Cerebral Palsy

Cerebral Palsy (CP)

What is Cerebral Palsy?

Cerebral Palsy (CP) is a term used to combine a number of neurologic disorders in infancy and early childhood which decrease muscle coordination and mental capacities. These deficits are permanent, typically not worsening with some issues improving with proper treatment and therapies.

What is the history of Cerebral Palsy?

Cerebral Palsy was first described by Dr. William J. Little. As a surgeon, he was often brought in to discuss surgical treatment of deformities developed from “nervous affections or paralysis.” (Cerebral Palsy; Keats, S, 1965). He was able to associate several symptoms (low birth weight, prematurity, asphyxia at birth, fits and uncontrollable behaviors, and subnormal intelligence) which later came to be known as Little’s Disease. Through the work and devotion of numerous doctors over the years many institutions came to understand this process better. The term “cerebral palsy” did not develop until Dr. Winthrop M. Phelps carefully coined this term to better distinguish the feeble-minded from those with true motor handicaps. By 1947 enough interest had accumulated to spark the development of the American Academy for Cerebral Palsy.

Today, there are a number of facilities, both private and public, that aid in the multi-disciplinary needs of those with cerebral palsy.

What causes Cerebral Palsy?

Cerebral Palsy (CP) is caused from abnormalities in the brain disrupting the ability to conduct the nerve impulses correctly. There is always some event (birth, trauma, infection) that can be traced back as the causative factor. The severity of the brain injury affects the severity of the resulting abnormalities / deficits.

Many of the brain injuries occur at birth. Some can occur during the pregnancy and after childbirth. The most notable causes of CP are: (1) random mutations in genes that control brain development, (2) infection(s) the mother carries during pregnancy affecting the developing baby, (3) fetal stroke - a disruption of blood supply to the developing brain, (4) lack of oxygen to the brain (asphyxia) during difficult labor or delivery, (5) infant infections causing inflammation in or around the brain, (6) traumatic head injury to an infant from a motor vehicle accident, fall or child abuse.

Are there different “types” of Cerebral Palsy?

There are several types of Cerebral Palsy. Each one carries its own significance as to functional capabilities. For some, a near normal level of daily activity can be reached with therapy, medications, bracing, and minor adjustments to activities. For others, more significant medical issues and needs will exit. The types of CP will necessitate the amount of assistance needed (help with daily activities as well as medical equipment needs). The specific type of Cerebral Palsy will be diagnosed by a doctor(s) who

specialize in neuromuscular disorders in children. The types of CP are: Spastic Cerebral Palsy or Spastic Diplegia (difficult or stiff movement), Ataxic Cerebral Palsy (loss of depth perception and balance), Athetoid / Dyskinetic Cerebral Palsy (uncontrolled or involuntary movements), Mixed Cerebral Palsy (a mix of two or more of the above), Hypotonic Cerebral Palsy (loss of muscle tone), Mild Cerebral Palsy (mild issues with muscle coordination, strength, and abilities).

What does a child with Cerebral Palsy look like?

Most children with CP may go through several months to years without anyone noticing any abnormalities. Most children with CP are diagnosed before the age of 3 years old. As the children grow and develop, loss of motor control, spasms, weakness, inability to walk, loss of eye muscle control, difficulty with speech, and many other neuromuscular abnormalities can progress to cause questions and concerns. For each child, the severity and type of CP will alter the order and significance of how these symptoms present.

What are the treatment options for Cerebral Palsy?

The treatment options for Cerebral Palsy differ based on the individual patient and the deficits / weakness from the muscle groups and amount of brain injury involved. Typically, patients will require multiple specialists to work with them on speech, walking, eating, picking things up, dressing, operating a wheelchair, and many other issues to achieve as much independence as possible. These specialists vary greatly in their field of expertise. Some hospitals and clinics may hold a multi-disciplinary clinic to allow the patient to be seen by all specialists in one visit.

Doctors – assess patient muscle function and any issues requiring treatment other than therapy. They can facilitate prescriptions for braces, wheelchairs, and any other medical equipment needed to aid in the care of the patient.

Physical therapist – work with the patients to develop maximal muscular control and aid in movements for activities of daily living. Often times, PT will see the patients in their home environments and be able to make better recommendations for medical equipment needs that the doctor can prescribe.

Nutritionist - help to assess dietary needs of the patients to ensure optimal health is maintained. Due to loss of muscle strength and control dietary changes such as thickened liquids or pureed foods may be necessary. Also, some patient working hard with physical therapy may require greater caloric intake which the nutritionist can monitor. Nutritionist can help with diet options to help insure healthy immune systems as well as optimal growth and development.

Speech and language pathologist – develop programs for patients to aid in a variety of teaching aids, language skill development, and assist in assessments of patients ability to chew and swallow foods appropriately.

Orthotist – is a specialist who works with medical equipment needs of the more severely debilitated patient. The orthotist can be seen infrequently in the clinic or even through an outside office whenever modifications, adjustments, or new equipment is needed. A prescription is needed from the doctor to allow the orthotist to provide any equipment which insurance may cover. The orthotist will assist with bracing to help walking patients, wheelchairs for those who do not walk, hand and arm braces for better function of hands, and body braces to help minimize curvature of the spine.

Outside these specialists, other services may be involved such as home health agencies to provide more complicated medical care and medical equipment companies to provide pieces of equipment needed in the care of the more severe or older / larger children.

Who or where to get help?

The first step for any treatment is to confirm the diagnosis. This is typically initiated by the pediatrician / family doctor. Once a diagnosis is confirmed, there are a variety of resources available to help provide information, support, therapy, and treatments. Below is the link to the Ohio Cerebral Palsy Resource website to help provide information of resources to help families care for patients with cerebral palsy.

Cerebral Palsy Program at Nationwide Children’s Hospital

Cerebral Palsy Association of Ohio
995 Goodale Boulevard # 2
Columbus, OH 43212-3865
Phone :(614) 228-8300

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000