Cerebral Palsy

Cerebral palsy (CP) is a group of permanent disorders affecting movement and posture that appear in early childhood. It is caused by non-progressive disturbances that occurred in the developing brain, often before birth. CP is the most common motor disability in childhood, affecting approximately 1 in 500 children globally. The condition is characterized by abnormal muscle tone, reflexes, and motor development, which can affect a person's ability to move and maintain balance and posture. The severity, specific symptoms, and affected body parts vary widely among individuals with CP. While the brain damage that causes cerebral palsy doesn't progress, the resulting movement disorders may change over time. Cerebral palsy is often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, as well as epilepsy and secondary musculoskeletal problems. Though there is no cure for cerebral palsy, various interventions and treatments can significantly improve a person's capabilities and quality of life.

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What Causes It?

Brain damage during fetal development - Including genetic abnormalities, maternal infections, or insufficient oxygen reaching the fetal brain.

Prenatal stroke - Disruption of blood supply to the developing brain.

Maternal infections - Such as rubella, cytomegalovirus, toxoplasmosis, or Zika virus during pregnancy.

Maternal fever during pregnancy - Particularly with infections like urinary tract infections.

Placental problems - Affecting oxygen and nutrient delivery to the fetus.

Rh incompatibility - When mother and baby have different blood types, leading to antibody development that damages fetal red blood cells.

Maternal exposure to toxins - Including certain medications, drugs, or environmental hazards during pregnancy.

Brain injury during birth - Due to prolonged oxygen deprivation (asphyxia) or trauma during delivery.

Severe jaundice - Untreated high levels of bilirubin that damage brain cells.

Brain infections in early infancy - Such as meningitis or encephalitis.

Traumatic brain injury - From accidents, falls, or abuse in infancy.

Premature birth - Especially very premature infants (less than 28 weeks gestation).

Low birth weight - Particularly infants weighing less than 1500 grams (3.3 pounds).

Multiple births - Twins, triplets, or higher multiples have increased risk.

In many cases, the specific cause remains unknown despite thorough investigation.

Signs & Symptoms

Symptoms vary widely based on type, severity, and affected body areas, but may include:

Delayed motor milestones - Late rolling over, sitting, crawling, or walking.

Abnormal muscle tone - Either too stiff (hypertonia/spasticity) or too floppy (hypotonia).

Abnormal posture - Unusual positions when sitting, crawling, or standing.

Coordination problems - Awkward or jerky movements.

Stiff muscles with exaggerated reflexes (spasticity) - The most common movement disorder in CP.

Involuntary movements - Slow, writhing movements or rapid, jerky movements.

Tremors or involuntary shaking.

Balance and coordination problems (ataxia) - Unsteady walking and difficulty with precise movements.

Favoring one side of the body - Using primarily one hand or dragging a leg when crawling.

Difficulty with fine motor tasks - Such as buttoning clothes or picking up small objects.

Difficulty with oral motor functions - Affecting speech, eating, or swallowing.

Speech difficulties (dysarthria) - Due to problems controlling facial and oral muscles.

Excessive drooling - Due to poor control of mouth and throat muscles.

Seizures - Occur in about 30-50% of individuals with CP.

Associated conditions may include:

Intellectual disabilities - Present in about 30-50% of people with CP.

Vision and hearing problems.

Sensory processing issues.

Behavioral or emotional challenges.

How We Diagnose

Our specialists use advanced diagnostic methods to accurately identify and assess your condition

Developmental Monitoring

Regular tracking of a child's growth, movements, and milestones during routine health visits. Concerns about delayed milestones or abnormal movements often prompt further evaluation. Parents are usually the first to notice when a child isn't meeting expected developmental milestones.

Neurological Examination

A detailed assessment by a pediatric neurologist or developmental pediatrician, evaluating muscle tone, reflexes, posture, coordination, balance, and primitive reflexes. The persistence of primitive reflexes beyond the normal age of disappearance may suggest CP.

Medical History and Observation

Comprehensive review of pregnancy, birth, and early development history to identify risk factors. Careful observation of the child's movements, postures, and functional abilities helps identify patterns consistent with CP.

