Cerebral Palsy
What is it?
Cerebral palsy (CP) is a physical disability that affects movement and posture. It is a permanent life-long condition but generally does not worsen over time.
An injury causes CP to the developing brain either during pregnancy or shortly after birth. Cerebral means ‘of the brain’, and palsy refers to a lack of muscle control. It’s an umbrella term that refers to disorders affecting a person’s ability to move.
CP affects body movement, muscle control, muscle coordination, muscle tone, reflex, posture and balance. People with cerebral palsy may also have visual, learning, hearing, speech, epilepsy and intellectual impairments. Around 34,000 people live with cerebral palsy in Australia – 1 in 700 babies diagnosed with CP.
Symptoms
Some signs may indicate a child has cerebral palsy. Not all signs are visible at birth and may become more evident as babies develop.
Babies
Babies
- Low muscle tone (baby feels ‘floppy’ when picked up)
- Unable to hold up his/her head while lying on their stomach or in a supported sitting position
- Muscle spasms or feeling stiff
- Poor muscle control, reflexes and posture
- Delayed development (can’t sit up or independently roll over by six months)
- Feeding or swallowing difficulties
- Prefers to use one side of their body
Toddlers/Children
Although the brain of toddlers/children with cerebral palsy remains injured, the injury does not worsen as they develop.
Depending on the level of severity of cerebral palsy, toddlers and children may experience difficulties with physical development, such as:
- not walking by 12-18 months
- not speaking simple sentences by 24 months
If a child is not reaching these milestones or displays some signs of cerebral palsy, parents may need to speak to their early childhood nurse, general practitioner or paediatrician.
In NSW, questions relating to developmental milestones are described in the Personal Health Record book (Blue Book) provided to families when their child is born.
Types & Severity
Cerebral palsy can affect a person’s posture, balance and ability to move, communicate, eat, sleep and learn. The parts of the body affected by cerebral palsy, the severity level, and the combination of symptoms can differ for each person. For example, one person may have a weakness in one hand and find tasks like writing or tying shoelaces challenging. Another person may have little or no control over their movements or speech and require 24-hour assistance.
People with cerebral palsy may experience uncontrolled or unpredictable movements, muscles can be stiff, weak or tight and sometimes have shaky movements or tremors. People with severe cerebral palsy may also have difficulties with swallowing, breathing, head and neck control, bladder and bowel control, eating and dental and digestive problems.
Cerebral palsy can be described by how it affects people’s movement, the part of the body, and how severe the effects are. The main types of cerebral pals
The main types of cerebral palsy are:
- Quadriplegia (bilateral cerebral palsy), where both arms and legs are affected. The muscle of the trunk, face and mouth are often also affected.
- Diplegia (bilateral cerebral palsy), where both legs are affected. The arms may be affected to a lesser extent.
- Hemiplegia (unilateral cerebral palsy) affects one side of the body (one arm and one leg).
There are other classifications for severity. These are:
- Spastic – 70-80% of individuals with cerebral palsy have motor cortex damage. This is the most common form of cerebral palsy, where muscles feel stiff and tight.
- Dyskinetic – 6% of individuals with cerebral palsy have Basal Ganglia damage which causes involuntary movements that are out of a person’s control.
- Ataxic – 6% of individuals with cerebral palsy have cerebellum damage that causes shaky movements and affects balance and a sense of positioning in space.
Mixed type – where there is a combination of damage to the brain.
Causes
Cerebral palsy (CP) is a physical disability that affects movement and posture. It is a permanent life-long condition but generally does not worsen over time. An injury causes CP to the developing brain either during pregnancy or shortly after birth.
For most people with cerebral palsy, the cause is unknown, and there is no single cause.
Researchers have determined that only a very small percentage of cases of cerebral palsy are due to complications at birth (e.g. asphyxia or lack of oxygen).
It is accepted that cerebral palsy usually arises from a series of causal pathways, i.e. a sequence of events that, when combined, can cause or accelerate injury to the developing brain.
