Cerebral Palsy

 Cerebral palsy (CP) is a neuro-

developmental impairment caused by a
non-progressive defect or lesion in single
or multiple locations in the immature
brain.  This defect causes cognitive and
motor impairment and possible sensory
deficits that are usually evident in early
childhood.
 In cerebral palsy, faulty development or
damage to motor areas in the brain impair
the body’s ability to control movement and
posture. This results in a number of
chronic neurological disorders. Cerebral
palsy is usually associated with events
that occur before or during birth, but may
be acquired during the first few months or
years of life as the result of head trauma
or infection.
 Cerebral palsy is neither contagious nor
inherited, nor is it progressive. The
symptoms of cerebral palsy (CP) differ
from person to person and change as
children and their nervous systems mature
 Some persons with severe CP are
completely disabled and require lifelong
care, while others display only slight
awkwardness and need no special
assistance. Complications associated with
CP include learning disabilities,
gastrointestinal dysfunction, tooth decay
(dental caries), sensory deficits, and
seizures.
Types
 Cerebral palsy (CP) is classified as spastic,
athetoid, ataxic, or mixed. These classifications
reflect the type of movement disturbance
displayed by the patient.
 Spastic CP–stiff, permanently contracted
muscles; 50% to 75% of cases
 Athetoid CP (also called dyskinetic cerebral
palsy)–slow, uncontrolled, writhing movements;
10% to 20% of cases
 Ataxic CP–poor coordination, balance, and
depth perception; 5% to 10% of cases
 Mixed CP–two or more types present; 10% of
cases (percentage may be higher)
 Causes

Acquired
Approximately 10% to 20% of children with
cerebral palsy acquire it after birth,
typically from brain damage sustained in
the first few months or years of life. In
such cases, the disorder may result from
brain infections like bacterial meningitis or
viral encephalitis, or from head trauma
sustained from an accident, fall, or inflicted
injuries (e.g., shaken baby syndrome).
 Congenital
The cause or causes of congenital CP—
the type that is present at birth—often are
unknown and many cases go undetected
for months. Certain events during
pregnancy, labor, and delivery can
damage motor centers in the developing
brain and cause cerebral palsy. However,
birth complications account for only about
3–13% of congenital CP cases.
 Infections during pregnancy, such as
German measles (rubella), can damage
the fetus’s developing nervous system.
Other potentially damaging infections
include cytomegalovirus and
toxoplasmosis.
Severe, untreated jaundice
(hyperbilirubinemia) can damage brain
cells in newborns and infants.
 Deprivation of oxygen to the brain
(asphyxia) or head trauma sustained
during labor and/or delivery can cause CP.
Severe asphyxia for a lengthy period can
produce brain damage called hypoxic-
ischemic encephalopathy, which causes
many infant deaths. Birth asphyxia is
associated with spastic quadriplegia
 Brain hemorrhage, or bleeding, can
occur in the fetus during pregnancy or in
newborns around the time of birth,
damaging fetal brain tissue and causing
neurological problems, including
congenital CP. These hemorrhages are a
type of stroke that may be caused by
broken, abnormal, or clogged blood
vessels in or leading to the brain, or by
respiratory distress, a common breathing
disorder in premature infants.
 Risk Factors
 Infants at the highest risk for developing
cerebral palsy exhibit one or more of these
factors:
 premature;
 low birth weight (<5 lb 7 1/2 oz);
 do not cry within 5 minutes of delivery;
 sustained on a ventilator more than 4
weeks;
 brain hemorrhage.
 Other risk factors include the following:
 Complications in pregnant mother (vaginal
bleeding after 6th month, proteinuria,
hyperthyroidism, high blood pressure, Rh
incompatibility, mental retardation, seizures)
 Breech birth (born feet or buttocks first)
 Labor and delivery complications  (vascular or
respiratory problems; may indicate brain
damage or  abnormal brain development)
 Multiple births  (twins, triplets, etc.; CP may be
due to prematurity or intrauterine growth
retardation)
 Birth defects  (malformation of spinal bones,
hernia in groin area, abnormally small jawbone,
microcephaly)
 Newborn seizures
 Low Apgar score  Infant heart rate, breathing,
muscle tone, reflexes, and skin color are each
scored as 0 (low), 1 (intermediate), or 2 (normal)
after delivery. A total score of 7-10 at 5 minutes
is considered normal; 4-6, intermediate; and 0-3,
low. Scores that remain low 10-20 minutes after 
delivery indicate increased risk for CP.