Cerebral Palsy
What is cerebral palsy?
Cerebral palsy is a physical disability that affects movement and posture.
In Australia there are approximately 34,000 people with cerebral palsy. Worldwide, the incidence of cerebral palsy is 1 in 700 births. There are currently 17 million people in the world who have cerebral palsy.
For most people with cerebral palsy, the cause is unknown. There is no known cure for cerebral palsy.
In Australia there are approximately 34,000 people with cerebral palsy. Worldwide, the incidence of cerebral palsy is 1 in 700 births. There are currently 17 million people in the world who have cerebral palsy.
For most people with cerebral palsy, the cause is unknown. There is no known cure for cerebral palsy.
Types of cerebral palsy
Cerebral palsy can be described by the way it affects people’s movement, the part of the body affected and by how severe the affects are.
QUADRIPLEGIA (A FORM OF BILATERAL CEREBRAL PALSY)
Both arms and legs are affected. The muscles of the trunk, face and mouth are often also affected.
DIPLEGIA (A FORM OF BILATERAL CEREBRAL PALSY)
Both legs are affected. The arms may be affected to a lesser extent.
HEMIPLEGIA (A FORM OF UNILATERAL CEREBRAL PALSY)
One side of the body (one arm and one leg) is affected.
OTHER CLASSIFICATIONS
Severity
- Gross motor skills – Gross Motor Function Classification System (GMFCS)
- Fine motor skills – Manual Ability Classification System (MACS)
- Communication – Communication Function Classification System (CFCS)
SPASTIC
- The most common form of cerebral palsy
- Muscles feel stiff and tight
DYSKINETIC
- Characterised by involuntary movements (i.e. out of a person’s control)
ATAXIC
- Characterised by shaky movements
- Affects balance and sense of positioning in space
MIXED TYPE
What causes cerebral palsy?
Cerebral palsy is the result of a combination of events either before, during or after birth that can lead to an injury in a baby’s developing brain.
There is no single cause of cerebral palsy. For most babies born with cerebral palsy, the cause remains unknown.Researchers now know that only a very small percentage of cases of cerebral palsy are due to complications at birth (e.g. asphyxia or lack of oxygen). Today, it is accepted that cerebral palsy usually arises from a series of causal pathways, i.e. a sequence of events that when combined can cause or accelerate injury to the developing brain.
In 13 out of 14 cases of cerebral palsy in Australia, the brain injury leading to cerebral palsy occurs either in the uterus (while the mother is pregnant) or before 1 month of age.
Stroke is the most common cause in babies who acquire cerebral palsy after 1 month of age. The stroke may occur spontaneously or arise from surgical or heart complications.
There is no single cause of cerebral palsy. For most babies born with cerebral palsy, the cause remains unknown.Researchers now know that only a very small percentage of cases of cerebral palsy are due to complications at birth (e.g. asphyxia or lack of oxygen). Today, it is accepted that cerebral palsy usually arises from a series of causal pathways, i.e. a sequence of events that when combined can cause or accelerate injury to the developing brain.
In 13 out of 14 cases of cerebral palsy in Australia, the brain injury leading to cerebral palsy occurs either in the uterus (while the mother is pregnant) or before 1 month of age.
Stroke is the most common cause in babies who acquire cerebral palsy after 1 month of age. The stroke may occur spontaneously or arise from surgical or heart complications.
Key facts about cerebral palsy
- Every 15 hours, an Australian child is born with cerebral palsy.
- It is the most common physical disability in childhood.
- Cerebral palsy is an umbrella term for a group of disorders. It is a condition that is permanent, but not unchanging.
- Cerebral palsy is a life-long physical disability due to damage of the developing brain.
- In most cases, brain injury leading to cerebral palsy occurs during pregnancy.
- Cerebral palsy, except in its mildest forms, can be evident in the first 12-18 months.
- Motor disability can range from minimal to profound, depending on the individual.
- It can range from weakness in one hand, to an almost complete lack of voluntary movement. People with significant physical disability may require 24 hour a day care.
- People with cerebral palsy are likely to also have other impairments in addition to their motor disability.
- Spastic hemiplegia, where one half of the body has difficulty with voluntary movement, is the most common presentation of cerebral palsy. Approximately 40% of people with cerebral palsy have hemiplegia.
- There is no known cure.
