birth weights. Multiple-birth babies are more likely
than single-birth babies to be born early or with a low birth weight.
Most children
with CP had a disruption in the normal development of parts of their brain
during fetal growth. Low-birth-weight, premature babies are more likely than full-term,
normal-weight babies to have had developmental problems during fetal growth
that can injure the brain. For example, a condition called
periventricular leukomalacia, or PVL, which reflects injury to the white matter
of the brain, is more likely in babies born prematurely than in those born at
full term.
Risk factors for cerebral palsy at birth
In rare
cases, some babies develop CP as a result of complications during the mother's
pregnancy or at birth. Risk factors include:
- Premature birth. Premature babies are more likely to have bleeding in the brain (intraventricular
hemorrhage, or IVH) or a brain injury called periventricular leukomalacia (PVL). Either of these problems may cause CP.
- Difficult or prolonged
labor.
- Brain infection or physical trauma can increase a baby's risk of getting CP.
- A lack of oxygen also increases a baby's risk. This isn't common.
- CP can itself cause a
baby to have a difficult birth because of body movement and posture problems
related to the condition.
- Placenta abruptio. The placenta usually separates from
the wall of the uterus several minutes after the birth of the baby. But if it
separates before the baby is born, the baby loses the blood and oxygen supply
from the mother.
- Infections in the mother's uterus or vagina, such as
strep infections, that transfer to the baby during
birth.
Risk factors after birth
Risk factors for
developing CP just after birth or within the first 2 or 3 years of life are
related to brain damage. They include:
- A serious illness, such as severe
jaundice,
meningitis, or
lead poisoning (very rare).
- A serious
head injury from an accident or fall. This includes injury to a baby from
shaking, throwing, or other force (shaken baby syndrome).
- Lack
of oxygen to brain tissues, such as the result of a brain tumor or a
near-drowning incident.
- Having some kinds of blood-clotting or
genetic problems.
When To Call a Doctor
Call 911 or other emergency services if your child with
cerebral palsy (CP):
- Is having problems
breathing.
- Chokes during feeding and you are not able to dislodge
the food.
Call a doctor right away if:
- Your child has a
seizure for the first time.
If you have a child diagnosed with CP, call your doctor if
your child has:
- A seizure (if it is the first time, call your
doctor or seek care right away).
- Constipation that isn't relieved
by home treatment.
- Skin irritation that isn't getting better,
starts to bleed or weep fluid, or causes pain.
- Feeding problems
that aren't relieved by home treatment, such as:
- A pattern of coughing and choking during
feeding. If food is inhaled into the lungs, it increases the risk of pneumonia.
- Trouble chewing, along with
weight loss or complaints of being hungry.
- Frequent accidents that threaten your child's
safety.
- Other signs of
complications. These may include bladder control problems,
bleeding gums, or an increase in joint stiffness.
If you have cerebral palsy and you are pregnant, talk
with a doctor about how CP can affect your pregnancy and delivery.
Who to see
A team of health care providers will be involved in your child's care. Health professionals who can diagnose and treat people
who have cerebral palsy include:
Other specialists who may be involved in the care of
people who have CP include:
Other health professionals who may be involved in the
care of people who have CP include:
Some health care clinics specialize in treating children
with CP. Call your local health department for the nearest clinic in your
area.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Diagnosing cerebral palsy
Developmental delays are often reported by parents or
observed by a doctor during routine
well-baby checks.
A doctor diagnoses CP based on:
- Questions about the child's
medical history, including details about the mother's
pregnancy.
- A
physical exam to look for signs of CP. The doctor will look to see if the child retains
newborn reflexes longer than normal. This can be a sign of CP. Postures and basic muscle function, hearing, and vision are
usually checked.
- Screening tests. Developmental questionnaires and other tests may be done.
- MRI of the head. This test can find brain abnormalities.
If the diagnosis is
unclear, more tests may be done. Sometimes these tests can help find out the severity of CP.
A doctor may closely monitor a newborn or child for signs of CP if he or
she has known risk factors. These factors may be related to
problems during pregnancy or birth,
being born early (premature birth), or
problems that occur within the first 2 or 3 years of life.
Doctors are careful not to diagnose CP too early,
because some babies who have
motor skill problems soon after birth never
get CP.
