What is Cerebral Palsy?
Cerebral palsy is a developmental disorder and leading cause of disability in young children. It affects approximately 500,000 children and adults, with around 8,000 babies and between 1,200 and 1,500 preschool-age children diagnosed each year.
Cerebral palsy occurs as a result of brain injury sustained during fetal development or birth. However, because the symptoms of CP affect a child’s coordination and independent movement, the injury is not always diagnosed right away, especially when the symptoms are mild. Parents usually notice that something is wrong when a child fails to reach developmental milestones such as rolling over, crawling or walking. This may lead to a diagnosis later in life, accounting for the children who are diagnosed as toddlers.
Cerebral palsy is caused by damage to the motor cortex of the brain. This is the part of the brain that affects muscle control and coordination. For this reason, children with cerebral palsy frequently struggle with walking and fine motor skills. The type and severity of symptoms can vary significantly from one patient to the next, and an individual’s case may be made more complex by the presence of coexisting conditions such as cognitive disability, epilepsy, vision problems and more.
For this reason, CP treatments are always highly individualized to suit the needs of the patient. There is no cure for cerebral palsy, but many treatments and therapies exist that can provide relief from symptoms.
Things to Know About Cerebral Palsy
When you first face a diagnosis of cerebral palsy for your child, you may struggle with understanding what the diagnosis will mean and how it will affect your life. CP is complex, and it differs between patients. There are a few general things that can help you begin to understand your child’s condition, however:
– Cerebral palsy describes a group of disorders that display similar symptoms. All CP is caused by brain injury to the motor cortex, affecting an individual’s balance, posture and ability to move.
– CP affects approximately 1 in 345 children. It is the most common form of motor disability in young children.
– The most common form of CP is spastic CP, affecting as much as 85 percent of all cases. In spastic cerebral palsy, the patient’s muscles are tightened, and this stiffness can result in awkward movement.
– Between 50 and 60 percent of children with cerebral palsy are able to walk independently or with the help of mobility aids and devices.
– A number of co-occurring conditions often exist alongside cerebral palsy. These include epilepsy, learning disabilities, cognitive disabilities and blindness. These conditions are not caused by CP but arise as a result of the type of brain injury that caused CP.
– Most CP is congenital, meaning it occurred before or during birth. Risk factors for congenital CP include premature birth, low birth weight and birth complications. Exposure to certain infections, medications and chemicals while in the womb can also lead to CP.
– CP can also be acquired after birth, most commonly as a result of traumatic brain injury or brain infection.
– The majority of children with CP are diagnosed within their first two years of birth. More severe cases are usually diagnosed earlier in life; mild symptoms may go unnoticed longer.
Although CP is a serious and lifelong condition, many treatments are available that can reduce the severity of symptoms and allow children with cerebral palsy to live long, independent and active lives.
History of Cerebral Palsy
Neuromuscular disorders with symptoms that match modern definitions of cerebral palsy have existed for centuries. Historical records describe cases that resemble what we now know of as CP occurring as far back as Ancient Egypt.
The first serious research into the underlying pathology of cerebral palsy began in the 1830s, when William John Little began to study disabling conditions. In 1853, Little published a paper describing neonatal injuries and congenital disabilities affecting the muscular system; by 1861, an early definition of cerebral palsy was reached. At that time, it was understood that “partial suffocation” of a child during birth could result in this disorder, which was then known as Little’s Disease.
Cerebral palsy received its modern name in 1889, when Sir William Osler, building upon Little’s research, began to study the disability. Several decades of research led to the development of the United Cerebral Palsy Foundation (UCP) in 1949, which continues to promote knowledge and support to this day.
What Causes Cerebral Palsy?
Cerebral palsy is a neuromuscular disorder caused by damage to the motor cortex of the developing brain. This affects motor functioning, including an individual’s ability to move, grasp objects and talk. It can also affect muscle tone, resulting in individuals with overly toned, tight muscles and rigid joints or loose, floppy muscles and joints.
The type and severity of CP symptoms will depend in large part on the extent of the brain injury and when it occurred. There are four primary situations that will lead to cerebral palsy to arise:
– Prenatal disturbance of brain cell migration. In the developing fetus, cells differentiate and move into place in order to form the appropriate type of cell. If something disrupts this process, preventing brain cells from migrating and developing properly, a number of neurological conditions can arise.
