Cerebral palsy is a serious disability in which the brain is damaged and not able to properly control body and muscle movement. The particular type of brain damage that causes cerebral palsy typically occurs during childbirth when the supply of oxygen to the baby's brain is temporarily interrupted. Cerebral palsy is the most common type of serious birth injury and is the subject of many malpractice lawsuits.What is Cerebral Palsy?
Cerebral palsy is a neurologic disability affecting body movement, muscle tone, and posture. The word "cerebral" means relating to the brain or intellect and "palsy" means incapacity or paralysis. CP is caused by a specific type of damage to the brain that is usually suffered during a traumatic or difficult childbirth. When the flow of oxygen to the baby's brain is interrupted during childbirth, cells in the brain quickly begin to die. This is what eventually leads to cerebral palsy.
The severity of cerebral palsy and its physical symptoms can vary significantly for each individual. Mild or moderate cases of cerebral palsy might only result in a minor limp or awkward movements. Severe cerebral palsy cases can leave the child totally disabled and confined to a wheelchair. Cerebral palsy is not a progressive disorder so it does not get worse with time. However, the damage to the brain that causes CP can never be reversed so there is no cure or effective treatment for the condition. In addition to the impact CP has on body movement, the condition can also result in seizures, cognitive impairment, and vision, hearing and speech issues.Different Types of Cerebral Palsy
There are 4 recognized types of cerebral palsy. The cerebral palsy subtypes are generally defined by the specific areas of the body that are affected and the particular type of brain injury and resulting disability.Spastic CP
Spastic cerebral palsy is the most common form of the disorder accounting for over 80% of all CP cases. Spastic CP causes debilitating muscle stiffness in the affected area of the body. The muscle stiffness can make it very difficult or impossible to move certain parts of the individual's body. When a normal person moves, their brain sends messages to their body which direct certain muscles to move in coordination with each other. In someone with spastic CP, these messages from the brain are impaired, causing muscles to suddenly stiffen and prevent movement. Cases of spastic CP are categorized into 3 different subtypes based on the area of the body that is affected:
- Diplegia: this subtype refers to spastic CP affecting muscles in the individual's legs and lower body. The upper body is usually not impacted. Individuals with spastic diplegia CP often have difficulty walking without special crutches, as the condition forces their knees and legs to pull inwards.
- Hemiplegia: this subtype involves spastic CP which affects one particular side of the body (left or right) and not the other. Most individuals with this subtype experience more stiffness in the arms and upper body of the affected side with the legs being less impacted.
- Quadriplegia: with this subtype the spastic CP affects the individual's entire body. All four limbs and the face are impaired by excessive muscle stiffness. This subtype is the most severe and often leaves individuals totally unable to walk.
Dyskinetic cerebral palsy is characterized by muscles that suddenly go from overly stiff to overly loose when the individual attempts to move. This causes sudden involuntary movements that can be very rapid or slow. Dyskinetic CP usually affects both the arms and the legs. In some cases, the muscles in the mouth and face are impaired, causing issues with talking and swallowing food.Ataxic CP
Ataxic cerebral palsy involves a significant lack of balance and coordination caused by interruption of the messages from the brain. Individuals with this type of CP may appear very clumsy, have trouble walking, or struggle with fine motor coordination.Mixed CP
This fourth category includes cases of cerebral palsy that involve a mix of 2 or more of the primary subtypes of CP. The most common type of mixed CP is spastic-dyskinetic.Symptoms & Signs of Cerebral Palsy
Cerebral palsy is usually the result of injury to a baby's brain caused by loss of oxygen during childbirth. As a result, individuals with CP are usually born with the disorder. However, the signs of cerebral palsy are often hard to detect at first. So, a formal diagnosis of the disorder may not be made until months or even years after birth. Most children are diagnosed with CP after 10-12 months, and almost all cases are diagnosed before 24 months. The signs and indications of cerebral palsy vary based on type and severity. Below are some of the more common signs of CP at various developmental stages:Under 6 Months:
- Not able to lift and control head
- Feels floppy like a rag doll when picked up
- Feels overly stiff in legs or arms
- Abnormal arching of back and neck stretching
- Crossed or scissor legs caused by stiffness
- Sudden contractions or movements (including seizures)
- Cannot roll over on their own
- Unable to bring hands together or bring hands to mouth
- Only uses one side of the body with apparent stiffness or closed fist
- Involuntary movements
- Fails to meet development milestones
- Speech, hearing, or vision issues
- Abnormal crawling with apparent dragging on one side
- Drags butt or hops on knees instead of crawling on all fours
- Limited range of motion and poor fine motor skills
- Slow development
- Excessive drooling
The signs of cerebral palsy will be identified by a pediatrician as the baby develops and usually leads to a diagnosis around 10-12 months.Causes of Cerebral Palsy During Childbirth
The underlying cause of all cases of cerebral palsy is the same. Cerebral palsy is caused by damage or developmental defects to the areas of the brain that control the movement of the body and coordination. Brain damage resulting in cerebral palsy can occur in the later stage of pregnancy, during labor & delivery, or shortly after birth. The exact source of brain damage can vary greatly. According to the American Pregnancy Association, 20% of cerebral palsy cases are caused by labor and delivery events and 70% are attributable to events during pregnancy.