Sometimes symptoms may not appear until the nervous
system matures. It
can take up to a few years before doctors can tell if a baby with body
movement and posture (motor) problems has CP.
Evaluating and monitoring cerebral palsy
After CP
is diagnosed, a child will also be checked for
other medical conditions that can occur with cerebral
palsy, such as:
- Other developmental delays in addition to ones already found.
Developmental abilities will be checked to find out if new symptoms, such as speech and
language delay, appear as a child's nervous system matures.
- Intellectual disability. This can be checked by intelligence testing.
- Seizures. An
electroencephalography (EEG) is used to check for
abnormal activity in the brain if a child has a history of
seizures.
- Problems with feeding and swallowing.
- Vision
or hearing problems.
- Behavioral
problems.
Most of the time, a doctor can predict many of the
long-term physical effects of CP when a child is 1 to 3 years old. But
sometimes such predictions aren't possible until a child reaches school age. That's
when learning, communication skills, and other abilities can be checked.
Some children need repeated testing that
may include:
- X-rays, to check for loose or
dislocated hips. Children with CP are usually X-rayed
several times during ages 2 to 5. Spinal X-rays also are done to look for curves
in the child's spine (scoliosis).
- Gait analysis. This
helps identify problems and guide treatment decisions.
Other tests may be needed, depending on a child's
symptoms, other conditions, or medicines he or she takes.
Treatment Overview
Even though CP can't be cured, a variety of treatments can help people who have CP to
make the most of their abilities and physical strength, prevent
complications, and improve their quality of life.
Specific treatment varies by individual and changes as
needed if new issues develop. In general, treatment focuses on ways to
maintain or improve a person's quality of life and overall health.
Regular visits with
your child's doctor and specialists are important for monitoring your child's
condition.
Treatment for CP includes:
- Physical therapy, which can help your child become as
mobile as possible.
- Medicines, which can help control some of the symptoms of CP and prevent
complications. For more information, see Medications.
- Certain kinds of surgery, which may sometimes be used for
a child with severe problems. For more information, see Surgery.
- Devices and equipment, such as braces, casts,
and splints.
- Pain management. For more information, see the topics Pain Management and Chronic Pain.
Physical
therapy and special equipment may be used together, such as for
constraint-induced movement therapy, also called shaping. This encourages a child to increase movements by presenting interesting activities
or objects and giving praise and rewards when a child attempts to use the
less-functioning muscles.
Ongoing treatment for cerebral
palsy (CP) focuses on continuing and adjusting existing treatments and adding
new treatments as needed.
Working with others
involved with your child's care, understanding your child's needs and rights,
and taking care of yourself and other family members are all important parts of treatment. For more information, see Home Treatment.
Physical therapy
Physical therapy is an important treatment that begins soon after a child is diagnosed. It often
continues throughout the child's life. It may begin before a
definite diagnosis is made, depending on the child's symptoms.
Physical therapy may help prevent the need for surgery. But its focus may change after surgery or for problems that are new
or getting worse. After surgery, specialized physical therapy may be needed for
6 months or longer.
Devices and equipment
Many people who have CP benefit from using something to
maintain or improve joint mobility, help strengthen muscles and relax
overactive (spastic) muscles, and assist with daily activities. These devices
and equipment may include special crutches, orthotics, casts, standers, special seats, walkers,
wheelchairs, special shoes, and other methods to help with
specific problems.
The specific types of devices used depend on a child's needs. For example, a
child may get a cast after surgery or to restrict movement in one
area to strengthen muscles and tendons in another part of the body. If both legs are affected by CP,
a child can learn to move around with the help of a scooter board (a device used to
self-propel while lying down), a modified stroller, a wheelchair, or other special
equipment.
Other treatments
Other therapies may also be needed,
depending on specific needs.
- Occupational therapy helps teens and adults adapt
to their limitations and live as independently as possible.
- Speech therapy helps control the mouth muscles. This therapy can be of great
help to children with speech or eating problems. Speech therapy often starts
before the child begins school and continues throughout the school
years.
- A registered dietitian can provide nutritional counseling when a child has problems eating or is not gaining weight.
- Both
massage therapy and
hatha yoga are designed to help relax tense muscles,
strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises
are sometimes used to try to prevent lung infections. More research is needed
to find out the health benefits of these therapies for people who have
CP.
