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Date issued: August 2021

Review date: August 2023

Ref: C-461 v2

PDF:  Cerebral Palsy final August 2021 v2.pdf [pdf] 334KB

This leaflet explains the definition, causes, symptoms and problems that may be seen more commonly in cerebral palsy, and outlines some treatments of cerebral palsy.

Receiving a new diagnosis can be confusing and overwhelming, especially with lots of new medical terminology to understand. It is really important not to be afraid to ask questions or reach out for support. You may find yourself experiencing feelings of panic, anger, worry, guilt or loss; this is all normal. It is also normal for different people involved in the child’s life to experience different and conflicting emotions. The important thing is to communicate with those around you and remember you can speak to a member of the team involved with your child if you have any worries or concerns.

What is Cerebral Palsy?

Cerebral palsy is an umbrella term that describes a group of conditions affecting the developing infant or child’s brain. It is the most common physical disability in childhood estimated to affect 1 in 400 children. Cerebral palsy results from malformation or injury to the areas of the brain that control movement and posture. It can occur during pregnancy, around the time of birth or within the first two years after birth.

How cerebral palsy affects a child will vary depending on the extent and location (in the brain) of the injury and the age of the child when it occurs.

All children with cerebral palsy have problems with movement as the main difficulty. Cerebral palsy can also affect sensation, perception, learning, communication, and eating and drinking. In some children, all of these functions are affected, but other children may have difficulties in only one of these areas.

The injury to the brain does not change but some of the symptoms may appear worse as your child grows and develops. This may mean that support is required from professionals throughout childhood.

Risk Factors

In some cases it is possible to identify a cause of cerebral palsy but not in all.  Complications during pregnancy and birth can result in cerebral palsy,

Being born extremely prematurely or with a very low birth rate puts an infant more at risk of having cerebral palsy. Conditions such as a congenital heart defect, neonatal seizures or an acquired infection such as meningitis will also put an infant more at risk.

Causes of Cerebral Palsy

Reduced oxygen to the brain can lead to certain areas of the brain being affected. This can be due to lack of oxygen to the infant, for example, during a difficult birth, or due to a blockage in the blood vessels to the brain, a stroke. A bleed (haemorrhage) from the blood vessels within the brain can affect the areas of the brain tissue where the bleed occurs.

There is growing evidence to suggest there are also genetic causes of cerebral palsy, leading to the brain incorrectly developing within the womb.

How do we know is someone has Cerebral Palsy?

Symptoms vary from child to child. You may notice your child appears to move differently to others their age. They may appear stiff or weak or have poor head control. One of the first signs is a delay in achieving motor skills such as sitting, rolling, crawling and standing. Other areas may be affected such as feeding, communication, vision, sleep, emotions and social development.

Types of Cerebral Palsy

Cerebral palsy can be divided into three main groups, depending on the area of brain affected and how it controls movement and posture:

Spastic Cerebral Palsy: when some muscles are stiff (muscle tone is increased). It is sub categorised into the areas of the body affected:-

• Hemiplegia (or unilateral) where one side of the body if affected.

• Diplegia where both sides of the body are affected but legs more so than arms. 

• Quadriplegia- where the whole body is affected arms, trunk and legs equally.

Dyskinetic/Athetoid Cerebral Palsy: Subcategorized into choreo athetoid and dystonic athetoid. When a child has fluctuating (high and low) muscle tone and uncontrolled writhing or jerky movements. This affects the whole body.

Ataxic Cerebral Palsy: Muscle tone is reduced and a child may have a tremor and poor balance. This affects the whole body.

Some children may have a mixed form if more than one area of the brain is affected.

How is Cerebral Palsy diagnosed?

Although symptoms may show I the first few months of infancy, a doctor may not be able to confirm the diagnosis until the end of the first or second year. Diagnosis is made by a Paediatrician with expertise in neurology and neuro-disability. The specialist will collect information about your child from family and healthcare professionals involved in their care. They will perform a thorough neurological examination and may request further investigations such as an MRI scan.