- Oxygen Deprivation: Oxygen deprivation (asphyxia) to the baby's brain is one of the leading causes of cerebral palsy. Throughout pregnancy and childbirth, a baby's brain is in a very vulnerable position. The brain needs a continuous supply of oxygen & blood. If the circulation of blood and oxygen to the baby's brain is interrupted or restricted, damage to brain cells can occur in a matter of minutes. There are a wide variety of obstetrical complications and events during pregnancy and childbirth that can threaten the supply of oxygen to the baby's brain.
- Maternal Infections: Maternal infections during pregnancy, labor, and delivery can potentially cause damage to the baby's brain resulting in cerebral palsy. Recent studies have shown that viral infections, such as rubella and cytomegalovirus, and parasitic infections, like toxoplasmosis, can damage the baby's developing brain and result in cerebral palsy. Infections of the placental membranes and amniotic fluids (chorioamnionitis) can also damage brain cells in the baby and cause cerebral palsy.
- Premature Birth: Babies that are born prematurely are 30 times more likely to be diagnosed with cerebral palsy compared to full-term babies. One of the main reasons for this is that premature babies frequently experience brain hemorrhages and periventricular leukomalacia (PVL), both of which cause the type of brain damage that results in cerebral palsy.
- C-Section Delays: When complications arise during labor and delivery, a timely emergency c-section can be the only way to avoid oxygen deprivation and brain damage to the baby. Unfortunately, mistakes are sometimes made by doctors in the delivery room, and emergency c-sections are not always performed when they should be. Even a very short delay in performing a c-section can damage the baby's brain and result in cerebral palsy.
- Head Trauma: External trauma to the baby's head during childbirth can potentially cause the type of brain damage that results in cerebral palsy. During a vaginal delivery, the baby often becomes stuck or has difficulty passing through the birth canal. When this occurs doctors will often use devices such as obstetrical forceps or vacuum extractors to dislodge the baby and facilitate delivery. Using these devices requires a high level of skill because they can easily cause an excessive level of force on the baby's head and cause internal damage.
Cerebral palsy is caused by damage to certain areas of the developing brain that control body movement. Sadly, once these parts of the brain are damaged, they will never fully heal and return to normal. Cerebral palsy is not a progressive disorder, so it will not get worse over time. But it is a permanent condition. Therefore, treatment options for cerebral palsy are focused more on the management of symptoms and increasing the individual's quality of life. Treatment plans for cerebral palsy are typically multifaceted and involve some combination of therapy, medication and sometimes surgery:
- Physical Therapy: Regular physical therapy is almost always the cornerstone of any cerebral palsy treatment program. Physical therapy can help children with CP to overcome and manage their body motor function and control. Physical therapy has been shown to improve strength, balance, posture, flexibility, and coordination in all types of cerebral palsy. Some physical therapy treatments utilize corrective orthotics.
- Occupational Therapy: While physical therapy focuses on improving gross motor function, occupational therapy targets fine motor function (e.g., gripping, writing, using scissors). Occupational therapy plans are usually uniquely tailored to the needs of each individual and can be very beneficial particularly for children with very severe cases of CP who struggle for any kind of physical independence.
- Speech Therapy: Not all children with cerebral palsy have speech issues, but for those that do, speech therapy will be one of the most important components of their treatment plan. Speech therapy does not just involve help improving language and oral communication skills, but also developing other skills such as eating and swallowing.
- Medication: Various medications are often used to help manage some of the more problematic symptoms of cerebral palsy. For instance, medications have been effectively used to minimize seizures, muscle spasticity, and involuntary movements.
- Surgery: There are a number of surgical treatment options to help children with certain types of cerebral palsy. Most of these surgical procedures are design for children with spastic CP. Spastic CP is characterized by excessive muscle tone and stiffness. The aim of a surgical intervention is to alleviate the results of excessive muscle tone by lengthening muscles and tendons. For example, a child with spastic CP who walks on their toes can have surgery to lengthen the tendons in their legs and enable them to walk normally.
Caring for a child with cerebral palsy is expensive. Treatment and management of CP can require extensive therapy and mobility aids that are not always covered by normal health insurance. The good news is that there are numerous publicly sponsored programs and organizations to help families with the financial burden imposed by cerebral palsy.Supporting Literature on Cerebral Palsy
- A. MacLennan, S. Thompson, J. Gecz. Cerebral Palsy: causes, pathways, and the role of genetic variants. Am J Obstet Gynecol, 2015 Vol. 213 Issue 6, 779-788.
- A. Colver, C. Fairhurst, P. Pharoah. Cerebral palsy. The Lancet, April 2014, Vol. 282 Issue 9924, 1240-1249.
- I. Krageloh-Mann & C. Cans. Cerebral Palsy Update. Brain Development: Vol. 31, Issue 7, August 2009, pp. 537-544.
- P. Rosenbaum, N. Paneth, A. Leviton, M. Goldstein, et al., The Definition of Cerebral Palsy. Dev Med Child Neurol. 2008 Mar; 50(3):240.
- M. Maenner, S. Blumberg, M. Kogan, D. Christensen, L. Schieve. Prevalence of cerebral palsy and intellectual disability among children identified in two U.S. National Surveys, 2011–2013. Annals of Epidemiology, March 2016 Vol. 26:3, 222-226.
- Karen W. Krigger, M.D., Cerebral Palsy: An Overview. Am. Family Physician, Jan. 2006, Vol. 73, No. 1.