Recommended reading: Speech and language therapy for children with cerebral palsy might improve their communication

skills, but more research is needed.
Cerebral palsy (CP) is a movement disorder caused by damage to the brain before, during or soon after birth. The ability for people with CP to communicate effectively is often impaired by problems with speech and also gestures usually used in communication. Speech and language therapy aims to help people with CP maximise their communication skills. This can include ways of enhancing natural forms ... more

A.D.A.M. Medical Encyclopedia.

Cerebral palsy
Spastic paralysis; Paralysis - spastic; Spastic hemiplegia; Spastic diplegia; Spastic quadriplegia
Last reviewed: September 16, 2009.

Cerebral palsy is a group of disorders that can involve brain and nervous system functions such as movement, learning, hearing, seeing, and thinking. Ther are several different types of cerebral palsy, including spastic, dyskinetic, ataxic, hypotonic, and mixed.

Causes, incidence, and risk factors
Cerebral palsy is caused by injuries or abnormalities of the brain. Most of these problems occur as the baby grows in the womb, but they can happen at any time during the first 2 years of life, while the baby's brain is still developing. In some people with cerebral palsy, parts of the brain are injured due to low levels of oxygen (hypoxia) in the area. It is not known why this occurs. Premature infants have a slightly higher risk of developing cerebral palsy. Cerebral palsy may also occur during early infancy as a result of several conditions, including:      Bleeding in the brain Brain infections (encephalitis, meningitis, herpes simplex infections) Head injury Infections in the mother during pregnancy (rubella) Severe jaundice

In some cases the cause of cerebral palsy is never determined.

Symptoms
Symptoms of cerebral palsy can be very different between people with this group of disorders. Symptoms may:    Be very mild or very severe Only involve one side of the body or both sides Be more pronounced in either the arms or legs, or involve both the arms and legs

Symptoms are usually seen before a child is 2 years old, and sometimes begin as early as 3 months. Parents may notice that their child is delayed in reaching, and in developmental stages such as sitting, rolling, crawling, or walking. There are several different types of cerebral palsy. Some people have a mixture of symptoms. Symptoms of spastic cerebral palsy, the most common type, include:

or writhing) of the hands. but intelligence can be normal Speech problems (dysarthria) Hearing or vision problems Seizures Pain. knees crossed or touching. which gets worse during periods of stress Tremors Unsteady gait Loss of coordination Floppy muscles. especially in adults (can be difficult to manage) Eating and digestive symptoms    Difficulty sucking or feeding in infants. Abnormal walk (gait): arms tucked in toward the sides. or both arms and legs The following symptoms may occur in other types of cerebral palsy:      Abnormal movements (twisting. The following other tests may be performed:  Blood tests . and joints that move around too much Other brain and nervous system symptoms:      Decreased intelligence or learning disabilities are common. feet. or chewing and swallowing in older children and adults Problems swallowing (at all ages) Vomiting or constipation Other symptoms:     Increased drooling Slower than normal growth Irregular breathing Urinary incontinence Signs and tests A full neurological exam is critical. jerking. In older people. They may tighten up even more over time. walk on the toes Joints are tight and do not open up all the way (called joint contracture) Muscle weakness or loss of movement in a group of muscles (paralysis) The symptoms may affect one arm or leg. legs make "scissors" movements. especially at rest. testing cognitive function is also important. both legs. arms. one side of the body. or legs while awake.     Muscles that are very tight and do not stretch.

including a neurologist. Special education or schooling may help. rehabilitation physician.     CT scan of the head Electroencephalogram (EEG) Hearing screen MRI of the head Vision testing Treatment There is no cure for cerebral palsy. fluids. fiber. Self and home care include:      Getting enough food and nutrition Keeping the home safe Performing exercises recommended by the health care providers Practicing proper bowel care (stool softeners. Medications may include: . unless physical disabilities or mental development makes this impossible. and speech therapists Other specialists. orthopedic help. occupational therapy. The following may help with communication and learning:      Glasses Hearing aids Muscle and bone braces Walking aids Wheelchairs Physical therapy. or other treatments may also be needed to help with daily activities and care. laxatives. physical. including:       Primary care doctor Dentist (dental check-ups are recommended around every 6 months) Social worker Nurses Occupational. Treatment requires a team approach. The goal of treatment is to help the person be as independent as possible. and gastroenterologist Treatment is based on the person's symptoms and the need to prevent complications. regular bowel habits) Protecting the joints from injury Putting the child in regular schools is recommended. pulmonologist.

and should be monitored. Expectations (prognosis) Cerebral palsy is a lifelong disorder.   Anticonvulsants to prevent or reduce the frequency of seizures Botulinum toxin to help with spasticity and drooling Muscle relaxants (baclofen) to reduce tremors and spasticity Surgery may be needed in some cases to:     Control gastroesophageal reflux Cut certain nerves from the spinal cord to help with pain and spasticity Place feeding tubes Release joint contractures Stress and burnout among parents and other caregivers of cerebral palsy patients is common. Support Groups For organizations that provide support and additional information. In severe cases. Many adults are able to live in the community. the person may need to be placed in an institution. Long-term care may be required. The disorder does not affect expected length of life. especially if you know that an injury occurred during birth or early infancy. Prevention . either independently or with different levels of help. see cerebral palsy resources. Complications             Bone thinning or osteoporosis Bowel obstruction Hip dislocation and arthritis in the hip joint Injuries from falls Joint contractures Pneumonia caused by choking Poor nutrition Reduced communication skills (sometimes) Reduced intellect (sometimes) Scoliosis Seizures (in about half of patients) Social stigma Calling your health care provider Call your health care provider if symptoms of cerebral palsy develop. The amount of disability varies.

Review Date: 9/16/2009. MHA. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Jenson HB.. . Behrman RE. Medical Director. In: Kliegman RM. Hoch. et al. A. Hirtz D. 19th ed. Massachusetts General Hospital. Ashwal S. MHA. Department of Neurology.A. Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Stanton BF. Ziviani J. Also reviewed by David Zieve. Philadelphia. Systematic review and meta-analysis of therapeutic management of upper-limb dysfunction in children with congenital hemiplegia. Neurology. Assistant Professor of Neurology. eds. MD. 2. 3.123:e1111-1122. and Neil K. Delgado MR. 2009. In most cases. MD. References 1. 2010 Jan 26. Sakzewski L. the injury causing the disorder may not be preventable. dramatic improvements in care over the last 15 years have not reduced the rate of cerebral palsy. Aisen M.62:851-863. Clinical Assistant Professor of Pediatrics. Reviewed by: Daniel B. MD. Kaneshiro. Neurology. Pregnant mothers with certain medical conditions may need to be followed in a high-risk prenatal clinic. Nelson Textbook of Pediatrics.M. et al. University of Washington School of Medicine. Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Johnston MV. Harvard Medical School.Getting the proper prenatal care may reduce the risk of some rare causes of cerebral palsy. Inc.74(4):336-43. 2004. Pediatrics. 2011: chap 591.D. However. 4. PhD. Pa: Saunders Elsevier. Boyd R. Encephalopathies.

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