– Prenatal poor myelination of nerve cells. In the body, myelin acts as insulation to protect nerve cells. Inadequate myelin can result in unprotected nerve cells, which can become damaged.
– Perinatal brain cell death. During the birthing process, brain cells may die as a result of asphyxia(suffocation) or blood loss. This is most commonly seen in difficult deliveries or periods of fetal distress late in pregnancy necessitating an emergency birth.
– Postnatal non-functional or inappropriate synapses. After birth, brain injury can result in brain damage and CP. Some common causes are brain infection, trauma and asphyxia.
Essentially, cerebral palsy is caused when the brain cells responsible for muscle control and movement either fail to develop appropriately or die as a result of injury.
Although not every case of CP is preventable, and the underlying causes of many CP cases are unknown, there are certain risk factors that can increase a child’s odds of developing cerebral palsy:
– Premature birth or low birth weight
– Fetal distress, including problems with the placenta, umbilical cord and amniotic fluid
– Long and difficult labor during which asphyxiation can occur
– Meningitis or other brain infection
– Trauma after birth, including accidents that could lead to brain damage
Although the exact cause of an individual’s cerebral palsy is not always uncovered, it’s estimated that between 10 to 15 percent of CP cases arise as a result of medical malpractice. This may include:
– Failure to recognize fetal distress during labor and intervene accordingly
– Failure to resuscitate a “blue baby” quickly enough after birth
– Writing a prescription for a medication unsafe for a pregnant mother
And other issues arising from a failure to provide an adequate standard of care before, during and after birth.
Is Cerebral Palsy a Disease?
Although a layperson may sometimes call cerebral palsy a disease, this term is medically incorrect. In medical terms, a disease has a specific identifiable cause such as environmental factors, infective agents or genetic anomalies. A disorder refers to a cluster of symptoms or abnormalities that may not have a single cause, or whose cause is not fully known or understood.
Because so many factors can cause CP, and the symptoms are so variable, it is more accurate to refer to it as a disorder.
Is There a Cure for Cerebral Palsy?
There is currently no known cure for cerebral palsy. Currently, CP is treated through medication and therapies that help to mitigate symptoms but cannot correct the underlying pathology. A child with cerebral palsy will continue to have CP throughout his or her life.
This is because CP is caused by brain injury, and modern medicine currently cannot regenerate brain tissue. Nerve and brain cells do not heal in the same way as other parts of the body, and the damage they sustain is generally irreparable. However, modern advancements in the use of stem cell therapy have shown some promising results in neuro-regenerative treatment.
Stem cells are a special type of undifferentiated cell. All cells in a developing fetus begin as stem cells, which then differentiate to become specific types of cells with a specific purpose. Some of these cells are retained in the body throughout a person’s life. By isolating these cells and injecting them into a damaged area, scientists believe that the cells can develop into brain and nerve tissue. This may lead to a cure for cerebral palsy and many other neurological conditions and disabilities in the future.
Types of Cerebral Palsy
Cerebral palsy is a disorder that can affect the patient in a number of ways, and the type and severity of symptoms will vary depending on the extent of brain injury sustained. For this reason, no two people with CP will have exactly the same circumstances. However, basic similarities between cases make it possible for CP to be divided into a number of identifiable types.
By understanding the type of cerebral palsy your child has, you can better understand the treatment options available. However, bear in mind that it is possible to have more than one type of CP, which will affect symptoms and treatment.
Spastic Cerebral Palsy
Spastic cerebral palsy is the most common type, affecting more than 70 percent of CP patients. This type is characterized by hypertonia, or increased muscle tone and stiff, tight muscles. People with spasticity may have muscles that they cannot relax, leading to rigid joints. If the patient can walk, he or she may exhibit an abnormal gait. Difficulties with eating and speaking are also common.
Spastic or pyramidal cerebral palsy can be further characterized by which parts of the body are affected.
This is the most severe type of spastic cerebral palsy. It is caused by significant brain damage and affects the entire body. Patients with spastic quadriplegia experience hypertonia in all four limbs, preventing them from walking or using their arms and hands effectively. Patients may also struggle to eat, swallow and talk. Seizures are common for people with this type of CP; cognitive disabilities are also common due to the extent of brain damage.
Other, less severe cases of spastic cerebral palsy may be diplegic, affecting primarily the legs, or hemiplegic, affecting the limbs on just one side of the body.