How does cerebral palsy affect people?
Cerebral palsy can affect a person’s posture, balance and ability to move, communicate, eat, sleep and learn.
The parts of the body affected by cerebral palsy, the level of severity and combination of symptoms can differ for each person. For example, one person may have a weakness in one hand and find tasks like writing or tying shoelaces challenging. Another person may have little or no control over their movements or speech and require 24 hour assistance.
People with cerebral palsy may experience uncontrolled or unpredictable movements, muscles can be stiff, weak or tight and in some cases people have shaky movements or tremors. People with severe cerebral palsy may also have difficulties with swallowing, breathing, head and neck control, bladder and bowel control, eating and have dental and digestive problems.
The parts of the body affected by cerebral palsy, the level of severity and combination of symptoms can differ for each person. For example, one person may have a weakness in one hand and find tasks like writing or tying shoelaces challenging. Another person may have little or no control over their movements or speech and require 24 hour assistance.
People with cerebral palsy may experience uncontrolled or unpredictable movements, muscles can be stiff, weak or tight and in some cases people have shaky movements or tremors. People with severe cerebral palsy may also have difficulties with swallowing, breathing, head and neck control, bladder and bowel control, eating and have dental and digestive problems.
Mobility issues
1 in 3 children with cerebral palsy will be unable to walk. At greatest risk are those who have spastic quadriplegia, intellectual disability, epilepsy, vision impairment and an inability to sit independently at 2 years of age.
See:
Communication issues
Cerebral palsy can affect a person’s ability to finely coordinate the muscles around the mouth and tongue that are needed for speech. The coordinated breathing that is needed to support speech can also be affected, e.g. some people may sound ‘breathy’ when they speak. Some people with cerebral palsy may not be able to produce any sounds, others may be able to produce sounds but have difficulty controlling their movement enough to produce speech that is clear and understood by others. 1 in 4 people with cerebral palsy cannot talk.
See:
Pain
3 in 4 people with cerebral palsy experience pain. Pain is often a result of the impairments that are associated with cerebral palsy, e.g. contractures, abnormal postures, dystonia, skin breakdown, hip subluxation, Gastro-oesophageal reflux and scoliosis. This pain can affect a person’s behavior, their ability to do things for themselves, to sleep and their social relationships. People might avoid day-to-day tasks that are important for independence, such as attending school and social events. Pain can be relieved, so it is best to be guided by your medical practitioner.
See:
Eating and drinking issues
Cerebral palsy can affect the muscles that open and close the mouth and move the lips and the tongue. Some people with cerebral palsy may have difficulties in chewing and swallowing food and drink – a condition known as dysphagia. Because cerebral palsy often impacts fine motor skills, many people are unable to easily use cutlery, hold a cup, or transfer food from a plate to their mouth using their hands. Others may suffer from gastroesophageal reflux – where acid from the stomach rises into the esophagus – which makes eating uncomfortable or painful. This can sometimes be controlled by medication.1 in 15 people with cerebral palsy are unable to take food through their mouth and need to be fed through a feeding tube.
See:
Saliva control
Because cerebral palsy can affect the muscles around the mouth, 1 in 5 children with cerebral palsy have saliva loss (also known as dribbling, drooling or sialorrhoea). The saliva loss may be more noticeable when they are concentrating on doing other tasks.
Intellectual disability
1 in 2 people with cerebral palsy have an intellectual disability. 1 in 5 people have a moderate to severe intellectual disability. Generally, the greater the level of a person’s physical impairment, the more likely it is that they will have an intellectual disability. However, there are people who have a profound level of physical impairment, who do not have an intellectual disability. Conversely, there can be others with a mild physical impairment who have an intellectual disability.
Learning difficulties
Children with cerebral palsy may experience specific learning difficulties. These may include a short attention span, motor planning difficulties (organisation and sequencing of movement), perceptual difficulties and language difficulties. These can impact on literacy, numeracy and other classroom skills and activities. Learning may also be affected by difficulties in fine motor and gross motor coordination and communication. Students with cerebral palsy need to put more effort into concentrating on their movements and sequence of actions than others, so they may tire more easily.
Hearing impairment
1 in 20 people with cerebral palsy also have some level of hearing impairment. 1 in 25 children with cerebral palsy are deaf.