For example: Although prematurity is the most significant risk factor for cerebral palsy, it is the sequence of events (causal pathways) that led to the premature birth that may have caused the cerebral palsy rather than the premature birth itself.
In Australia, in 13 out of 14 cases of cerebral palsy, the brain injury leading to cerebral palsy occurs either in the uterus (while the mother is pregnant) or before one month of age.
Stroke is the most common cause in babies who acquire cerebral palsy after one month. The stroke may occur spontaneously or arise from surgical or heart complications.
Risk factors
Risk factors do not cause cerebral palsy. However, some risk factors may increase the chance of a child being born with cerebral palsy. Some risk factors for cerebral palsy have been identified. These include:
Risk factors do not cause cerebral palsy. However, some risk factors may increase the chance of a child being born with cerebral palsy. Some risk factors for cerebral palsy have been identified. These include:
- premature birth (less than 37 weeks)
- low birth weight (small for gestational age)
- blood clotting problems (thrombophilia)
- an inability of the placenta to provide the developing foetus with oxygen and nutrients
- RH or A-B-O blood type incompatibility between mother and baby
- infection of the mother with German measles or other viral diseases in early pregnancy
- bacterial infection of the mother, foetus or baby that directly or indirectly attacks the infant’s central nervous system
- prolonged loss of oxygen during the pregnancy or birthing process, or severe jaundice shortly after birth.
Who is at the most significant risk?
The Australian Cerebral Palsy Register Report 2013 has identified four groups that, statistically, have a greater risk of cerebral palsy.
- Males - Males are at greater risk of having cerebral palsy
- Premature babies - Prematurity is associated with higher rates of cerebral palsy
- Small babies - Low birth weight is associated with higher rates of cerebral palsy. This may be a result of prematurity or slow intrauterine growth. Around 42% of children with cerebral palsy had low birth weight, compared to just over 6% of the Australian population.
- Twins, triplets and higher multiple births - 11% of children with cerebral palsy were from multiple births, whereas the rates of multiple births are only 1.7% in the Australian population.
Is cerebral palsy genetic/hereditary?
Familial cerebral palsy is uncommon; approximately 1% of people with cerebral palsy will have a sibling with the condition. It is even uncommon in twins – when one twin has cerebral palsy, 90% of co-twins will not have cerebral palsy.
However small, these statistics suggest that some genetic factors might be involved in cerebral palsy.
Researchers generally believe that a genetic disposition to specific characteristics, i.e. prematurity or heart problems, may start a chain of events (causal pathways) that can result in a child having cerebral palsy.
Diagnosis
Cerebral Palsy Early Diagnosis Clinic
The Early Diagnosis Clinic is a bulk-billed diagnostic clinic for babies at high risk of cerebral palsy. The clinic aims to fast-track diagnosis and enable quicker access to early interventions, family support and better outcomes for the future.
The Early Diagnosis Clinic is a bulk-billed diagnostic clinic for babies at high risk of cerebral palsy. The clinic aims to fast-track diagnosis and enable quicker access to early interventions, family support and better outcomes for the future.
Infants 12 months or younger are eligible if they have clinical history indicating risk for cerebral palsy or motor dysfunction. The clinic comprises an expert multi-disciplinary team, including a paediatric neurologist, social worker, occupational therapist, physiotherapist and speech pathologist. The team conduct a comprehensive assessment, which includes physical (including vision and pain), neurological, motor function, feeding, communication and parent well-being.
Cerebral palsy is a complex disability, and diagnosis is not always easy. Doctors may suspect cerebral palsy if a baby has slow motor development, has tight or floppy muscle tone, or displays unusual postures.
Cerebral palsy is a complex disability, and diagnosis is not always easy. Doctors may suspect cerebral palsy if a baby has slow motor development, has tight or floppy muscle tone, or displays unusual postures.