Athetoid Cerebral Palsy
Also called dyskinetic or dystonic CP, athetoid cerebral palsy makes up 10 to 20 percent of all CP patients. It is most commonly characterized by uncontrollable movements. Some common symptoms include:
- Slow writhing of the body
- Jerky movements in extremities
- Difficulty holding head up
- Difficulty swallowing and eating
Athetoid cerebral palsy frequently affects the upper extremities and neck more than the lower body. It does not frequently occur with cognitive impairment, but patients may struggle to speak and eat.
Ataxic Cerebral Palsy
The least common type of cerebral palsy, ataxic CP affects around 5 to 10 percent of patients. The name comes from the root word “ataxia,” meaning “incoordination,” which describes the difficulties with balance and coordination that occur with this type of CP.
The most common symptoms of ataxic CP include:
- Difficulty coordinating voluntary movements
- Problems with posture and balance
- Struggles with cognitive function
- Language skills
People with ataxic cerebral palsy may experience tremors when attempting voluntary movements. They also may have an unsteady gait and difficulty with any task requiring fine motor skills, especially in the hands and fingers.
Ataxic CP is often diagnosed later in life than other types, usually after a child has reached 18 months of age.
Mixed Cerebral Palsy
Because different forms of cerebral palsy are caused by injuries to different areas of the brain, and multiple brain injuries can occur, some patients exhibit more than one type of CP. In mixed-CP cases, symptoms of more than one type are present. For example, some of a patient’s muscles may be hypertonic while other muscle groups are hypotonic.
The most common mixture of symptoms is a blend of athetoid and spastic symptoms. Athetoid and ataxic symptom combinations occur least frequently. A patient with mixed spastic and athetoid CP might commonly exhibit stiff muscles coupled with involuntary movements.
Mixed cerebral palsy accounts for 10 percent of all CP cases.
Severity of Location
In addition to the type of symptoms experienced, cerebral palsy can also be classified by the severity of symptoms. Most CP cases result in at least some amount of paralysis, and the severity of paralysis and its spread across the body can vary from one person to another. The groupings are:
- Monoplegia: Affecting just one limb or body part
- Diplegia/paraplegia: Affecting two body parts, often both legs
- Hemiplegia: Affecting all of the limbs on the right or left side of the body
- Double hemiplegia: Affecting all four limbs
- Quadriplegia: Affecting the whole body, including neck and trunk
More widespread paralysis comes with a greater risk of dangerous side effects, such as pneumonia, as well as an increased likelihood of co-occurring conditions like cognitive disability and epilepsy.
What Are the Symptoms of Cerebral Palsy?
Because there are so many types of CP, symptoms will vary from one patient to the next. The specific symptoms an individual exhibits will depend on the type of cerebral palsy they have as well as the location of the affected muscle groups. However, a number of symptoms are common in children with CP, and similar early signs may be noticed by parents or caretakers.
Cerebral palsy is diagnosed based on the presence of the following clinical signs:
- Improper muscle tone, including hypotonia, hypertonia and dystonia
- Poor coordination and difficulties with movement
- Abnormal reflexes, including excessive or underdeveloped reflexes
- Difficulties with maintaining posture and balance
- Impaired gross motor functioning
- Difficulties with fine motor control
- Poor oral motor function
Not every child with cerebral palsy will exhibit all of these symptoms. However, the presence of some or all of these symptoms with no other identifiable cause may lead a doctor to investigate the possibility of cerebral palsy. A diagnosis will be confirmed with brain imaging.
How is Cerebral Palsy Diagnosed?
In most cases, cerebral palsy is first suspected when a parent or caretaker notices delays in a child’s development. Children are expected to hit certain milestones as they grow, such as holding up their heads, rolling over, crawling and walking. Failure to reach these milestones or exhibiting unusual behavior when attempting these movements is often the first sign that something is wrong.
Once initial symptoms or developmental delays are noticed, the child’s doctor will run a number of diagnostic tests, including brain imaging to identify areas of brain injury. Imaging types include:
- MRI (magnetic resonance imaging), which provides a three-dimensional view of the brain.
- CT (computed tomography) scan, which takes X-rays of the brain from multiple angles to provide a cross-section view of the brain.
- EEG (electroencephalogram), which measures electrical activity within the brain.
- Ultrasound, which uses high-powered sound waves to provide an image of the brain.
