Cerebral palsy

Diagnosis

If your family doctor or pediatrician suspects your child has cerebral palsy, he or she will evaluate your child's signs and symptoms, review your child's medical history, and conduct a physical evaluation. Your doctor may refer you to a specialist trained in treating children with brain and nervous system conditions (pediatric neurologist).

Your doctor will also order a series of tests to make a diagnosis and rule out other possible causes.

Brain scans

Brain-imaging technologies can reveal areas of damage or abnormal development in the brain. These tests may include the following:

• Magnetic resonance imaging (MRI). An MRI uses radio waves and a magnetic field to produce detailed 3-D or cross-sectional images of your child's brain. An MRI can often identify any lesions or abnormalities in your child's brain.

  This test is painless, but it's noisy and can take up to an hour to complete. Your child will likely receive a mild sedative beforehand. An MRI is usually the preferred imaging test.

• Cranial ultrasound. This can be performed during infancy. A cranial ultrasound uses high-frequency sound waves to obtain images of the brain. An ultrasound doesn't produce a detailed image, but it may be used because it's quick and inexpensive, and it can provide a valuable preliminary assessment of the brain.

Electroencephalogram (EEG)

If your child has had seizures, your doctor may order an electroencephalogram (EEG) to determine if he or she has epilepsy, which often occurs in people with cerebral palsy. In an EEG test, a series of electrodes are affixed to your child's scalp.

The EEG records the electrical activity of your child's brain. If he or she has epilepsy, it's common for there to be changes in normal brain wave patterns.

Laboratory tests

Laboratory tests may also screen for genetic or metabolic problems.

Additional tests

If your child is diagnosed with cerebral palsy, you'll likely be referred to specialists for assessments of other conditions often associated with the disorder. These tests may identify:

• Vision impairment
• Hearing impairment
• Speech delays or impairments
• Intellectual disabilities
• Other developmental delays
• Movement disorders

Treatment

Children and adults with cerebral palsy require long-term care with a medical care team. This team may include:

• Pediatrician or physiatrist. A pediatrician oversees the treatment plan and medical care.
• Pediatric neurologist. A doctor trained to diagnose and treat children with brain and nervous system (neurological) disorders may be involved in your child's care.
• Orthopedic surgeon. A doctor trained to treat muscle and bone disorders may be involved to diagnose and treat muscle conditions.
• Physical therapist. A physical therapist may help your child improve strength and walking skills, and stretch muscles.
• Occupational therapist. An occupational therapist can provide therapy to your child to develop daily skills and to learn to use adaptive products that help with daily activities.
• Speech-language pathologist. A doctor trained to diagnose and treat speech and language disorders may work with your child if your child suffers from speech, swallowing or language difficulties.
• Developmental therapist. A developmental therapist may provide therapy to help your child develop age-appropriate behaviors, social skills and interpersonal skills.
• Mental health specialist. A mental health specialist, such as a psychologist or psychiatrist, may be involved in your child's care. He or she may help you and your child learn to cope with your child's disability.
• Recreation therapist. Participation in art and cultural programs, sports, and other events that help children expand physical and cognitive skills and abilities. Parents of children often note improvements in a child's speech, self-esteem and emotional well-being.
• Social worker. A social worker may assist your family to find services and plan for care transitions.
• Special education teacher. A special education teacher addresses learning disabilities, determines educational needs and identifies appropriate educational resources.

Medications

Medications that can lessen the tightness of muscles may be used to improve functional abilities, treat pain and manage complications related to spasticity or other cerebral palsy symptoms.

It's important to talk about drug treatment risks with your doctor and discuss whether medical treatment is appropriate for your child's needs. Medication selection depends on whether the problem affects only certain muscles (isolated) or the whole body (generalized). Drug treatments may include the following:

• Isolated spasticity. When spasticity is isolated to one muscle group, your doctor may recommend onabotulinumtoxinA (Botox) injections directly into the muscle, nerve or both. Botox injections may help to improve drooling. Your child will need injections about every three months.

  Side effects may include pain, mild flu-like symptoms, bruising or severe weakness. Other more-serious side effects include difficulty breathing and swallowing.

• Generalized spasticity. If the whole body is affected, oral muscle relaxants may relax stiff, contracted muscles. These drugs include diazepam (Valium), dantrolene (Dantrium) and baclofen (Gablofen).

  Diazepam carries some dependency risk, so it's not recommended for long-term use. Its side effects include drowsiness, weakness and drooling.

  Dantrolene side effects include sleepiness, weakness, nausea and diarrhea.

  Baclofen side effects include sleepiness, confusion and nausea. Note that baclofen may also be pumped directly into the spinal cord with a tube. The pump is surgically implanted under the skin of the abdomen.

Your child also may be prescribed medications to reduce drooling. Medications such as trihexyphenidyl, scopolamine or glycopyrrolate (Robinul, Robinul Forte) may be helpful, as can Botox injection into the salivary glands.

Therapies

A variety of nondrug therapies can help a person with cerebral palsy enhance functional abilities:

• Physical therapy. Muscle training and exercises may help your child's strength, flexibility, balance, motor development and mobility. You'll also learn how to safely care for your child's everyday needs at home, such as bathing and feeding your child.

