Cerebral palsy is a group of disorders that affect movement and muscle tone or posture. It's caused by damage that occurs to the immature, developing brain, most often before birth.
Signs and symptoms appear during infancy or preschool years. In general, cerebral palsy causes impaired movement associated with exaggerated reflexes, floppiness or spasticity of the limbs and trunk, unusual posture, involuntary movements, unsteady walking, or some combination of these.
People with cerebral palsy can have problems swallowing and commonly have eye muscle imbalance, in which the eyes don't focus on the same object. They also might have reduced range of motion at various joints of their bodies due to muscle stiffness.
The cause of cerebral palsy and its effect on function vary greatly. Some people with cerebral palsy can walk; others need assistance. Some people have intellectual disabilities, but others do not. Epilepsy, blindness or deafness also might be present. Cerebral palsy is a lifelong disorder. There is no cure, but treatments can help improve function.
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Signs and symptoms of cerebral palsy can vary greatly from person to person. Cerebral palsy can affect the whole body, or it might be limited primarily to one or two limbs, or one side of the body. Generally, signs and symptoms include problems with movement and coordination, speech and eating, development, and other problems.
Movement and coordination
- Stiff muscles and exaggerated reflexes (spasticity), the most common movement disorder
- Variations in muscle tone, such as being either too stiff or too floppy
- Stiff muscles with normal reflexes (rigidity)
- Lack of balance and muscle coordination (ataxia)
- Tremors or jerky involuntary movements
- Slow, writhing movements
- Favoring one side of the body, such as only reaching with one hand or dragging a leg while crawling
- Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing, a wide gait or an asymmetrical gait
- Difficulty with fine motor skills, such as buttoning clothes or picking up utensils
Speech and eating
- Delays in speech development
- Difficulty speaking
- Difficulty with sucking, chewing or eating
- Excessive drooling or problems with swallowing
- Delays in reaching motor skills milestones, such as sitting up or crawling
- Learning difficulties
- Intellectual disabilities
- Delayed growth, resulting in smaller size than would be expected
Damage to the brain can contribute to other neurological problems, such as:
- Seizures (epilepsy)
- Difficulty hearing
- Problems with vision and abnormal eye movements
- Abnormal touch or pain sensations
- Bladder and bowel problems, including constipation and urinary incontinence
- Mental health conditions, such as emotional disorders and behavioral problems
The brain disorder causing cerebral palsy doesn't change with time, so the symptoms usually don't worsen with age. However, as the child gets older, some symptoms might become more or less apparent. And muscle shortening and muscle rigidity can worsen if not treated aggressively.
When to see a doctor
It's important to get a prompt diagnosis for a movement disorder or delays in your child's development. See your child's doctor if you have concerns about episodes of loss of awareness of surroundings or of unusual bodily movements or muscle tone, impaired coordination, swallowing difficulties, eye muscle imbalance, or other developmental issues.
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Cerebral palsy is caused by abnormal brain development or damage to the developing brain. This usually happens before a child is born, but it can occur at birth or in early infancy. In many cases, the cause isn't known. Many factors can lead to problems with brain development. Some include:
- Gene mutations that result in genetic disorders or differences in brain development
- Maternal infections that affect the developing fetus
- Fetal stroke, a disruption of blood supply to the developing brain
- Bleeding into the brain in the womb or as a newborn
- Infant infections that cause inflammation in or around the brain
- Traumatic head injury to an infant, such as from a motor vehicle accident, fall or physical abuse
- Lack of oxygen to the brain related to difficult labor or delivery, although birth-related asphyxia is much less commonly a cause than historically thought
A number of factors are associated with an increased risk of cerebral palsy.
Certain infections or toxic exposures during pregnancy can significantly increase cerebral palsy risk to the baby. Inflammation triggered by infection or fever can damage the unborn baby's developing brain.
- Cytomegalovirus. This common virus causes flu-like symptoms and can lead to birth defects if a mother has her first active infection during pregnancy.
- German measles (rubella). This viral infection can be prevented with a vaccine.
- Herpes. This infection can be passed from mother to child during pregnancy, affecting the womb and placenta.
- Syphilis. This is a sexually transmitted bacterial infection.