The period parents may have to wait before their child is diagnosed with cerebral palsy can vary. Very premature babies are usually overseen and may have an early MRI scan (magnetic resonance imaging). However, most children with cerebral palsy are not born prematurely. Most are born at full term, and it is not until they do not meet the usual infant milestones that any form of disability is considered. An MRI might show that they have an injury to the brain, but it is often too early to predict the impact at that stage.
The General Movements Assessment can be conducted from birth until 5 months of age. It is a strong predictor of cerebral palsy, mainly when specific changes to the brain are seen on an MRI. However, General Movements Assessment cannot predict the severity of cerebral palsy.
If a General Movements Assessment suggests that a baby is at risk of cerebral palsy, then intervention can start as early as possible.
How do doctors diagnose cerebral palsy?
They will pay special attention to the child’s movements – both their voluntary movements as well as their muscle tone.
They will pay special attention to the child’s movements – both their voluntary movements as well as their muscle tone.
Some children may have very relaxed, floppy muscles, while others have stiff, tight muscles.
Doctors will also look for unusual postures or if the child favours one side over the other.
The doctor may order scans such as MRI or CT.
One of the frustrations for parents is that sometimes a diagnosis can take a long time, with repeated tests and visits to specialists.
This may be because the child has a mild form of cerebral palsy, but it could also be because the doctor needs to make sure it is not another type of movement disorder that may be progressive (get worse over time).
What is the General Movements Assessment?
The General Movements Assessment is a non-invasive and cost-effective way to identify neurological issues which may lead to cerebral palsy and other developmental disabilities. The assessment can be completed from birth to 20 weeks of age (corrected for prematurity).
The General Movements Assessment is a non-invasive and cost-effective way to identify neurological issues which may lead to cerebral palsy and other developmental disabilities. The assessment can be completed from birth to 20 weeks of age (corrected for prematurity).
Infants have typical and distinct spontaneous “general movements” from birth to 20 weeks post-term. Infants whose general movements are absent or abnormal are at higher risk of neurological conditions, particularly cerebral palsy. The General Movements Assessment is used to identify absent or abnormal general movements and, depending on the type of general movements’ abnormality, can be highly predictive of cerebral palsy by about 3 months of post-term age. Intervention can start very early, with potentially better outcomes, if an infant is diagnosed as at risk of cerebral palsy using the General Movements Assessment.
How is the assessment done?
General movements are assessed with the awake infant lying on their back while calm and alert. The infant should not have toys or pacifiers; parents could be watching nearby but not interacting with their baby. The baby is videoed for 3-5 minutes, and the assessment is scored from the video.
Much allied health and medical personnel in Australia have been trained to observe and score General Movements Assessments.
General movements are assessed with the awake infant lying on their back while calm and alert. The infant should not have toys or pacifiers; parents could be watching nearby but not interacting with their baby. The baby is videoed for 3-5 minutes, and the assessment is scored from the video.
Much allied health and medical personnel in Australia have been trained to observe and score General Movements Assessments.
Should a child have the General Movements Assessment?
A General Movements Assessment may give information on how a baby’s neurological system develops if he/she is under 20 weeks post-term age and there were medical concerns at birth (such as prematurity, lack of oxygen, stroke, or congenital heart disease). The assessment is not currently used as a screening tool for healthy babies.
Source:
Cerebral Palsy Alliance
Note:
Medical conditions MUST always be diagnosed by a medical professional.
The following information is structured to provide basic information to HWH Support Workers and Clinical Care Managers.
A General Movements Assessment may give information on how a baby’s neurological system develops if he/she is under 20 weeks post-term age and there were medical concerns at birth (such as prematurity, lack of oxygen, stroke, or congenital heart disease). The assessment is not currently used as a screening tool for healthy babies.
Source:
Cerebral Palsy Alliance
Note:
Medical conditions MUST always be diagnosed by a medical professional.
The following information is structured to provide basic information to HWH Support Workers and Clinical Care Managers.