Brain Imaging

MRI (Magnetic Resonance Imaging) is the preferred imaging method, showing detailed brain structure and potentially identifying areas of damage. CT scans or cranial ultrasound (for young infants) may also be used. These can help identify the location and extent of brain abnormalities, though normal imaging doesn't rule out CP.

Electroencephalogram (EEG)

Records brain electrical activity and may be used if seizures are suspected, as epilepsy commonly co-occurs with cerebral palsy.

Laboratory Tests

Blood tests to rule out genetic or metabolic conditions that might mimic CP. Genetic testing may be recommended if there are specific concerns about inherited disorders.

Standardized Assessment Tools

Formal evaluations like the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), and Communication Function Classification System (CFCS) help characterize the type and severity of CP.

Multidisciplinary Evaluation

Assessment by various specialists including physical therapists, occupational therapists, speech-language pathologists, and orthopedic surgeons to thoroughly evaluate function and develop a comprehensive care plan.

Treatment Options

Personalized treatment plans tailored to your specific needs and condition

Physical Therapy

The cornerstone of CP management, focusing on improving muscle strength, balance, posture, and gross motor skills. Therapists use exercises, stretching, and specialized techniques to optimize movement patterns and prevent contractures. They also provide guidance on appropriate adaptive equipment and home exercise programs.

Occupational Therapy

Focuses on developing fine motor skills, self-care abilities (feeding, dressing, grooming), and adaptive techniques for daily activities. Therapists may recommend assistive devices or environmental modifications to enhance independence at home and school.

Speech-Language Therapy

Addresses communication difficulties and feeding/swallowing problems. This may include techniques to improve articulation, language development, and the use of alternative or augmentative communication systems for non-verbal individuals.

Medication Management

Various medications can help manage specific symptoms, including oral medications for generalized spasticity (baclofen, diazepam, dantrolene), botulinum toxin injections for localized spasticity, and medications for associated conditions like seizures, pain, or drooling.

Orthotic Devices

Custom-made braces, splints, or supports that help improve limb position, prevent deformities, and enhance function. Ankle-foot orthoses (AFOs) are commonly used to improve walking patterns and stability.

Assistive Technology

Devices that help with mobility (wheelchairs, walkers, gait trainers), communication (speech-generating devices, communication boards), and independence in daily activities. Advances in technology continue to expand possibilities for enhanced function and participation.

Surgical Interventions

Orthopedic procedures to lengthen tight muscles, correct bone deformities, or stabilize joints. Neurosurgical procedures like selective dorsal rhizotomy can reduce spasticity in selected cases. Surgery is typically considered when non-surgical approaches aren't sufficient to address functional limitations or pain.

Intrathecal Baclofen Therapy

For severe spasticity, a surgically implanted pump delivers baclofen directly to the spinal fluid, allowing effective spasticity management with lower doses and fewer side effects than oral medication.

Home Remedies

Home Exercise Program

Consistently perform exercises recommended by your physical and occupational therapists. These might include stretching to prevent contractures, strengthening exercises, and functional activities to practice skills. Create a regular schedule for exercises and incorporate them into daily routines to improve compliance.

Positioning and Handling

Learn proper positioning techniques to promote good alignment, prevent pressure sores, and facilitate function. Use recommended supports like cushions, wedges, or specialized seating during daily activities. Regular position changes help prevent complications from immobility.

Assistive Device Maintenance

Ensure that orthotic devices, wheelchairs, walkers, or other equipment are properly fitted, cleaned, and maintained. Check regularly for signs of wear, pressure points, or growth-related fit issues. Consistent use of prescribed devices optimizes their benefit.

Communication Support

For children with speech difficulties, consistently use recommended communication methods at home, whether simple sign language, picture communication boards, or electronic communication devices. Respond to all communication attempts, regardless of method, to encourage continued efforts.

Sensory Activities

Incorporate sensory-rich experiences that address your child's specific needs, whether sensory-seeking or sensory-avoiding. This might include deep pressure activities, textured toys, swinging, or vibration. Follow guidelines from your occupational therapist for activities appropriate to your child's sensory profile.