- Toxoplasmosis. This infection is caused by a parasite found in contaminated food, soil and the feces of infected cats.
- Zika virus infection. This infection is spread through mosquito bites and can affect fetal brain development.
- Intrauterine infections. This includes infections of the placenta or fetal membranes.
- Exposure to toxins. One example is exposure to methyl mercury.
- Other conditions. Other conditions affecting the mother that can slightly increase the risk of cerebral palsy include thyroid problems, preeclampsia or seizures.
Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include:
- Bacterial meningitis. This bacterial infection causes inflammation in the membranes surrounding the brain and spinal cord.
- Viral encephalitis. This viral infection similarly causes inflammation in the membranes surrounding the brain and spinal cord.
- Severe or untreated jaundice. Jaundice appears as a yellowing of the skin. The condition occurs when certain byproducts of "used" blood cells aren't filtered from the bloodstream.
- Bleeding into the brain. This condition is commonly caused by the baby having a stroke in the womb or in early infancy.
Factors of pregnancy and birth
While the potential contribution from each is limited, additional pregnancy or birth factors associated with increased cerebral palsy risk include:
- Low birth weight. Babies who weigh less than 5.5 pounds (2.5 kilograms) are at higher risk of developing cerebral palsy. This risk increases as birth weight drops.
- Multiple babies. Cerebral palsy risk increases with the number of babies sharing the uterus. The risk also can be related to the likelihood of premature birth and low birth weight. If one or more of the babies die, the survivors' risk of cerebral palsy increases.
- Premature birth. Babies born prematurely are at higher risk of cerebral palsy. The earlier a baby is born, the greater the cerebral palsy risk.
- Delivery complications. Problems during labor and delivery may increase the risk of cerebral palsy.
Muscle weakness, muscle spasticity and coordination problems can contribute to a number of complications either during childhood or in adulthood, including:
- Contracture. Contracture is muscle tissue shortening due to severe muscle tightening that can be the result of spasticity. Contracture can inhibit bone growth, cause bones to bend, and result in joint deformities, dislocation or partial dislocation. These can include hip dislocation, curvature of the spine (scoliosis) and other orthopedic deformities.
- Malnutrition. Swallowing or feeding problems can make it difficult for someone who has cerebral palsy, particularly an infant, to get enough nutrition. This can impair growth and weaken bones. Some children or adults need a feeding tube to get enough nutrition.
- Mental health conditions. People with cerebral palsy might have mental health conditions, such as depression. Social isolation and the challenges of coping with disabilities can contribute to depression. Behavioral problems can also occur.
- Heart and lung disease. People with cerebral palsy may develop heart disease, lung disease and breathing disorders. Problems with swallowing can result in respiratory problems, such as aspiration pneumonia.
- Osteoarthritis. Pressure on joints or abnormal alignment of joints from muscle spasticity may lead to the early onset of this painful degenerative bone disease.
- Osteoporosis. Fractures due to low bone density can result from several factors such as lack of mobility, inadequate nutrition and anti-epileptic drug use.
- Other complications. These can include sleep disorders, chronic pain, skin breakdown, intestinal problems and issues with oral health.
Most cases of cerebral palsy can't be prevented, but you can reduce risks. If you're pregnant or planning to become pregnant, you can take these steps to keep healthy and minimize pregnancy complications:
- Make sure you're vaccinated. Getting vaccinated against diseases such as rubella, preferably before getting pregnant, might prevent an infection that could cause fetal brain damage.
- Take care of yourself. The healthier you are heading into a pregnancy, the less likely you'll be to develop an infection that results in cerebral palsy.
- Seek early and continuous prenatal care. Regular visits to your doctor during your pregnancy are a good way to reduce health risks to you and your unborn baby. Seeing your doctor regularly can help prevent premature birth, low birth weight and infections.
- Avoid alcohol, tobacco and illegal drugs. These have been linked to cerebral palsy risk.
Rarely, cerebral palsy can be caused by brain damage that occurs in childhood. Practice good general safety. Prevent head injuries by providing your child with a car seat, bicycle helmet, safety rails on the bed and appropriate supervision.
Sept. 01, 2021