Cerebral palsy (CP) is the most common motor disability in childhood. Because it affects the part of the brain that controls muscle movement, people with CP have difficulty with muscle tone, control, coordination, and body movement. CP is often related to brain damage that occurs before or during birth, but it can also be caused by abnormal brain development or brain damage following an infection or injury within the first two years of life.
Typical age of CP diagnosis
Of children with cerebral palsy have spastic CP, characterized by muscles that spasm or are stiff or tight
Percent of children with CP who can walk independently
About two to three in 1,000 children have CP. It is more common in boys than girls and is more common among black children than white children.
Most cases of CP are related to brain damage that occurred before or during birth, known as congenital CP. Babies have an increased risk of CP if they are premature or low birth weight, a twin or other multiple birth, conceived through in vitro fertilization or other infertility treatments, or have kernicterus, which is a type of brain damage due to severe untreated jaundice. If a mother has an infection during pregnancy, such as chickenpox, rubella, or bacterial infection, or experiences complications during birth that disrupts the baby’s oxygen supply or blood flow, her baby can also have an increased risk of CP.
A small percentage of CP is caused by brain damage more than 28 days after birth. This type is called acquired CP and may be the result of bleeding in the brain, a brain infection like meningitis, or a serious head injury.
In general, CP is caused by the abnormal development of, or damage to, the brain affecting muscle control and movement. For most children with CP, the specific cause for this abnormal development or brain damage is unknown.
Symptoms can range from mild to severe, depending on the individual. Early signs of CP involve not meeting developmental motor milestones, which are goals for when a child typically achieves specific movements such as rolling over, sitting up, crawling, and walking. A baby with CP may feel floppy or stiff, be unable to roll, and have difficulty moving hands and arms.
Common symptoms of CP include spasticity or tight muscles that don’t stretch, tight joints, abnormal walking, exaggerated reflexes, muscle weakness, unusual posture, and involuntary movements. CP can affect one limb, one side of the body, all four limbs, or a combination. Symptoms do not worsen over time, but they can become more apparent as a child grows and moves through developmental stages. While about half of children with CP can walk independently, about a third have limited to no ability to walk.
If a pediatrician has concerns about a baby’s motor milestones and movement, they will screen for developmental delays. Regular developmental screenings are typically conducted at well-child office visits via a parent questionnaire or doctor’s testing.
If the screening results are of concern, a developmental evaluation can provide a medical diagnosis. The primary care doctor or specialist will take a medical history and evaluate the child’s motor skills, muscle tone, and reflexes. Other brain imaging and genetic testing can also support a diagnosis.
Most cases of CP are diagnosed by age 3. If symptoms are mild, it may take longer to diagnose. There are four types of cerebral palsy: spastic (the most common), dyskinetic, ataxic, and mixed.
Many children with cerebral palsy also have other diagnoses or co-occurring conditions. For example, about 4 in 10 children with CP also have epilepsy, and about 1 in 10 have autism spectrum disorder. They may also have intellectual disabilities, impaired hearing or vision, speech problems, and oral-motor dysfunction.
While there is no cure for CP, there are treatments to improve symptoms and function. Many children receive treatment through early intervention programs, school-based services, and physical and occupational therapy to improve walking and stretch muscles.
If needed, orthotic devices, wheelchairs, or walkers can assist with mobility. Depending on individual symptoms, speech therapy, communication aids, medications to relax muscles, or surgery may also be helpful.
Current research focuses on early brain development and the possible causes of CP, including genetic defects, events that trigger an abnormal release of chemicals, and white matter damage. With a better understanding of what contributes to CP, we can know more about preventing, screening for, and treating this brain disorder.
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