- Therapies to stimulate learning and sensory development may
benefit babies and young children. Some also help people of other ages. These
therapies cannot repair damaged parts of the brain. But they may be able to
stimulate undamaged parts of the brain.
- Behavioral therapy may help
some school-age children with CP learn better ways to communicate with others.
- Biofeedback may be useful as part of physical therapy
or on its own. Although it doesn't help everyone with CP, some people
who use the technique learn how to control their affected muscles or reduce
muscle tension.
You may hear about a wide range of
controversial treatments, some of which may cause
harm. Several
controversial treatments exist for CP, such as
electrical stimulation and special diets. Be sure to talk to your doctor about any type of treatment you
are considering for your child.
Preparing for independent living
Many adults with CP get jobs if
they have good support from their family and community. You can enroll your
teen in
occupational therapy as part of a gradual preparation
for independent living. Your child may need extra help and encouragement to
prepare for added expectations and responsibilities.
Prevention
The cause of
cerebral palsy (CP) sometimes isn't known. But links
have been identified between CP and certain conditions during pregnancy, birth,
and early childhood. Some of these can be prevented. Some cannot.
Before and during pregnancy
Doing all you can before and during pregnancy can help lower the risk that a brain injury will occur in a developing baby. Here are some tips for healthy habits before and during pregnancy.
- Eat nutritious foods.
- Don't smoke.
- Avoid exposure to harmful substances.
- See your doctor
regularly.
For babies and young children
Help prevent CP in your young child by minimizing your child's risk for
getting a brain injury.
If your child has not been diagnosed with CP, pay attention to whether your child is reaching
early developmental milestones. Report anything you notice to your doctor at regularly scheduled
well-child visits or anytime you have concerns.
Home Treatment
Family members working together with
doctors can use home treatment to provide the best possible care for a child with
cerebral palsy (CP).
Tips for parents and family members
- Learn about the condition. Being informed can
help you understand how best to help your child. Local or national cerebral palsy
organizations can help, especially in dealing with the impact of daily emotional
and lifestyle issues. Talk with your doctor or call your local hospital for
suggestions. For more information, see the Other Places to Get Help section of
this topic.
- Learn about your child's educational rights. Laws in the United States give children with special needs access to free public school services and some free treatments. These educational rights also include protection of the parents' rights to be
fully informed about or disagree with educational decisions concerning their
child. Contact your state and local education departments for specific
information about these accommodations. Also,
vocational training may benefit some teens and young
adults.
- Work with teachers and school officials. Work
with your child's teachers, school administrators, special learning
consultants, and school boards to develop the best educational plan for your
child. A cooperative team approach helps your child realize his or her
potential.
- Provide emotional support. The needs of a child
with CP change over time. As children grow and become more aware of their
physical limitations, they need to be able to talk about their feelings and how
they are treated. It is sometimes easier for them to talk with someone who isn't a family member. Ask your doctor about whether emotional
counseling would benefit your child. Also, include
your child when making decisions about his or her health care.
- Take care of yourself. Get proper rest, eat well,
exercise, and learn
ways to cope with the challenges of raising a child with CP. You will be
better equipped to help your child when you have physical energy and emotional
strength.
- Help each other. The entire family is affected
when one member has CP.
Helping family members cope with this situation is
important, especially for siblings. You can help prevent other children from
having unrealistic fears and concerns, feeling left out, or becoming
overwhelmed.
You and your family and
friends can help your child reach his or her highest potential. Focus on your child's strengths. And build
self-esteem by helping your child learn to do things
by himself or herself.
Growth and Development: Helping Your Child Build Self-Esteem.
Helping with daily routines
Each person with CP
has unique strengths and areas of difficulty. But most people who have CP need
ongoing help with:
- Using the toilet. Some people who have
CP have poor bladder control or problems that make using a
toilet difficult. Special
undergarments and training by an
occupational therapist may help.
- Bowel elimination. People who have CP often become
constipated, making stools difficult to pass. For information about
preventing and treating constipation, see the topic
Constipation, Age 11 and Younger or
Constipation, Age 12 and Older.
- Dressing. Provide clothing and shoes that are easy to put on and
take off, such as those that zip or button in the front or that
have large buttons, ties, or Velcro fasteners.
- Speaking. Problems with jaw and mouth muscles, and also hearing loss, can make it difficult to form words.
Speaking slowly and reading with your child often are examples of ways to help
your child communicate.
