The Percy Hedley Foundation has been working with children and adults with cerebral palsy for over 50 years, and has helped their families understand the condition and its implications. During that time, staff have built up a vast experience of the condition, of ways of assessing and managing it, and of therapeutic approaches to help those with CP. In this article, head physiotherapist, Anne Coates, explains the condition and its affects.

Cerebral Palsy

Cerebral palsy (CP) is the commonly used name for a group of conditions characterised by motor dysfunction, due to non-progressive damage to the brain early in life. This may result in mild, moderate or severe impairment of the co-ordination of muscle action and the ability to control upright posture. The areas of the brain affected, can vary the outcome. The damage itself does not worsen or improve, however the effects on the body as a child develops and grows will change.

Cerebral Palsy is more common than generally realised and can affect 1 in 400 children. It can affect children from all social backgrounds and ethnic groups.

Associated problems may include:-

  • Speech, language and communication difficulties
  • Vision
  • Hearing
  • Perceptual impairment
  • Cognitive difficulties
  • Epilepsy

These factors may present in varying degrees, and no two children will be affected in exactly the same way.

Causes of Cerebral Palsy

It is often difficult for a doctor to give an exact reason why a baby's brain has been damaged or why it has failed to develop and causes can be complex. The brain can be affected before birth, during birth or after birth.

The main known causes of Cerebral Palsy are:-

  • Infections during the early stages of pregnancy such as rubella, cytomegalovirus, toxoplasmosis.
  • Prematurity.
  • A difficult or traumatic birth, resulting in direct trauma or asphyxia.
  • An episode of bleeding or poor blood supply to part of the brain.
  • Abnormal brain development.
  • Genetic.

Cerebral palsy means that the messages sent from the brain to the muscles and joints are impaired and therefore movements do not take place in a smooth and coordinated pattern. Any part of the body or all of the body can be affected.

Types of Cerebral Palsy

CP can be classified according to the parts of the body affected.

  • Monoplegia - Affects one limb
  • Hemiplegia - Affects one side of the body
  • Paraplegia - Affects lower limbs
  • Quadriplegia/Tetraplegia - Affects all four limbs

CP can also be described by the way in which the lesion affects the messages to the muscles, as determined by the area of the brain affected.

Spastic cerebral palsy

This is caused by damage in the cerebral cortex of the brain. It is characterised by stiff, increased muscle tone and tightness which affects the way in which joints move. This makes movement hard work and spasticity can be increased with effort, anxiety and posture.

Dyskinetic or Dystonic Cerebral Palsy

This is due to damage in the area of the brain called the basal ganglia that affects coordination and control of movement. Children have involuntary and variable muscle tone affecting the whole body. They have difficulties with control of posture for sitting and standing. The unwanted movements can increase on effort, excitement or anxiety. Speech and eating may also be affected due to the same involuntary movement and control, affecting the mouth, lips and tongue.

Ataxic Cerebral Palsy

This is a relatively rare form of Cerebral Palsy and may affect less than 10% of the cerebral palsy population. The part of the brain affected is called the cerebellum and it is this part of the brain that regulates and co-ordinates movement and is responsible for balance. All four limbs and trunk are usually affected. Children with this type of CP have poor sensation of balance and often stagger when walking. They may also have a tremor as they intend to carry out a movement.

Mixed Type of CP

It is common for children to have features of more than one type of CP and some children will have a description of their presentation that will highlight the main problems e.g the child can have ataxic CP with some spasticity.

Ways of Lessening the Physical effect of CP

It is important to the child to try and reduce the effect of the CP whilst promoting maximum independence. Some interventions may be:-

  • Splints/calipers
  • Ankle foot orthoses (AFO's)
  • Serial plastering
  • Botulinum Toxin injections (Botox)
  • Muscle relaxant medication
  • Passive and active movements
  • Orthopaedic Surgery
  • Corrective seating
  • Speech and Language Therapy, Occupational Therapy and Physiotherapy
  • A holistic Educational approach
 

CP and Ageing

Due to poor mechanical efficiency, people with CP may experience the effects of ageing earlier than expected. They may have:

  • Increased pain and discomfort
  • Osteoarthritis
  • Increase in muscle spasms
  • Increase in contractures and deformities
  • Less efficient motor control
  • Postural problems
  • Back pain
  • Gastro intestinal problems

For all these reasons particular attention needs to be paid to:

  • Seating and posture
  • Spinal monitoring
  • Monitoring of stiffness and contractures
  • Maintaining range of joint movement
  • Upright walking posture and persistence with walking
  • Maintaining therapy
  • Weight gain
  • Injury
  • Surgery
 

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