Vision impairment
Vision impairment is not uncommon in people with cerebral palsy. Children with the more severe forms of cerebral palsy are more likely than others to experience myopia, absence of binocular fusion, dyskinetic strabismus (also known as ‘turned eye’ or ‘squint’), severe gaze dysfunction, and optic neuropathy or cerebral visual impairment. 1 in 10 children with cerebral palsy are blind.
Behavior and emotional wellbeing
One in 4 children with cerebral palsy have behaviour problems. At greatest risk are those with an intellectual disability, epilepsy, severe pain or a milder level of physical disability. Problem behaviors include dependency, being headstrong, hyperactive, anxious, or prone to conflict with their peer group, or exhibiting antisocial behaviours. Children with cerebral palsy may also have emotional problems such as difficulties with their peer group and strong emotional responses to new challenges. Teenagers and adults with cerebral palsy may be more prone to depression and anxiety disorders.
See:
Epilepsy
1 in 4 children with cerebral palsy have epilepsy. When children have cerebral palsy and an intellectual disability, the incidence of epilepsy is higher – 48%. Seizures can affect speech, intellectual and physical functioning. Medication is the most effective intervention for epilepsy and the child’s doctor or therapist may also recommend modifications to the student’s school supports and equipment. Some medications have side effects which cause drowsiness or irritability. Both epilepsy and the related medication can affect a person’s behavior and attention span.
Sleep issues
1 in 5 children with cerebral palsy have a sleep disorder. There are a range of contributing factors, including the muscle spasms associated with cerebral palsy, other forms of musculo-skeletal pain, and decreased ability to change body position during the night. Epilepsy is also known to disturb sleep and is likely to predispose to sleep disorders. Blindness or severe visual impairment can affect the timing and maintenance of sleep through their effect on melatonin secretion and the lack of light perception.
See:
Spinal and hip abnormalities
Abnormalities of the spine and hips are associated with cerebral palsy and can make sitting, standing and walking difficult, and cause chronic pain. 1 in 3 children with cerebral palsy have hip displacement. Children and adults who have a severe physical disability or those whose body is affected on both sides are at greater risk of hip problems. This means that people who use wheelchairs most of the time are more at risk of hip problems than those who walk with assistive devices or independently.
Bladder and bowel control
Continence and constipation are issues for many people with cerebral palsy. 1 in 4 children with cerebral palsy have bladder control problems. Children with intellectual disability and/or a severe form of cerebral palsy are most at risk. Lack of mobility and difficulty eating can predispose people with cerebral palsy to constipation.
1 in 3 children with cerebral palsy will be unable to walk. At greatest risk are those who have spastic quadriplegia, intellectual disability, epilepsy, vision impairment and an inability to sit independently at 2 years of age.
See:
- Ankle Foot Orthoses
- Conductive education
- Constraint-induced movement therapy for the leg (CIMT-Leg)
- Early motor intervention
- Hydrotherapy for adolescents and adults
- Massage for pain and movement
- Powered mobility
- Treadmill training for people with cerebral palsy
Communication issues
Cerebral palsy can affect a person’s ability to finely coordinate the muscles around the mouth and tongue that are needed for speech. The coordinated breathing that is needed to support speech can also be affected, e.g. some people may sound ‘breathy’ when they speak. Some people with cerebral palsy may not be able to produce any sounds, others may be able to produce sounds but have difficulty controlling their movement enough to produce speech that is clear and understood by others. 1 in 4 people with cerebral palsy cannot talk.
See:
- Communication Partner Training
- Conductive education
- Eye-gaze technology
- Speech generating devices
- Speech therapy for children with dysarthria
Pain
3 in 4 people with cerebral palsy experience pain. Pain is often a result of the impairments that are associated with cerebral palsy, e.g. contractures, abnormal postures, dystonia, skin breakdown, hip subluxation, Gastro-oesophageal reflux and scoliosis. This pain can affect a person’s behavior, their ability to do things for themselves, to sleep and their social relationships. People might avoid day-to-day tasks that are important for independence, such as attending school and social events. Pain can be relieved, so it is best to be guided by your medical practitioner.
