Cerebral palsy is the most common motion disability in childhood, affecting roughly 1 in 323 children in the United States. Cerebral palsy was once thought to be caused only by a lack of oxygen during child birth, but research published near the turn of the millennium showed the number of cases caused by a lack of oxygen was actually much lower. What does cause cerebral palsy? And what exactly is cerebral palsy? This article will help answer those questions and more.
What is cerebral palsy?
Cerebral palsy refers to a group of disorders that affect a person’s ability to move. Cerebral meaning “of the brain” and palsy meaning “lack of muscle control,” the disorder can affect body movement, muscle control, muscle coordination, muscle tone, balance, reflex and posture.
What causes cerebral palsy?
Cerebral palsy is caused when the part of the brain that controls movement is damaged or does not develop normally. This occurs either before, during or shortly after birth.
Most children (about 85 to 90 percent) who have cerebral palsy have Congenital Cerebral Palsy, meaning they were born with it. Some causes of Congenital Cerebral Palsy include genetic abnormalities, congenital brain malformations, maternal infections or fever, and fetal injury.
A small number of children have Acquired Cerebral Palsy, meaning they developed the disorder after birth. Some causes of Acquired Cerebral Palsy include brain damage in the first few months or years of life, brain infections like bacterial meningitis or viral encephalitis, problems with blood flow to the brain, and head trauma from an accident or child abuse.
- Damage to white matter of the brain (periventricular leukomalacia, or PVL) – gaps in brain tissue that interfere with the normal transmission of signals.
- Abnormal brain development (cerebral dysgenesis) – mutations in genes, infections, fevers, trauma and other conditions can interrupt the normal process of growth
- Bleeding in the brain (intracranial hemorrhage) – commonly caused by fetal stroke
- Severe lack of oxygen in the brain (asphyxia) – caused by an interruption in breathing or poor oxygen supply
What are the different types of cerebral palsy?
There are several types of cerebral palsy and each affects a person’s ability to move differently. The symptoms of cerebral palsy can range from mild to severe, but the condition does not get worse over time.
Spastic Cerebral Palsy
Spastic cerebral palsy is the most common type, accounting for about 70 to 80 percent of children and adults with cerebral palsy in the United States. This form of the disability is characterized by stiff muscles which make moving difficult.
There are three different forms of spastic cerebral palsy and each depends on the parts of the body affected.
Spastic hemiplegia – Only one side of the body is affected with spastic hemiplegia and usually the arm is affected more than the leg.
Spastic deplegia – This type of spastic cerebral palsy affects both sides of the body. In many cases, tightness in the muscles of the hips and legs cause both legs to cross which is called scissoring.
Spastic quadriplegia – Spastic quadriplegia is the most severe form of spastic cerebral palsy and affects all four limbs as well as the trunk, and oftentimes the muscles that control the tongue and mouth. Spastic quadriplegia is often accompanied with other disabilities including mental retardation.
Dyskinetic Cerebral Palsy
Also called athetoid cerebra palsy, this form of the disability affects about 10 to 20 percent of individuals diagnosed. It is characterized by fluctuations in muscle tone, which can range from too tight to too loose, and uncontrolled movements that can be slow and writhing or rapid and jerky.
Children with dyskinetic cerebral palsy often have trouble learning how to control their bodies well enough to sit and walk. It can also affect the muscles in the face and tongue, causing difficulties with swallowing, sucking and speech.
Ataxic Cerebral Palsy
This is the least common form of cerebral palsy, affecting about five to 10 percent of individuals with the disability. Ataxic cerebral palsy affects a person’s balance and coordination making it difficult to walk. It can also make motions that require precision, like writing, difficult.
What are some risk factors of cerebral palsy?
According to CPF, there are numerous risk factors that can put babies at a greater risk of developing cerebral palsy either during pregnancy or at birth.
Risks during pregnancy
- Multiple births – Twins, triplets and other multiple births are linked to an increased risk of cerebral palsy.
- Infections during pregnancy – Certain infections in the mother can cause inflammation that leads to brain damage in the developing fetus. These infections include rubella (German measles), cytomegalovirus, toxoplasmosis and chorioamnionitis.
- Blood type incompatibility between mother and child – Rh disease occurs when the mother’s blood type is different from her baby’s and the mother’s system doesn’t tolerate it. Her body then attacks the baby’s blood cells which can cause brain damage.
- Exposure to toxic substances – Mothers who are exposed to substances like mercury are at a greater risk of having a baby with cerebral palsy. Exposure to alcohol, cigarettes and drugs can also increases this risk.
- Other conditions – mothers with thyroid abnormalities, intellectual disability, excess protein in the urine or seizers are slightly more likely to have a child with cerebral palsy.
Risks during childbirth
- Low birth weight or premature birth – Babies born less than 37 weeks and babies weighing less than 5.5 pounds at birth are at an increased risk.
- Breech presentation – Infants with cerebral palsy are more likely to have been in breech position (feet first) at the beginning of labor, instead of head first.
- Complicated labor and delivery – Complications like detachment of the placenta, uterine rupture or problems with the umbilical cord during childbirth can disrupt oxygen supply to the baby and result in cerebral palsy.
