Cerebral Palsy

Cerebral palsy (CP) is the term used to describe a chronic motor disability in children, with early onset, that is nonprogressive in nature. The disorder is caused by a malfunction of the brain (cerebral) and results in a variety of motor problems (palsy). Many also refer to this as a "static encephalopathy". Other neurological diseases involving the peripheral nervous system can look similar in some patients.

Even pediatric neurologists may disagree on the diagnosis in certain children. In the very young, not all the signs and symptoms are present, so a diagnosis cannot be made. With time, the clinical picture becomes clearer.

CP affects 1 - 2.5 per thousand school aged children. It is usually divided into two basic forms, spastic (increased muscle tone) and nonspastic. Those with the nonspastic forms may have a decrease in tone in the trunk, but variable to increased tone in the extremities. Some kids will have abnormal involuntary movements (chorea, athetosis, dystonia) that interfere with normal movements. Others may have a significant balance problem (ataxia), usually with low muscle tone.

Spastic CP is associated with increased muscle tone, such that the extremity resists passive movement and the child may assume abnormal postures such as arching the back, stiffening the legs, or a crouched gait. The reflexes are very prominent, and, in some, abnormal involuntary movements occur. Spastic CP is divided into (1) spastic hemiplegia: where one side of the body is involved, (2) spastic diplegia: greater involvement in the legs; seen mainly in premature infants, (3) spastic quadriplegia: affecting all four limbs and frequently the most severe form, (4) choreoathetoid types: with involuntary motor movements and (5) mixed types.

What causes CP?

In many cases no cause is found, despite extensive testing. A wide variety of causes are possible, including infectious diseases, biochemical problems (metabolic diseases), genetic abnormalities, toxic exposure and structural disorders of the central nervous system.

The prevalence of CP has not changed much in the last thirty years, except for an increase in the rate in premature infants. It was once thought that trauma during the birth process was responsible for much CP, but a large scientific study in the United States (involving 55,000 pregnancies) has shown that, of infants born at term who later develop CP, only about 10% of CP results directly from events during labor and delivery.

In a child newly diagnosed with CP, many tests may be necessary to define the cause, especially to rule out (1) genetic disorders - that might recur in another child in the family, (2) progressive disorders of the nervous system - that might worsen over time, (3) treatable conditions - although few, there are some rare problems that may respond to specific interventions and (4) to confirm the diagnosis and suggest future needs.

For more information on Cerebral Palsy, contact:

United Cerebral Palsy Association