- Keeping active. Your child
needs to move his or her limbs to help keep muscles strong and joints flexible.
Have him or her move and play as much as possible. Involve other family members
too. Ask the doctor, physical therapist, or other parents for
ideas.
- Safety. People who have CP are prone to falls and other
accidents, especially if they have
seizures. You can take safety measures at
home—such as having sturdy furniture—to help
your child avoid accidents. Use common sense and care around sharp
objects. And never leave a person who has CP alone while he or she is bathing.
Feeding and grooming
- Feeding and eating. Children with CP may have problems being able to chew, suck, and swallow. Using special utensils and serving soft foods may help. A registered dietitian can suggest ways to help your child eat healthy foods and make food easier to chew and swallow. A person with severe CP may need a feeding tube in order to eat.
- Bathing and grooming. People who have CP who do not have control of
their hands or arms usually cannot groom themselves. Some children can be
taught some self-grooming with practice.
Dental and skin care
- Dental care. CP can cause problems with the jaw muscles, teeth, mouth, and tongue. And it can make it hard to use a toothbrush. Regular cleanings and special equipment, such as a teeth-cleaning
water spray, can help.
- Skin care.
Drooling can cause skin irritation around
the chin, mouth, and chest. You can help protect your child's skin by blotting rather than wiping drool, using cloths
to cover the chest, and applying lotions or cornstarch to areas that get irritated.
Teen years
As your
child approaches the teen years and young adulthood, be aware of his or her
changing needs.
- Give teens and adults with CP plenty of
emotional support and understanding. Family members
and friends can help them deal with the daily
challenges of having CP.
- Gradually prepare your child for
independent living. Usually teens have learned to use
their talents and strengths. But they may need extra help and encouragement to
prepare for added expectations and responsibilities.
- Talk to your teen about intimate relationships. Teens and
young adults with CP may need more guidance than other people their age in developing
these relationships.
Learn to change your routines as your child with CP grows and develops. For example,
you may not be able to continue caring for a severely affected child who is
growing tall and heavy. Try to plan ahead for the time when your
grown child with CP is not under your care.
Planning for adulthood
Preparing your child for
adulthood takes careful planning. It also requires patience and resourcefulness
on your part.
- Encourage independent living skills. A time
may come when you or other family members can no longer assist your child in all areas.
- Plan for an
adult's current and future health care needs. Complications of cerebral palsy may develop and affect quality of life. Also, some forms of CP are
more severe and require special assistance.
- Use occupational therapy and similar programs that may be
helpful. Most adults with CP are employed, despite moderate to severe physical
disability. Laws protect the rights of disabled people to
find and hold employment (among other rights). Learn about
the Americans with Disabilities Act (ADA) of 1990 at www.ada.gov.
Older adults
with CP may need extra help preparing for retirement.
Medications
Medicines can help control some of the
symptoms of
cerebral palsy (CP), prevent or minimize
complications, and treat
other medical conditions related to CP.
Medicine choices
Muscle relaxants (antispasmodics) are the most common medicines used for
people who have CP. They can help relax tight muscles and reduce muscle
spasms. Most antispasmodics are taken by mouth. Some are injected directly into stiff or spastic muscles. Examples include:
- Baclofen (such as Gablofen).
- Botulinum toxin (such as Botox).
- Diazepam (such as
Valium).
Anticonvulsants help prevent or control seizures. These include:
- Lamotrigine (Lamictal).
- Oxcarbazepine (Trileptal).
Anticholinergics help some people who have CP who
have uncontrollable body movements (dystonic cerebral palsy) or who drool
often. These include:
- Benztropine (Cogentin).
- Glycopyrrolate (Robinul).
Stool softeners and mild laxatives may help treat
constipation, which is a common complaint of people who have CP.
What to think about
Some doctors believe that oral antispasmodic medicines should not be given to growing children. They are
concerned that side effects from these medicines can cause problems for
children that are worse than the tight muscles and muscle spasms related
to CP. For example, drowsiness is a side effect that may interfere with a child's ability to concentrate and learn in
school. Other doctors believe that the benefits of these medicines outweigh the
risk of side effects.
Ask your doctor the following questions
about any medicine prescribed for your child:
- How successful is it in treating my child's
problem?
- What are the short-term and long-term side
effects?
- What are the chances that the medicine will stop working?
