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
• meningitis
• 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 muscles.

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 problems:

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
• epilepsy
• vision problems
• inward or outward turning of the eyes
• hearing problems
• feeding and swallowing problems
• dental problems
• joint deformities (dislocations), scoliosis (curvature of the spine).

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.

Therapy

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.

Equipment Aids

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 necessary.

Other Treatments

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.

Educational Programs

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 transportation.

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 potential.

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

(800) USA-1UCP

Suggested Reading

See:

Cerebral Palsy: Book List