Clinical Reference Systems: Pediatric Advisor 10.0
Cerebral palsy (CP) is a disorder of movement and posture
that appears in the early years of life. The term CP does
not refer to a single disorder, but to a group of different
disorders in which movement disability is the main feature.
Your pediatrician or a specialist can tell you if your child
has CP. It is more difficult to tell if your child has CP
during the first 6 months of life. But, the sooner
treatment begins the better.
What causes cerebral palsy?
Cerebral palsy can result from damage to parts of the brain
that control movement. This can happen before birth, at the
time of birth, or in early childhood. Recent studies have
shown that difficulties during the birth process itself are
not a common cause of CP.
CP may be caused by:
- complications of severe prematurity
- fetal infections
- birth defects
- head trauma.
Your doctor may have x-rays or blood tests done to check if
there are any medical or surgical therapies that might
help. These tests may also show if the CP is genetic. This
is helpful to know when you are planning to have another
child. Often the cause of CP is difficult to figure out and
may never be known.
What are the types of CP?
CP can be mild, moderate, or severe. The different types of
CP depend on the type and degree of movement problems. The
most common type is spastic CP.
Types of CP:
Spastic: The child has above normal tone or stiffness of
Athetoid: There is damage to the part of the brain that
influences and modifies electrical impulses sent
from the brain to the muscles; damage to
this system can cause movements such as tremors,
jerks, or writhing movements.
Atonic: The child is weak, lacking normal muscle tone.
Mixed: A combination of any of the above.
There are also terms used for the location of the movement
Monoplegia: one arm or one leg is affected.
Hemiplegia: the arm and leg on the same side are affected.
Paraplegia: only the legs are affected.
Diplegia: major movement problems with the legs and minor
problems with the arms.
Quadriplegia: arms, legs and and spine are affected.
What can I expect in the future?
Families that have just been told that their child has CP
are often concerned that their child will be severely
handicapped and perhaps will never walk. This may be true
for some children with CP.
CP has a wide range of disability, from mild motor
disability and normal intelligence to severe motor and
intellectual handicaps. As your child's nervous system
matures, changes may occur. For example, an infant who is
at first hypotonic (not enough muscle tone) may later become
spastic (too much muscle tone).
In children with severe motor handicaps it is often
difficult to predict their intellectual potential when they
are very young. This is especially true when children have
additional problems such as visual or hearing loss. Only
professionals experienced with multiple-handicapped, motor-
impaired children should try to assess intellectual levels
in these children.
What other problems might occur?
When the developing nervous system is injured, areas other
than the motor system can also be affected. Some problems
your child may have in addition to motor problems include:
- mental retardation
- vision problems
- inward or outward turning of the eyes
- hearing problems
- feeding and swallowing problems
- dental problems
- joint deformities (dislocations), scoliosis (curvature of
These other handicaps do not occur in every child with CP.
However, your child should be checked and treated by a team
of physicians and therapists. Each of your child's needs
can be taken care of by a specialist on the team.
How is CP treated?
There is no cure for cerebral palsy. However, many
therapies can help your child keep the abilities he have and
develop new abilities.
The aim of physical and occupational therapy is to make
normal movements easier, stop abnormal postures, and prevent
deformities. Your child will also need to learn skills used
in daily living. This will help your child gain
independence. These skills include feeding, toileting,
bathing, and dressing. Using special tools and aids also
helps your child achieve maximum independence.
As your child grows, one of the primary concerns is how your
child will get around. This depends on how severe the
handicap is. Your child may use walkers, motorized
wheelchairs, positioning aids, and other equipment when
Any other disabilities your child may have, such as mental
retardation and communication disorders, should be treated
if possible. Your doctor will refer your child to
specialists for treatment of these problems. Children of
normal intelligence with motor disorders who have difficulty
speaking can benefit from certain communication devices.
These devices range from pictures or symbols on a shallow
box that your child can point at, to computer-enhanced
systems. This allows children to communicate.
You may hear of new or alternative treatments and therapies
for your child through the media or friends. Your physician
can help you decide if these treatments for CP could help or
might be harmful.
If your child 3 years old or younger, ask your physician
about early intervention programs (EIPs). Many states offer
EIPs for children aged 0 to 3 with CP. Some states also
offer special education classes for children between the
ages of 3 and 5 years who have special needs.
For older children ask about special education classes and
individual education plans. Find out about any special
educational, therapeutic, and family services that may be
available to you. Local schools may provide occupational
and physical therapy and speech and language therapy.
Public Law 94-142 requires all states to provide special
changes in classrooms for school-aged children with CP until
they are 21 years old. Public Law 99-457 has instituted
similar services for preschool children and their families.
These public laws outline specific parental rights for
special educational and family services. It is the
responsibility of every school board to inform parents of
these rights and to follow the law.
Schools must develop an Individual Education Plan (IEP) for
each child with special educational and therapeutic needs.
Both the parent and the school need to agree on the IEP. An
IEP includes educational objectives, class placement, plans
for evaluation, and any other special services that are
necessary. The special services might include occupational
and physical therapy, speech and language therapy, and
What are the psychosocial problems with CP?
After hearing that your child has CP, you may feel grief,
guilt, and disappointment. Support groups, therapists, and
organizations can help you recognize and cope with these
feelings. Your doctor can direct you to these resources
in your community.
Many support services are usually available to both your
child and your family. A child with CP can recognize that
he is different during preschool and early school years.
When your child realizes that his handicap is permanent, he
may become depressed and angry. Counseling can help your
child with these feelings.
Encourage your child to participate in peer groups. Social
interaction is important for your child to reach his or her
It is important that you become an informed consumer of the
medical and educational resources available to your child.
Books, your doctor, parents of children with CP, and
organizations such as the United Cerebral Palsy Association
can offer valuable assistance.
For further information, call or write:
United Cerebral Palsy Association
7 Penn Plaza, Suite 804
New York, New York 10001
Cerebral Palsy: Book List