What options are available if this happens?
- How might it
affect my child's growth and development?
See the
new medicine information form(What is a PDF document?) for more questions to ask.
Surgery
Surgery for people who have
cerebral palsy (CP) may help reduce muscle stiffness or spasms and allow more flexibility and control of the affected limbs and joints.
Surgery choices
The main surgery choices are:
- Orthopedic surgery (for muscles, tendons, and joints). It's done to increase range
of motion. For example, the surgeon may lengthen a tendon, cut through muscles
or tendons, or attach a tendon to a different part of the bone.2 Surgery to treat spinal curves (scoliosis) or to prevent or treat hip
dislocation is also done.
- Selective dorsal rhizotomy (cutting nerves of affected limbs) for contracture or other mobility problems. This procedure is usually
considered only for children who have severe muscle tightness in the legs.
Other surgeries related to cerebral palsy
- Surgery for various orthopedic problems. Surgery for other
problems is sometimes needed for children with CP. These surgeries vary
depending on the specific problems involved. For example, some children may
need surgery to correct uneven leg length.
- Medicine-related surgery. A small pump is surgically implanted
under the skin in the belly for some people who have CP. This pump can
deliver medicines, such as baclofen, directly into the fluid
surrounding the spinal cord.
When surgery may be used
A
thorough checkup is needed to help the doctor find out which muscles and
nerves are affected and what type of surgery would best treat the condition. A
gait analysis may be part of the exam.
Doctors don't agree about the
best age for children to have surgery for cerebral palsy. Some may suggest surgery at a young age, while others may suggest other treatments before surgery. Use this surgery information form(What is a PDF document?) to help you decide what's right for your child.
Surgery isn't used nearly as often for the arms as for
the legs. Surgery on arm deformities carries more risks related to sensory
damage.
Sometimes medicine or
physical therapy is used to postpone or prevent the
need for surgery.
Physical therapy after surgery
The type of therapy and special equipment needed after surgery (such
as braces, casts, and splints) depends on the child's specific needs. Most children need physical therapy after
surgery. In
general, post-surgical physical therapy usually starts as soon as possible and
may continue for as long as 6 months.
Other Places To Get Help
Organizations
| National Institute of Neurological Disorders and
Stroke |
| NIH Neurological Institute |
| P.O. Box 5801 |
| Bethesda, MD 20824 |
| Phone: | 1-800-352-9424 |
| Phone: | (301) 496-5751 |
| TDD: | (301) 468-5981 |
| Web Address: | www.ninds.nih.gov |
| |
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders. |
|
| Centers for Disease Control and Prevention (CDC):
National Center on Birth Defects and Developmental Disabilities
(NCBDDD) |
| 1600 Clifton Road, MS E-87 |
| Atlanta, GA 30333 |
| Phone: | 1-800-CDC-INFO (1-800-232-4636) |
| TDD: | 1-888-232-6348 |
| Email: | cdcinfo@cdc.gov |
| Web Address: | www.cdc.gov/ncbddd |
| |
NCBDDD aims to find the cause of and prevent birth
defects and developmental disabilities. This agency works to help people of all
ages with disabilities live to the fullest. The website has information on
many topics, including genetics, autism, ADHD, fetal alcohol spectrum
disorders, diabetes and pregnancy, blood disorders, and hearing loss. |
|
| KidsHealth for Parents, Children, and
Teens |
| Nemours Home Office |
| 10140 Centurion Parkway |
| Jacksonville, FL 32256 |
| Phone: | (904) 697-4100 |
| Web Address: | www.kidshealth.org |
| |
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health, from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest. |
|
| March of Dimes |
| 1275 Mamaroneck Avenue |
| White Plains, NY 10605 |
| Phone: | (914) 997-4488 |
| Web Address: | www.marchofdimes.com |
| |
The March of Dimes tries to improve the health of babies
by preventing birth defects, premature birth, and early death. March of Dimes
supports research, community services, education, and advocacy to save babies'
lives. The organization's website has information on premature birth, birth
defects, birth defects testing, pregnancy, and prenatal care. |
|
| National Dissemination Center for Children with
Disabilities |
| 1825 Connecticut Avenue NW |
| Suite 700 |
| Washington, DC 20009 |
| Phone: | 1-800-695-0285 (voice/TTY)
(202) 884-8200 (voice/TTY) |
| Fax: | (202) 884-8441 |
| Email: | nichcy@fhi360.org |
| Web Address: | http://nichcy.org |
| |
The National Dissemination Center for Children with
Disabilities (NICHCY) is the national information and referral center that
provides information on disabilities and disability-related issues for
families and professionals. The focus is on children and
youth, birth to age 22. |
|
| United Cerebral Palsy |
| 1825 K Street NW |
| Suite 600 |
| Washington, DC 20006 |
| Phone: | 1-800-872-5827
(202) 776-0406 |
| Fax: | (202) 776-0414 |
| Email: | info@ucp.org |
| Web Address: | www.ucp.org |
| |
United Cerebral Palsy (UCP) offers family support for people with cerebral palsy. UCP publishes
newsletters, brochures, pamphlets, scientific reports, and books. UCP also
works for the rights of people with cerebral palsy. There are chapters in every
state. |
|
References
Citations
- Palmer FB, Hoon AH (2011). Cerebral palsy. In M Augustyn et al., eds., The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care, 3rd ed., pp. 164–171. Philadelphia: Lippincott Williams and Wilkins.