In addition to brain imaging, testing may be done to identify the following:
- Hearing impairment
- Vision impairment
- Cognitive function
- Other symptoms that frequently co-occur with cerebral palsy
A cerebral palsy diagnosis can be reached when symptoms are present and a brain injury can be found. Most cases of cerebral palsy, up to 70 percent, are diagnosed by a child’s first birthday, with 43 percent of severe cases being diagnosed in the first months of life. The more severe the symptoms, the earlier a diagnosis can generally be formed.
Is Cerebral Palsy Preventable?
Because there is no cure, cerebral palsy research has focused primarily on prevention and treatment. As the underlying causes of CP are becoming better understood, certain steps can be taken to prevent cerebral palsy by mitigating risk factors.
Some of the risk factors for developing CP include:
– Premature birth and low birth weight
– Long, difficult labor
– Serious illness and infection
– Genetic abnormalities
– Medical malpractice
– Exposure to certain medications or substances during fetal development
Some of these risks can be managed or mitigated. Improved genetic screening options allow parents to identify certain risk factors before conception or early in pregnancy.
The most preventable cause of cerebral palsy is medical malpractice. Although malpractice only accounts for an estimated 10 to 15 percent of diagnosed CP cases, every case is preventable. Parents whose children have been affected by medical negligence should pursue legal help action against the responsible medical staff for accountability and to prevent future children from enduring the same fate.
What Are the Treatment Options for Cerebral Palsy?
Cerebral palsy treatments can improve the overall quality of life for patients. By managing symptoms and preventing secondary conditions from developing or worsening, cerebral palsy treatments can focus on allowing a child to live the best life possible. Although the disorder cannot be cured, symptom management and therapy will allow the patient to adjust to their disability.
The most common forms of treatment are specialized therapies, which aid in improving specific actions and symptoms, and medication that can reduce pain, relax muscles and prevent seizures. Surgery can, in some cases, also be helpful.
The effectiveness of treatment will vary depending on the severity of CP symptoms. In some cases, individuals with CP can go on to live independent, productive lives as adults thanks to therapy and CP treatments.
CP treatment can assist with:
- Managing pain symptoms
- Improving joint flexibility
- Increasing mobility
- Improving muscle definition and tone
- Managing secondary symptoms
- Allow for greater independence
Treatment can begin immediately when symptoms are first noted, with some treatment options available before the child has received a formal diagnosis. The type of treatment administered may vary throughout the child’s life to reflect changes in condition and the patient’s capabilities. For example, therapy may become more intensive as a child grows older.
Because there are so many aspects to living with cerebral palsy, your child’s medical team may be made up of multiple specialists. Some of the doctors you may work with to provide treatment include:
- Physical therapists
- Occupational therapists
- Speech therapists
- Orthopedic surgeons
Your child’s pediatrician may act as the primary care provider, offering referrals to specialists and guiding the care process.
Cerebral Palsy Medications
Medication can help to reduce certain symptoms and manage pain. The most commonly prescribed drugs for CP patients are muscle relaxants, which work to reduce spasticity, and anti-seizure medication. Some cerebral palsy medications your child may take include:
- Baclofen: A muscle relaxant that provides long-term reductions in muscle spasticity
- Dantrium/Dantrolene: A muscle relaxant taken for severe spasms
- Diazepam/Valium: An overall relaxant that can ease tension and may help with seizures
- Botox: When injected directly into affected muscles, it can ease spasticity
- Flexeril: A muscle relaxant that works by blocking nerve impulses sent to the brain
- Depakene: An anti-seizure drug known for treating petit mal and grand mal seizures
- Dilantin: One of the better known and most effective anti-seizure drugs
All medications come with potential side effects, and these should be discussed with your doctor so that you can ensure an appropriate trade-off between benefits and drawbacks.
Cerebral Palsy Surgery Options
Orthopedic surgery is not always effective, but it can offer impressive results for the right candidate. The purpose of surgery as a CP treatment is to improve mobility or reduce the possibility of complications. For example, muscle spasticity can lead to joints being pulled out of position or dislocated; surgical intervention can prevent this from happening. Surgery can address:
- Muscle spasticity
- Gastrointestinal problems
- Joint problems
- Muscle contracture
- Hip dislocation
In some cases, surgery can also help to alleviate pain. However, not every individual will be a good candidate for surgery, and risks should be assessed before pursuing this treatment.
Cerebral Palsy Therapy Options
A number of therapy options are available, depending on the individual’s symptoms and needs. Therapy is one of the most common and effective CP treatments for improving quality of life and boosting independence, and it is most useful when blended with other treatment options.