See:
- Botulinum Toxin-A injections for supporting pain and comfort
- Cognitive-behaviour therapy for pain
- Gastrostomy feeding
- Hydrotherapy for adolescents and adults
- Massage for pain and movement
- Sleep positioning systems
Eating and drinking issues
Cerebral palsy can affect the muscles that open and close the mouth and move the lips and the tongue. Some people with cerebral palsy may have difficulties in chewing and swallowing food and drink – a condition known as dysphagia. Because cerebral palsy often impacts fine motor skills, many people are unable to easily use cutlery, hold a cup, or transfer food from a plate to their mouth using their hands. Others may suffer from gastroesophageal reflux – where acid from the stomach rises into the esophagus – which makes eating uncomfortable or painful. This can sometimes be controlled by medication.1 in 15 people with cerebral palsy are unable to take food through their mouth and need to be fed through a feeding tube.
See:
Saliva control
Because cerebral palsy can affect the muscles around the mouth, 1 in 5 children with cerebral palsy have saliva loss (also known as dribbling, drooling or sialorrhoea). The saliva loss may be more noticeable when they are concentrating on doing other tasks.
Intellectual disability
1 in 2 people with cerebral palsy have an intellectual disability. 1 in 5 people have a moderate to severe intellectual disability. Generally, the greater the level of a person’s physical impairment, the more likely it is that they will have an intellectual disability. However, there are people who have a profound level of physical impairment, who do not have an intellectual disability. Conversely, there can be others with a mild physical impairment who have an intellectual disability.
Learning difficulties
Children with cerebral palsy may experience specific learning difficulties. These may include a short attention span, motor planning difficulties (organisation and sequencing of movement), perceptual difficulties and language difficulties. These can impact on literacy, numeracy and other classroom skills and activities. Learning may also be affected by difficulties in fine motor and gross motor coordination and communication. Students with cerebral palsy need to put more effort into concentrating on their movements and sequence of actions than others, so they may tire more easily.
Hearing impairment
1 in 20 people with cerebral palsy also have some level of hearing impairment. 1 in 25 children with cerebral palsy are deaf.
Vision impairment
Vision impairment is not uncommon in people with cerebral palsy. Children with the more severe forms of cerebral palsy are more likely than others to experience myopia, absence of binocular fusion, dyskinetic strabismus (also known as ‘turned eye’ or ‘squint’), severe gaze dysfunction, and optic neuropathy or cerebral visual impairment. 1 in 10 children with cerebral palsy are blind.
Behavior and emotional wellbeing
One in 4 children with cerebral palsy have behaviour problems. At greatest risk are those with an intellectual disability, epilepsy, severe pain or a milder level of physical disability. Problem behaviors include dependency, being headstrong, hyperactive, anxious, or prone to conflict with their peer group, or exhibiting antisocial behaviours. Children with cerebral palsy may also have emotional problems such as difficulties with their peer group and strong emotional responses to new challenges. Teenagers and adults with cerebral palsy may be more prone to depression and anxiety disorders.
See:
- Cognitive behaviour therapy for anxiety
- Counselling at the Time of Diagnosis
- Solution focused brief therapy
- Stepping Stones Triple P parenting program
Epilepsy
1 in 4 children with cerebral palsy have epilepsy. When children have cerebral palsy and an intellectual disability, the incidence of epilepsy is higher – 48%. Seizures can affect speech, intellectual and physical functioning. Medication is the most effective intervention for epilepsy and the child’s doctor or therapist may also recommend modifications to the student’s school supports and equipment. Some medications have side effects which cause drowsiness or irritability. Both epilepsy and the related medication can affect a person’s behavior and attention span.
Sleep issues
1 in 5 children with cerebral palsy have a sleep disorder. There are a range of contributing factors, including the muscle spasms associated with cerebral palsy, other forms of musculo-skeletal pain, and decreased ability to change body position during the night. Epilepsy is also known to disturb sleep and is likely to predispose to sleep disorders. Blindness or severe visual impairment can affect the timing and maintenance of sleep through their effect on melatonin secretion and the lack of light perception.
See:
Spinal and hip abnormalities
Abnormalities of the spine and hips are associated with cerebral palsy and can make sitting, standing and walking difficult, and cause chronic pain. 1 in 3 children with cerebral palsy have hip displacement. Children and adults who have a severe physical disability or those whose body is affected on both sides are at greater risk of hip problems. This means that people who use wheelchairs most of the time are more at risk of hip problems than those who walk with assistive devices or independently.