Effects of Cerebral Palsy:

Physical Ability:

Alterations in muscle tone affect the movement that can be produced. The more severe the child’s physical difficulties, the more likely it is they will have difficulty with skills such as walking and carrying tasks involved using upper body. If a child can sit by two years of age (corrected age, if they were born prematurely) it is more likely that they will be able to walk unaided by age six. If a child cannot sit or roll by two years of age, they are unlikely to be able to walk unaided.

Speech Development:

Around one in two individuals with cerebral palsy has some element of communication difficulty. The more severe the physical and learning difficulties, the more likely they are to have difficulties with speech and language. If the child has uncontrolled epilepsy, they may have difficulties with all forms of communication, including speech. A child with dyskinetic or ataxic cerebral palsy is more likely to have difficulties with speech and language than a child with spastic cerebral palsy.

Vision:

Visual impairment occurs in about half of individuals with cerebral palsy. They may be at risk of cortical visual impairment, when there is no eye disorder, but the brain has difficulty receiving or interpreting the visual input. This occurs in around one in five individuals with cerebral palsy and is more common with more severe motor impairment. Other visual impairment may include squints and visual field disturbances.

Hearing:

Hearing impairment occurs in around one in ten individuals with cerebral palsy and is worse in those with severe movement difficulties. It is more common in those with dyskinetic or ataxic cerebral palsy than in those with spastic cerebral palsy

Learning Disabilities:

About half of children with cerebral palsy have problems with learning, memory, understanding and use of language especially if they have severe movement difficulties.

Behavioural Difficulties:

Around one in every five children and young people with cerebral palsy may have emotional and behavioural difficulties, find it hard to make friends and have difficulties with attention, concentration and hyperactivity.

Epilepsy:

This occurs in around one in three children with cerebral palsy especially in children with severe movement difficulties.

Treatment

Professionals with expertise in the treatment of cerebral palsy can provide advice and support around treatment options. If a child is diagnosed with cerebral palsy, there is no cure but there is treatment for some of the symptoms so the child or young person can achieve their maximum functional potential. A multidisciplinary team of professionals may get involved to support your child. These may include:

A Community Paediatrician will coordinate medical input and help solve any medical issues your child may have. Medicines may be used to help reduce the tightness of the muscles as controlling spasms may help a child move more freely

Physiotherapy and Occupational Therapy aims to maximise a child’s independence and function and can help with learning everyday skills such as sitting, standing, walking, feeding, dressing and hand function. It is important to prevent secondary complications such as deformities or contractures of the muscles and you will be involved with your child’s therapist in learning exercises and stretches  which you can carry out with your child at home on a day to day basis. Monitoring of the hips and spine is often required during growth and an Orthopaedic Surgeon may need to be involved if complications develop.

An individual with cerebral palsy may need support to access their physical environment (home, school, community activities) an Occupational Therapist may support this by recommending specialist equipment or adaptations.

Speech and Language Therapists help with any speech problems and difficulties relating to feeding and swallowing. Dietetic input may be required to ensure support for an adequate diet and growth.

Children with hearing or visual impairment can be helped by means of hearing aids or glasses and, if required, with input from the specialist local authority service for the visually or hearing impaired.

Psychological support may be helpful to support children with emotional difficulties and behavioural issues. If mental health issues develop then referral to Child and Adolescent Mental Health Service may be helpful.

Input from a Social Worker from the disabled children’s team from the local authority may be needed to support with short breaks / respite care and transition.

A Portage team may help in early years to support a child’s additional educational needs and later this support may be provided via an Education, Health and Care Plan.

Useful sources of information

Cerebral Palsy Foundation: http://www.yourcpf.org

Children’s Hemiplegia and Stroke Association: www.chasa.org

Contact for families with disabled children: https://contact.org.uk

Early year’s material (information for parents): https://www.ncb.org.uk

Scope: https://www.scope.org.uk/

Fun‘n’Games: https://research.ncl.ac.uk/hemiplegiaresearch-fungames/

Disability Living Allowance: https://www.gov.uk/disability-living-allowance-children

Special Educational Needs: https://www.gov.uk/children-with-special-educational-needs.

Contact us:

If you have any queries or concerns please contact:

Plymouth Child Development Centre

University Hospitals Plymouth NHS Trust

Scott Business Park

Beacon Park Road

Plymouth

PL2 2PQ

01752 433434