- Low Apgar score – The Apgar score is an assessment of how well a baby is doing at birth. It rates a baby’s Activity (muscle tone), Pulse, Grimace (reflex response), Appearance (color) and Respiration at one minute and five minutes after birth. Each category is rated from 0 to 2, 2 being the strongest rating.
- Severe jaundice – Jaundice (the yellowing of the skin and whites of the eyes) is caused by a buildup of biliruben in the blood. If the condition goes untreated, it can cause damage to brain cells which may lead to cerebral palsy.
- Seizures – An infant who has seizures as a higher risk of being diagnosed with cerebral palsy later in childhood.
What are the signs and symptoms of cerebral palsy?
Except in its mildest forms, cerebral palsy can be evident in the first 12 to 18 months of a child’s life, though a specific diagnosis may not be made until age two or older, according to CPF.
The symptoms of cerebral palsy differ based on the type and severity of the disorder, but may include:
- Lack of muscle coordination when performing voluntary movements
- Stiff or tight muscles and exaggerated reflexes
- Weakness in one or more arm or leg
- Walking on the toes, a crouched gait, or a “scissored” gait
- Variations in muscle tone, either too stiff or too floppy
- Excessive drooling or difficulties swallowing or speaking
- Shaking or random involuntary movements
- Difficulty with precise movements such as writing or buttoning up a shirt
Infants with cerebral palsy are often slow to reach developmental milestones, like learning to roll over, sit, crawl or walk.
Some people with cerebral palsy may have other medical disorders, including seizures and abnormal physical sensations or perceptions. People with cerebral palsy may also have vision, hearing or speech problems.
Is cerebral palsy usually caused by a lack of oxygen at birth?
A lack of oxygen during birth was once thought to be the main causes of cerebral palsy. When a report written by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) was released in 2003 that viewpoint began to change, as the report estimated only about 10 percent or less of cases actually resulted from a lack of oxygen during labor and delivery.
A lack of oxygen puts babies at risk of brain damage which could lead to the development of cerebral palsy. Intrapartum asphyxia, or a lack of oxygen during delivery, occurs in about 1 out of every 1,000 live births in the United States, according to Seattle Children’s Hospital.
There are many factors that could lead to intrapartum asphyxia. According to Healthline.com, causes of intrapartum asphyxia include:
- The baby’s airway becoming blocked
- If the baby is anemic, his or her blood cells will not carry enough oxygen
- Difficult or long delivery
- The mother does not get enough oxygen before or during birth
- The mother’s blood pressure is too high or low during delivery
- An infection that affects the mother or baby
- The placenta separates from the uterus too quickly, resulting in a loss of oxygen
- The umbilical cord becomes wrapped around the baby
How is cerebral palsy treated?
Though cerebral palsy isn’t curable, there are numerous treatment options that can improve a person’s quality of life. Treatments will vary from person to person depending on the severity and type of disorder and can include therapeutic and surgical options, as well as medications.
Therapeutic options include:
- Physical therapy
- Occupational therapy
- Recreational therapy
- Speech and language therapy
Drug therapy options include:
- Oral medications to relax stiff, contracted or overactive muscles
- Botox to relax muscles
- Intrathecal baclofen therapy uses an implantable pump to deliver a muscle relaxant to the spinal cord
Surgical options include:
- Orthopedic surgery
- Surgery to cut overactive nerves
How common is cerebral palsy?
Cerebral palsy is the most common motor disability in childhood, with about 1 in 323 children identified with the disorder, according to statistics from the Centers for Disease Control.
Cerebral palsy is more common in boys than girls, and is more common in black children than white or Hispanic children.
Most children with cerebral palsy have spastic CP (77.4 percent) and many have at least one co-occurring condition – 41 percent had epilepsy and 6.9 percent were autistic.
Over half of children (58.2 percent) with cerebral palsy are able to walk independently, 11.3 percent walked using a handheld mobility device and 30.6 percent had limited walking ability or were wheelchair bound, according to the CDC.
How is cerebral palsy diagnosed?
The earlier cerebral palsy is diagnosed, the better it is for both the child and his or her family. Most kids with cerebral palsy are diagnosed within the first 2 years of life, but milder forms may not be diagnosed until age 4 or 5.
Doctors may use brain imaging techniques, as well as developmental tests, to diagnosis children with cerebral palsy.
Brain imaging techniques
Doctors may use different types of brain imaging techniques to determine the location and type of damage to the brain. These techniques include:
- Magnetic resonance imaging (MRI)
- Cranial ultrasound
- Computed tomography (CT)
Doctors normally test a child’s motor skills during regular doctor visits. These tests help doctors evaluate a child’s symptoms and possibly rule out other diseases or disorders that may be masquerading as cerebral palsy. Lab tests are also helpful in identifying other conditions to may cause symptoms similar to cerebral palsy.
During a motor skills test, doctors look at a child’s:
- Muscle tone
- Age-appropriate motor control
- Hearing and vision
Can parents file a malpractice lawsuit after their child was born with cerebral palsy?
Before the report by American College of Obstetricians and Gynecologists and the American Academy of Pediatrics was published in 2003, a large number of lawsuits were filed by parents whose children were born with cerebral palsy.
After 2003, it became much more difficult to argue in court that a child’s cerebral palsy was caused by a lack of oxygen during birth.
Parents who feel their child’s cerebral palsy was caused by medical malpractice should speak with a lawyer or attorney to determine if there is a possible case.