Bladder and bowel control
Continence and constipation are issues for many people with cerebral palsy. 1 in 4 children with cerebral palsy have bladder control problems. Children with intellectual disability and/or a severe form of cerebral palsy are most at risk. Lack of mobility and difficulty eating can predispose people with cerebral palsy to constipation.
Treatment for cerebral palsy
Although cerebral palsy is a lifelong disability, there are many interventions that can help reduce its impact on the body and the individual’s quality of life. An intervention is a service that aims to improve the condition of cerebral palsy and the day-to-day experience of the person living with it.
Children with cerebral palsy may be supported by a team of professionals including health professionals and community-based support services who work together to help the child and family reach their goals.
Through their late teens and early 20s, many young people take increasing responsibility for their own health and wellbeing. Their team may include health professionals and mainstream community providers such as fitness trainers.
Children with cerebral palsy may be supported by a team of professionals including health professionals and community-based support services who work together to help the child and family reach their goals.
Through their late teens and early 20s, many young people take increasing responsibility for their own health and wellbeing. Their team may include health professionals and mainstream community providers such as fitness trainers.
Interventions for movement difficulties
Medication
Medical specialists may prescribe medications that assist movement issues. Some medications are taken orally (e.g. diazepam) and others are injected or delivered through surgically implanted pumps (e.g. Baclofen). Many children with cerebral palsy benefit from Botulinum toxin type A injections into muscles affected by spasticity. This intervention is used from about two years of age and is most effective when used in conjunction with therapy.
See:
Surgical procedures
Selective Dorsal Rhizotomy (SDR) is a neurosurgical procedure that is used in a small percentage of children with cerebral palsy to permanently reduce spasticity in their legs.
Physiotherapy and occupational therapy
Physiotherapists and occupational therapists focus on encouraging a person’s day-to-day movement skills such as sitting, walking, playing, dressing and toileting. They will use a range of specialist interventions such as movement training and equipment, e.g. walking frames, wheelchairs, supportive seating, footwear and orthotics.
See:
Physiotherapists and occupational therapists may also focus on preventing impairments that might affect movement. They use casts, orthotics and muscle strengthening exercises.
See:
Medication
Medical specialists may prescribe medications that assist movement issues. Some medications are taken orally (e.g. diazepam) and others are injected or delivered through surgically implanted pumps (e.g. Baclofen). Many children with cerebral palsy benefit from Botulinum toxin type A injections into muscles affected by spasticity. This intervention is used from about two years of age and is most effective when used in conjunction with therapy.
See:
- Botulinum Toxin-A injections for supporting pain and comfort
- Occupational therapy following botulinum toxin-A injections
Surgical procedures
Selective Dorsal Rhizotomy (SDR) is a neurosurgical procedure that is used in a small percentage of children with cerebral palsy to permanently reduce spasticity in their legs.
Physiotherapy and occupational therapy
Physiotherapists and occupational therapists focus on encouraging a person’s day-to-day movement skills such as sitting, walking, playing, dressing and toileting. They will use a range of specialist interventions such as movement training and equipment, e.g. walking frames, wheelchairs, supportive seating, footwear and orthotics.
See:
- Ankle Foot Orthoses
- Bimanual upper limb therapy
- Conductive education
- Constraint-induced movement therapy for the leg (CIMT-Leg)
- Goal directed training
- Home programs
- Hydrotherapy for adolescents and adults
- Massage for pain and movement
- Powered mobility
- Treadmill training for people with cerebral palsy
Physiotherapists and occupational therapists may also focus on preventing impairments that might affect movement. They use casts, orthotics and muscle strengthening exercises.
See:
Support for people with cerebral palsy
- Your local general practitioner (GP)
- National Disability Insurance Scheme (NDIS): The NDIS is a way of providing funding to individuals with a disability. The goal of the NDIS is to provide you with the resources you need now, so you can build your capacity and independence for the future.
- Services and support through organisations such as CPL - Choice, Passion, Life or FNQ Cerebral Palsy Support Group Inc.
- Physio Labs - Give us a call on 07 5610 1933 to see how we can support you
References
- https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/
- https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/types-of-cerebral-palsy/
- https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/causes/
- https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/facts-about-cerebral-palsy/
- https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/how-cerebral-palsy-affects-people/
- https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/interventions/