  For the first 1 to 2 years after birth, both physical and occupational therapists provide support with issues such as head and trunk control, rolling, and grasping. Later, both types of therapists are involved in wheelchair assessments.

  Braces or splints may be recommended for your child. Some of these supports help with function, such as improved walking. Others may stretch stiff muscles to help prevent rigid muscles (contractures).

• Occupational therapy. Using alternative strategies and adaptive equipment, occupational therapists work to promote your child's independent participation in daily activities and routines in the home, the school and the community.

  Adaptive equipment may include walkers, quadrupedal canes, seating systems or electric wheelchairs.

• Speech and language therapy. Speech-language pathologists can help improve your child's ability to speak clearly or to communicate using sign language.

  Speech-language pathologists can also teach your child to use communication devices, such as a computer and voice synthesizer, if communication is difficult.

  Another communication device may be a board covered with pictures of items and activities your child may see in daily life. Sentences can be constructed by pointing to the pictures.

  Speech therapists may also address difficulties with muscles used in eating and swallowing.

• Recreational therapy. Some children may benefit from recreational therapies, such as therapeutic horseback riding. This type of therapy can help improve your child's motor skills, speech and emotional well-being.

Surgical or other procedures

Surgery may be needed to lessen muscle tightness or correct bone abnormalities caused by spasticity. These treatments include:

• Orthopedic surgery. Children with severe contractures or deformities may need surgery on bones or joints to place their arms, hips or legs in their correct positions.

  Surgical procedures can also lengthen muscles and tendons that are proportionally too short because of severe contractures. These corrections can lessen pain and improve mobility. The procedures may also make it easier to use a walker, braces or crutches.

• Severing nerves. In some severe cases, when other treatments haven't helped, surgeons may cut the nerves serving the spastic muscles in a procedure called selective dorsal rhizotomy. This relaxes the muscle and reduces pain, but can also cause numbness.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Alternative medicine

Some children and adolescents with cerebral palsy use some form of complementary or alternative medicine.

For example, hyperbaric oxygen therapy is widely promoted for cerebral palsy treatment despite limited evidence of efficacy. This and other unproven therapies for cerebral palsy should be viewed with skepticism. Controlled clinical trials involving therapies such as hyperbaric oxygen therapy, resistance exercise training using special clothing, assisted motion completion for children and certain forms of electrical stimulation have been inconclusive or showed no benefit to date, and the therapies are not accepted mainstream clinical practice.

Stem cell therapy is being explored as a treatment approach for cerebral palsy, but research is still assessing whether such approaches are safe and effective. Studies in the U.S. and elsewhere are examining the safety and tolerability of umbilical cord blood stem cell infusion in children with cerebral palsy.

Coping and support

When a child is diagnosed with a disabling condition, the whole family faces new challenges. Here are a few tips for caring for your child and yourself:

• Foster your child's independence. Encourage any effort at independence, no matter how small. Just because you can do something faster or more easily than your child doesn't mean you should.
• Be an advocate for your child. You are an important part of your child's health care team. Don't be afraid to speak out on your child's behalf or to ask tough questions of your physicians, therapists and teachers.

• Find support. A circle of support can make a big difference in helping you cope with cerebral palsy and its effects. As a parent, you may feel grief and guilt over your child's disability.

  Your doctor can help you locate support groups, organizations and counseling services in your community. Your child may also benefit from family support programs, school programs and counseling.

Preparing for your appointment

If your child has cerebral palsy, how you learn about your child's condition may depend on the severity of the disabilities, when problems first appeared, and whether there were any risk factors during pregnancy or delivery.

What you can do

• Write down current symptoms, even if some may seem unrelated to your child's cerebral palsy concerns.
• Make a list of all your or your child's medications, vitamins and supplements.
• Bring any clinical notes, scans, laboratory test results or other information from your primary care provider to your Mayo Clinic caregivers.
• Write down your or your child's key medical information, including other conditions.
• Write down key personal information, including any recent changes or stressors in your child's life.
• Write down questions to ask your doctor.
• Ask a relative or friend to accompany you, to help you remember what your doctor says.

What to expect from your doctor

Your doctor may ask you several questions during appointments, including:

• What concerns do you have about your child's growth or development?
• How well does he or she eat?
• How does your child respond to touch?
• Do you observe any favoring of one side of the body?
• Is your child reaching certain milestones in development, such as rolling over, pushing up, sitting up, crawling, walking or speaking?

Questions to ask your doctor

If your family doctor or pediatrician believes that your child exhibits signs of cerebral palsy, you may want to discuss the following questions:

• What diagnostic tests will we need?
• When will we know the results of the tests?
• What specialists will we need to see?
• How will we screen for disorders commonly associated with cerebral palsy?
• How will you monitor my child's health and development?
• Can you suggest educational materials and local support services regarding cerebral palsy?
• Can my child be followed through a multidisciplinary program that addresses all of his or her needs on the same visit, such as a cerebral palsy clinic?

What you can do in the meantime

Well-baby visits

It's important to take your child to all regularly scheduled well-baby visits and annual appointments during childhood. These visits are an opportunity for your child's doctor to monitor your child's development in key areas, including:

• Growth
• Muscle tone
• Muscle strength
• Coordination
• Posture
• Age-appropriate motor skills
• Sensory abilities, such as vision, hearing and touch