Conditions

Cerebral Palsy

Condition FAQs

Overview

Cerebral Palsy (CP) is a general term for damage to the parts of the brain that control muscle activity. Movement and coordination are often affected. The disability can be mild, moderate, or severe. Some children can walk by themselves. Others need help from braces, crutches, walkers, or wheelchairs.

Symptoms

Children with CP may be slow to meet developmental targets such as rolling over, sitting up, crawling, and walking. Your child may demonstrate other symptoms. CP may affect may body systems other than motor skills. For example:

Developmental delay including learning disabilities or speech problems
Seizures
Vision or hearing difficulties
Problems with teeth, swallowing, or constipation
Curvature of the spine (scoliosis)
Joint contractures or hip dislocations

Evaluation & Examination

Early signs of CP include being late in learning to roll over, sit up, crawl, or walk. Sitting up by oneself usually happens between 6 and 8 months of age. Walking by yourself usually starts by 18 months of age. If your child is slow to do these things, you should ask your pediatrician about possible developmental delay. Pediatric neurologists (brain and nerve doctors) and/or pediatric orthopedic surgeons also help with the evaluation and diagnosis.

Your doctor will look at your child’s muscle tone and reflexes. He/she will also check the range of motion of the joints. He or she will also watch to see what your child can do, such as sitting, crawling, and using the hands. Watching your child walk is also an important part of the evaluation.

Many times, no other tests are needed to evaluate for CP. Sometimes your doctor will order a magnetic resonance imaging (MRI) test of your child’s brain to look for abnormalities.

Treatment

In the early years (before the age of 3), treatment is to help the child gain his/her milestones like walking. Early intervention programs (EIP) offer physical therapy (PT), occupational therapy (OT), and speech therapy (ST). As the child reaches school age, treatment shifts to keeping function. For example, PT helps keep the joints moving and improves strength, while braces and assistive devices (crutches, walkers, wheelchairs) help the child join in with his/her classmates. When your child is older, treatment options may include surgery.

Special Treatment Options

Special shoes are rarely needed.

Braces are a very important part of treatment. Braces can help keep your child’s feet flat on the ground. This can help him/her feel more stable and can help prevent foot problems. Braces also can help keep the muscles stretched out, which sometimes avoids the need for surgery.

Medications are sometimes used to decrease spasticity.

Onabotulinumtoxin A (Botox) can be helpful in some patients. It is useful to help stretch tight muscles in patients with full motion in their joints. In other words, Botox will not help if the joints themselves are stiff.

Stem cell injections are NOT an approved treatment in the United States for CP. The FDA offers current information on the state of stem cell research.

Operative Treatment

Keep in mind that CP is a term that includes many kinds of patients with different problems. It is difficult to guess if your child will need surgery. Every child with CP is different. When doctors do recommend surgery, it is rarely performed before 6 years of age. When appropriate, most pediatric orthopedic surgeons agree that an ideal time to perform surgery is between 7 and 12 years old. Procedures can include tendon lengthening, moving tendons from one muscle to another, or cutting the bone to re-align it. Some patients benefit from a pump that delivers medicine to the fluid around the spine. This medicine, known as baclofen, relaxes muscles. Cutting selective nerves in the lower spinal cord may also help to relax the muscles. This is known as a dorsal rhizotomy.

Prognosis

Your child - and your child’s CP - is unique, so you will need to discuss your child with your doctors. There are still some common, expected facts about your child’s growth and development. Most children with CP will have delayed milestones - walking later than other children, for example- but will continue to show improvement until about 6 years of age. Your child’s function may remain the same in the early school years. When your child enters the teenage years and starts to grow taller and heavier, his/her muscles may have a harder time functioning due to the increased forces required. Because of this, your child may seem to have worse function.

More information

Your local doctors can direct you to information and resources specific to your area. The American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) is an organization that focuses on the well being of people with cerebral palsy and other childhood-onset disabilities. Visit aacpdm.org for more information.

Also visit OrthoInfo - Cerebral Palsy

Q: What is Cerebral Palsy?

Cerebral Palsy (CP) is a term for damage or injury to the parts of the brain that affects a child's ability to control his/her muscles. Movement and coordination are often affected. The physical disabilities can be mild, moderate, or severe. Some children can walk by themselves, while others need assistance from crutches, walkers, or wheelchairs.

CP may include a range of other problems, in addition to affecting motor skills. For example:

Developmental delay, including learning disabilities or speech problems
Seizures
Vision or hearing difficulties
Problems with teeth, swallowing, or constipation
Curvature of the spine
Joint contractures or hip dislocations

Q: What causes Cerebral Palsy?

Cerebral Palsy has been associated with many causes, but sometimes there is no definite cause. Premature birth and low birth weight are the most well-known associations with CP, but not all premature or tiny babies are affected. Infections - before birth or in infancy - have been associated with CP.

Q: When should I take my child to the doctor for Cerebral Palsy?

Early signs of CP include delays in meeting milestones, such as learning to roll over, sit up, crawl or walk. Sitting up alone usually happens between 6 and 8 months of age. Walking independently usually starts by 18 months of age.

Q: How is Cerebral Palsy treated?

In the early years - especially before the age of 3 - the focus of treatment is on helping the child gain his/her milestones. Early intervention programs offer physical therapy (PT), occupational therapy (OT), and speech therapy (ST). As the child reaches school age, the focus of treatment shifts to maintaining function. For example, PT keeps the joints moving, while braces and assistive devices (crutches, walkers, wheelchairs) help the child participate with his/her classmates. Depending on your child’s function and age, treatment options may also include surgery.

Q: Will Botox help?

Botox can be helpful in select patients. It's most useful in patients who have very tight muscles, but still have full motion in their joints. Botox won't help once the joints are stiff.

Q: Will my child need special shoes or braces?

Special shoes are rarely needed. However, braces are an important part of treatment for some children. Braces can help keep the feet flat on the ground and improve stability. Braces may also keep the muscles stretched out, which may help avoid the need for surgery.

Q: Will my child need surgery?

Remember that CP is a general term for patients with different disabilities. Some patients with CP only have one leg or arm involved, and some patients have both legs and arms involved. It is difficult to predict if your child will need surgery because each CP patient is different. When doctors do recommend surgery, it is rarely needed before 6 years of age.

Q: Will activities make my child’s Cerebral Palsy worse?

No. You do not need to limit your child’s activities t need to limit your child or apart of overall good health.

Q: Does Cerebral Palsy get worse over time?

This is an important question. There is no cure for CP, and the underlying brain injury does not get worse over time; however, many of the other impairments - seizures, tight muscles, scoliosis, etc. - will change as your child grows.

Q: Should we give our child stem cell injections?

Stem cell injections are NOT an approved treatment in the United States for cerebral palsy. The FDA offers current information on the state of stem cell research: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm286155.htm.

Q: Where can I get more information?

Your local doctors can direct you to information specific for your region. The American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) is an organization that focuses on the well-being of people with cerebral palsy and other childhood-onset disabilities. Visit aacpdm.org for more information.

Questions to ask your doctor:

Are there early intervention programs available in our area?
Is it safe for my child to exercise, run and jump?
Is there anything that my child should avoid doing?
Will Cerebral Palsy cause my child any long-term problems?