Complications of Cerebral Palsy

No two cases of cerebral palsy are exactly alike, and that includes differences in the complications and other conditions people with cerebral palsy may have.

For example, urinary incontinence is common among those who do not have control over their bladder muscles. But others may have complete control over their bladder muscles.

Knowing what complications and conditions occur more often with cerebral palsy can help families and individuals seek appropriate care.

Some of the most common complications of cerebral palsy relate to slowed or altered growth and development, especially in a person’s muscles and bones. An estimated 42 percent of people with cerebral palsy cannot walk independently, according to the U.S. Centers for Disease Control and Prevention (CDC). (1)

Children with cerebral palsy often do not meet the same developmental milestones as their peers. Infants may not gain weight as quickly as others their age, and they may remain shorter than average in childhood into adolescence and adulthood.

Muscles and bones in the limbs affected by cerebral palsy may not grow to full length, causing shorter, thinner limbs. More severe cases of cerebral palsy may be associated with delayed puberty.

Contractures are also common complications that can be very painful. A contracture means a muscle has become stuck in an abnormal position, often increasing muscle spasticity. Contractures also cause deformities in joints and bones. Abnormally shortened or lengthened muscles can cause problems with bone growth as well.

Improper spine growth can cause chronic pain and make it difficult to stand, sit, or walk. Spinal deformities can include scoliosis, a disorder in which the spine curves sideways; kyphosis, or a humpback-shaped spine; and lordosis, or swayback, in which the lower back arches inward excessively.

In addition to chronic pain, deformed or misaligned joints can contribute to osteoporosis and osteopenia. With osteoporosis, bones lose mass and become brittle and more likely to break. Osteopenia, or low bone density, also increases risk of fractures.

The brain injury that caused a person’s cerebral palsy may cause other conditions too, such as seizure disorders. A seizure occurs when the brain’s nerve activity is abnormal. Up to half of people with cerebral palsy have had one or more seizures, and an estimated 41 percent have epilepsy. (1,2)

The brain has electrical activity similar to the electricity that powers your home. When the electrical currents in the brain act erratically, it causes a seizure, just as an electrical short in your house causes flickering lights or a temporary blackout.

Seizures can last from 30 seconds to several minutes, but they may look different each time, even in the same person. A person may go completely still, seeming to stare into space, or they may suddenly jerk, twitch, and move uncontrollably. (3)

During a seizure, a person may stop talking, talk nonsensically, garble words, move their lips, wring their hands, breathe heavily, blink their eyes rapidly or move them in different directions, bite their tongue, or have dilated pupils.

Sometimes the person is conscious and aware during the seizure. Other times they may experience altered consciousness, such as feeling outside their body, or they may lose consciousness.

People very rarely die during a seizure, but seizures affect daily activities, such as driving or swimming, and physical injury can occur during the seizure. Anti-epileptic medications are used most often to control seizures. Brain surgery may also reduce their frequency.

Other neurological problems include sleeping disorders, which occur in approximately 1 in 5 people with cerebral palsy. (4) In addition, an estimated 7 percent of people with cerebral palsy are on the autism spectrum. (1)

About one-third to one-half of people with cerebral palsy have cognitive, or intellectual, disability. This disability occurs most often in those with spastic quadriplegia, where all four limbs are affected. Those who have both cerebral palsy and epilepsy also have a higher risk of intellectual disability. (2)

Learning disabilities are also more common among people with cerebral palsy. Some people with cerebral palsy especially struggle with receiving spatial and auditory information and making sense of it. For example, they may have a poor sense of direction or need information repeated out loud several times to process it.

Others struggle with speech, such as pronouncing or recalling words. According to the Cerebral Palsy Foundation, 1 in 5 people with cerebral palsy cannot talk, but a larger proportion have other speech and language problems. (3) About 1 in 3 people with cerebral palsy experience slow language development, difficulty shaping words with their mouths, or difficulty articulating clearly. (2)

Sometimes other people mistake a difficulty with speech and language for lower intelligence. Although intellectual disability is common, most people with cerebral palsy have average or above-average intelligence.

One in 10 people with cerebral palsy have severe vision impairment, and 1 in 25 have a severe hearing problem, according to the Cerebral Palsy Foundation.

Sight problems may involve the eyes appearing “crossed,” which can affect depth perception — the ability to tell how far away or close something is.

Some people with cerebral palsy simply have poor vision in one or both eyes, such as blurriness or not being able to see very far ahead of them. Glasses, contacts, or surgery may be able to correct some of these problems.

Jaundice or inadequate oxygen in the brain during or shortly after birth may cause hearing difficulties ranging from partial hearing loss to complete deafness.

Some people with cerebral palsy do not have control over certain facial muscles. Poor control of eye muscles may cause slow or rapid blinking that interferes with sight, or uncontrolled eye movements.

An inability to fully control mouth muscles, such as those of the lips, jaw, throat, and tongue, can lead to drooling and difficulty chewing or swallowing. These problems often then interfere with healthy eating, putting the person at risk for malnutrition. Malnutrition can cause a variety of other problems, such as intellectual disability, poor growth and development, and poor weight gain. (5)

Difficulty with fine motor skills and controlling oral muscles may make dental hygiene harder. Gum disease and cavities are therefore more common in people with cerebral palsy, and sometimes medications make these problems worse.

Heart disease, lung disease, and pneumonia are all more likely in people with cerebral palsy than in the average population. Some lung problems result from inhaling food into the lungs, while others relate to muscles that make it harder to breathe.

People with cerebral palsy are at higher risk for depression, anxiety, and mood disorders. These mental health problems may be related to their disabilities, such as difficulty managing their condition or frustration with restrictions on their activities.

A person with cerebral palsy may also experience feelings of isolation and stigma, particularly if they are treated differently by those around them and struggle to make friends.

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