Cerebral palsy is a condition characterized by an impairment of the body's ability to control movement and posture. It results from faulty development of, or damage to the "motor" areas of the brain, which are responsible for controlling movement. In some cases, cerebral palsy is accompanied by other manifestations of brain injury, such as seizures, intellectual impairment, behavioral problems, hearing deficits, or vision disorders.
The brain damage which causes cerebral palsy remains permanent from the time of injury. There is no cure for cerebral palsy, and it is not contagious. Accordingly, most medical authorities describe cerebral palsy as a "condition" rather than a "disease." Although the brain damage that causes cerebral palsy cannot be cured, the functional problems associated with cerebral palsy can often be improved through therapy, medication, or, in some cases, surgery.
How common is cerebral palsy?
Approximately 500,000 people in the United States have been diagnosed with cerebral palsy. More than 5,000 children, the vast majority of whom are babies or infants, are diagnosed with cerebral palsy each year. The incidence of cerebral palsy (number of cases diagnosed as a ratio of the total population) has remained relatively constant over the past 30 years. This should not be interpreted as evidence that, despite all of the progress during that time with regard to enhanced access to prenatal care, more reliable assessments of fetal well-being through the use of fetal heart rate monitoring, fetal acid-base measurement, and biophysical profile scoring, there is nothing that medical professionals can do to prevent cerebral palsy. Experience and common sense tell us that this cannot be true. Rather, the unchanging incidence of cerebral palsy is a direct result of continually increasing survival rates for critically premature or otherwise frail babies who, without benefit of recent improvements in prenatal or neonatal intensive care would not have survived beyond the newborn period. These babies are at substantially higher risk of suffering brain damage than are babies born at or near term.
Are there different types of cerebral palsy?
Doctors generally classify cerebral palsy into four categories, depending upon the type of motor difficulties experienced by the patient. They are as follows:
Spastic cerebral palsy is the most common type, affecting more than half of all patients. It is characterized by muscles that are stiff and permanently contracted. With this type of cerebral palsy, the muscle tone in the affected limbs is increased. In addition, spastic cerebral palsy is often classified according to which limbs are affected, and how severely. A prefix representing limb involvement is added to the term "plegia" which means paralysis, or "paresis" which means weak. The terms used are as follows:
It should be noted that monoplegia and triplegia are extremely rare.
Ataxic cerebral palsy involves problems with balance and depth perception. These patients will walk with an unsteady gait, have poor coordination, and often have problems with fine motor control (the movements needed to perform such tasks as writing or buttoning a shirt).
Athetoid cerebral palsy is characterized by involuntary, uncontrolled movement of the arms, hands, legs, or feet. Severe cases may also afflict the muscles of the face, mouth or tongue, resulting in grimacing, speech difficulties, or drooling.
Mixed cerebral palsy describes two or more types occurring in the same person. At least 10 percent of patients with cerebral palsy suffer from a mixture of two or more types.
What are the symptoms of cerebral palsy?
The symptoms of cerebral palsy differ widely from one person to another, depending upon the areas of the brain which were injured, and the extent of damage. Some who are afflicted with severe cerebral palsy may be completely disabled and require special medical, surgical, nursing, and therapeutic care for their entire lives. At the opposite end of the spectrum, persons who are minimally injured may display nothing more than slight awkwardness with movement and require no special assistance. Some of the most commonly encountered symptoms of cerebral palsy include the following:
What are the causes of cerebral palsy?
There are several possible causes of cerebral palsy. Lack of oxygen to the brain can ultimately cause brain cells to die, resulting in permanent damage. The lack of oxygen can be caused by various types of problems with the placenta, umbilical cord compression, or maternal problems such as a stroke due to toxemia (also called eclampsia) or a ruptured uterus.
Trauma to the baby's head due to improper use of forceps or a vacuum extractor at the time of delivery can cause bleeding in the brain, resulting in cerebral palsy. Other possible causes of bleeding in the brain include a stroke due to broken, abnormal, or clogged blood vessels in or leading to the brain, or by respiratory distress due to prematurity.
Cerebral palsy can also be due to infections acquired by the baby during passage through the birth canal, such as herpes, CMV (cytomegalovirus), or Group B Strep.
Over the past 20 years, medical research has attempted to ascribe an ever-increasing proportion of cases of cerebral palsy to events that precede labor and delivery. While it seems likely that some cases of cerebral palsy may originate from brain damage prior to labor and delivery, many of the recent medical studies in this area are seriously flawed, and represent little more than a transparent effort to manipulate statistics in order to assist doctors and hospitals in avoiding responsibility for medical malpractice during childbirth.
Can cerebral palsy be treated?
Although there is no cure for cerebral palsy, many of the symptoms can be treated and/or managed in ways that will improve many children's functional abilities. Management/treatment needs will vary widely, depending upon the nature and extent of brain damage. In general, optimal care of a child afflicted with cerebral palsy requires the coordination of an interdisciplinary team of health care professionals. These generally include some or all of the following:
Is cerebral palsy preventable?
The most clearly preventable cases of cerebral palsy are those which result from medical mistakes. Maloccurrences during pre-natal care, labor and delivery, or the newborn period which can cause brain damage resulting in cerebral palsy, and which can and should be prevented, include the following:
Not all cases of cerebral palsy have an identifiable cause. As to those cases, there is on-going medical research attempting to identify all of the potential causes of cerebral palsy, and to develop strategies to minimize risk factors. Common preventive measures currently followed include Rh testing and immunization where appropriate, prompt recognition and treatment of bacterial infection of the maternal reproductive and urinary tracts, avoiding unnecessary exposure to x-rays and certain medications during pregnancy, education regarding harmful effects of drugs, cigarettes, and alcohol use during pregnancy, improved treatment of diabetes, nutritional deficiencies and anemia, treatment of newborn jaundice with photo therapy in the hospital nursery, enhanced access to early prenatal care, and established protocols for assembling pediatric resuscitation teams in the delivery room whenever a distressed baby is anticipated.
The web sites listed below contain information which may be useful to people interested in learning more about cerebral palsy, including resources that are available to help cerebral palsy patients and their families. Kenneth M. Sigelman & Associates is not affiliated with any of these other sites, and cannot be responsible for their content. Please feel free to contact us if you are aware of other helpful links to include in this site.
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