Adaptive Mealtime Strategies

Use recommended specialized utensils, cups, or plates to promote independence in eating. Position properly during meals to support safe swallowing. Follow feeding guidelines from speech or occupational therapists, especially for children with swallowing difficulties.

Stress and Fatigue Management

Recognize that physical activities require more energy for people with CP, leading to earlier fatigue. Plan activities with rest breaks, prioritize energy for important tasks, and adjust expectations during illness or growth spurts when fatigue may increase.

Skin Care

For children with limited mobility, check skin daily for redness or pressure areas, especially over bony prominences. Keep skin clean and dry, use moisturizers for dry skin, and ensure proper positioning to distribute pressure evenly and prevent skin breakdown.

Prevention Tips

Attend all scheduled appointments with healthcare providers, therapists, and specialists.

Follow through with recommended imaging studies, tests, or assessments to monitor condition and guide treatment.

Maintain regular preventive dental care, which may require specialized approaches for children with oral motor difficulties.

Ensure proper nutrition and hydration, working with a dietitian if feeding difficulties or growth concerns exist.

Monitor for and address complications like scoliosis, hip displacement, or contractures through regular orthopedic evaluations.

Prevent respiratory complications through good positioning, assisted coughing techniques if needed, and prompt treatment of respiratory infections.

Get recommended immunizations, including annual flu vaccines, as respiratory illnesses can be more serious in children with CP.

Address sleep problems, which are common in CP and can affect overall health, behavior, and learning.

Monitor vision and hearing regularly, as sensory impairments are more common in CP and can affect development and function.

Ensure proper bowel and bladder management to prevent constipation or urinary tract infections.

Monitor bone health, as reduced mobility can lead to lower bone density and increased fracture risk.

Be vigilant about pain assessment, as children with communication difficulties may not express pain in typical ways.

Plan for care transitions, including from pediatric to adult healthcare services.

Maintain your own physical and mental health as a caregiver through respite care and support services.

Keep documentation of medical records, treatment plans, and educational assessments organized and accessible.

Surgical Solutions

Advanced surgical procedures performed by our expert specialists

Orthopedic Surgery

Procedures to address musculoskeletal issues that limit function or cause pain. These may include muscle lengthening to release contractures (especially in hamstrings, heel cords, or hip adductors), tendon transfers to improve muscle balance, osteotomies to correct bone deformities, or joint fusion (arthrodesis) to stabilize unstable joints. Hip reconstruction may be necessary for hip displacement or dislocation, which is common in children with CP who have limited mobility.

Selective Dorsal Rhizotomy (SDR)

A neurosurgical procedure that reduces spasticity by selectively cutting some of the sensory nerve fibers that contribute to muscle stiffness. The surgeon identifies and cuts the specific nerve rootlets that are causing abnormal muscle tone while preserving those that support normal movement. This procedure is typically considered for children with spastic diplegic CP who have good underlying strength and potential for improved walking ability.

Intrathecal Baclofen Pump Implantation

Surgical placement of a pump system that delivers baclofen directly to the spinal fluid to reduce severe spasticity. The pump is implanted under the skin of the abdomen, with a catheter that delivers the medication to the intrathecal space around the spinal cord. This allows for effective spasticity management with much lower doses than oral medication, resulting in fewer side effects. The pump requires regular refills and programming adjustments.

Deep Brain Stimulation (DBS)

An emerging treatment option primarily for dyskinetic or dystonic forms of CP that don't respond well to other treatments. This involves surgical implantation of electrodes in specific areas of the brain connected to a stimulator device. The electrical stimulation helps regulate abnormal brain signals that cause involuntary movements. While widely used for conditions like Parkinson's disease, its use in CP is still evolving and generally considered for older children or adults with severe dystonia.

Gastrostomy Tube Placement

For children with significant feeding difficulties or swallowing problems that compromise nutrition or cause aspiration, surgical placement of a feeding tube directly into the stomach may be recommended. This can be done as a percutaneous endoscopic gastrostomy (PEG) or through a small laparoscopic procedure. While not treating the CP itself, this addresses the important associated issue of ensuring adequate nutrition and hydration.

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