Multiple therapy options exist, including:
- Speech therapy, which can improve language skills and help with eating and swallowing.
- Physical therapy, which can improve mobility and coordination.
- Occupational therapy, which can help an individual adjust to his or her home, school or work environment.
- Recreational therapy, which can build social skills and provide a creative outlet.
- Music therapy, which can be calming and offer a creative outlet.
- Behavioral therapy, which can help with providing healthy coping mechanisms for emotional troubles.
- Hippotherapy, which uses horses to improve balance and muscle strength.
- Intensive suit therapy, which utilizes a special suit apparatus to improve balance and muscle control.
Therapy can also be helpful for parents and caregivers by providing practical solutions for common problems as well as creating opportunities for emotional support and coping mechanisms.
What is the Life Expectancy for a Child with Cerebral Palsy?
Cerebral palsy is a lifelong condition, but it is not degenerative. This means that symptoms will not worsen over time. With treatment and therapeutic interventions, many children with cerebral palsy can grow up and live independent and productive lives. Many more can live well into adulthood with the help of professional caregivers and familial assistance.
Because there is so much variance between individual cases of CP, it is difficult to estimate an average cerebral palsy lifespan. An individual’s longevity will depend primarily on the severity of symptoms and the successfulness of treatment. One study published by the National Institutes of Health suggests that the most severe cases, may have a 25 percent chance of living to age 30. Less severe cases can live much longer.
The factors that influence an individual’s life expectancy include:
- Level of disability. Those who suffer from paraplegia have a higher risk of developing complications than those whose symptoms affect less of the body.
- Presence of secondary conditions. Complications arising from co-occurring conditions can lead to increased mortality.
- Ability to eat independently. An estimated 1 in 15 children with cerebral palsy must be fed through a feeding tube. This can affect longevity and give way to additional complications.
- Mobility. Individuals who can move independently or with the help of mobility aids will often lead longer lives than those who are totally paralyzed. This is due in large part to the risk of complications such as bed sores, choking and pneumonia.
There is no one-size-fits-all answer or solution to the question of how long a child with cerebral palsy will live. It is always best to consult with your child’s physician to discuss his or her individual prognosis so that plans can be made accordingly. By understanding the potential risks and possibilities of complications, you can help to mitigate these factors and help ensure your child’s quality of life and lifespan are the best possible.
How Do I Know if My Child’s Cerebral Palsy Was Caused by Medical Malpractice?
Medical malpractice accounts for a relatively small but significant number of new cerebral palsy cases each year. It’s also the most easily prevented cause of CP. If your child has recently been diagnosed with CP, you may wish to contact a cerebral palsy attorney to help you investigate the circumstances surrounding the birth and identify whether malpractice may have been responsible.
Medical malpractice occurs when a medical professional’s negligence or carelessness results in a medical error. These can occur at any level. For example, a doctor may fail to recognize fetal distress, leading to a birth injury. A nurse may fail to protect an infant from infection in NICU. An administration error might result in diagnostic information not being relayed to the parents in time. Any and all of these could result in complications that could lead to cerebral palsy.
Common medical errors include:
- Malpractice during birth and delivery, including failure to detect fetal distress, improper use of forceps, delayed resuscitation of an infant and other similar issues.
- Lack of adequate information early in pregnancy. If a doctor failed to screen for congenital defects or did not advise the parent on test findings, a wrongful birth lawsuit could be pursued.
- Improper handling of maternal infections. This could include failure to test for illnesses, not providing adequate treatment and not following up with infant testing after birth to determine the presence of infection.
- Medication errors, including improper dosage or medications that are inappropriate for use in a pregnant mother.
- Diagnostic mistakes that lead to a worsening in symptoms or failure to provide adequate care, resulting in brain injury.
- System and administrative errors that could lead to any of the above or other issues that might result in injury to a developing fetus or newborn.
It is not always easy to identify medical malpractice, and the statute of limitations will vary from one state to the next. For this reason, if your child has been diagnosed with cerebral palsy or you have any reason to suspect that medical negligence may have occurred, it’s important to speak with an attorney. Most attorneys will consult with you for free to determine whether or not you have a viable case, and the sooner you begin the investigation the better your chances of successfully pursuing a lawsuit to receive a settlement you may rightfully deserve. You can read our legal guide for more detailed information on this topic.