- Hoon AH Jr, Tolley F (2013). Cerebral palsy. In ML Batshaw et al., eds., Children with Disabilities, 7th ed., pp. 423–450. Baltimore: Paul H Brookes Publishing.
Other Works Consulted
- Ade-Hall RA, Moore AP (2000). Botulinum toxin type A
in the treatment of lower limb spasticity in cerebral palsy. Cochrane Database of Systematic Reviews (1). Oxford: Update
Software.
- Anttila H, et al. (2008). Effectiveness of physical
therapy interventions for children with cerebral palsy: A systematic review.
BMC Pediatrics, 8(14): 1–10.
- Ashwal S, et al. (2004). Practice parameter:
Diagnostic assessment of the child with cerebral palsy. Neurology, 62(6): 851–863.
- Bernard TJ, et al. (2011). Neurologic and muscular disorders. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 20th ed., pp. 696–777. New York: McGraw-Hill.
- Committee on Children with Disabilities, American
Academy of Pediatrics (1999, reaffirmed 2010). The treatment of neurologically impaired children
using patterning. Pediatrics, 104(5): 1149–1151.
- Delgado MR, et al. (2010). Practice parameter: Pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology, 74(4): 336–343.
- Desch LW (2013). Assistive technology. In ML Batshaw et al., eds., Children With Disabilities, 7th ed., pp. 641–656. Baltimore: Paul H Brookes Publishing.
- Diamond M, Armento M (2010). Children with disabilities. In WR Frontera, ed., DeLisa's Physical Medicine and Rehabilitation, vol. 2, pp. 1475–1502. Philadelphia: Lippincott Williams and Wilkins.
- Glader L, Tilton A (2009). Cerebral palsy. In WB Carey et al., eds., Developmental-Behavioral Pediatrics, 4th ed., pp. 653–662. Philadelphia: Saunders Elsevier.
- Hoare BJ, et al. (2010). Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy (Update). Cochrane Database of Systematic Reviews (1).
- Murphy NA, et al. (2008). American Academy of
Pediatrics clinical report: Promoting the participation of children with
disabilities in sports, recreation, and physical activities. Pediatrics, 121(5): 1057–1061.
- Rapin I (2010). Disorders of motor and mental development. In LP Rowland, TA Pedley, eds., Merritt's Neurology, 12th ed., pp. 568–574. Philadelphia: Lippincott Williams and Wilkins.
- Renshaw TS, Deluca PA (2006). Cerebral palsy. In RT Morrissy, SL Weinstein, eds., Lovell and Winter's Pediatric Orthopaedics, 6th ed., vol. 1, pp. 551–603. Philadelphia: Lippincott Williams and Wilkins.
- Simpson DM, et al. (2008). Assessment: Botulinum neurotoxin for the treatment of spasticity (and evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70(19): 1691–1698.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Susan C. Kim, MD - Pediatrics |
|---|
| Specialist Medical Reviewer | Louis Pellegrino, MD - Developmental Pediatrics |
|---|
| Last Revised | September 20, 2012 |
|---|
Seton is proud to have four hospitals – the only hospitals in Central Texas - that have earned the Magnet designation, the highest award for nursing excellence given by the American Nurses Association.