What Is Cerebral Palsy? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Cerebral palsy (CP) is a group of neurological disorders caused by a brain injury or abnormality that happens before, during, or immediately after birth, while the brain is still developing. A person cannot catch cerebral palsy or transmit it to someone else.
The disorder affects a person’s ability to control their motor functions or movement. “Cerebral” refers to the brain’s cerebrum, which controls movement. People with cerebral palsy have difficulty controlling certain body movements or cannot control them at all.
Cerebral palsy is a permanent condition, but many therapies and treatments can help people manage their condition and improve their quality of life.
The symptoms and early signs of cerebral palsy are a long list, but they nearly all involve some evidence that a person lacks control over their muscle movements. If parents notice their child missing important developmental milestones, they should be sure to let their pediatrician know. The Centers for Disease Control and Prevention (CDC) offers helpful milestone checklists.
Any of a person’s motor skills — skills related to any type of movement — can be affected, including fine motor skills, gross motor skills, and oral motor skills. Oral motor skills are related to anything you do with your mouth, such as eating, drinking, sucking, or chewing gum.
Fine motor skills refer to tasks that use small muscles from one area of the body, usually the hands, fingers, or toes. These skills include writing, eating with silverware, curling your toes, turning a doorknob, or buttoning your shirt.
Gross motor skills use many muscles throughout the body for large movements, such as walking, jumping, running, swimming, bending, reaching, and carrying items.
Examples of symptoms include stiff muscles, jerky reflexes, tremors, poor coordination or balance, trouble speaking, seizures, incontinence, stiff or “floppy” muscles, slow movement, problems with sucking or swallowing, or trouble picking things up.
Cerebral palsy may also cause certain neural pathways — the paths in the body where nerve signals travel — to work improperly or slowly. The condition can also affect a person’s posture and balance, depending on the individual. However, more than half of people with cerebral palsy can walk on their own.
A wide range of exposures or incidents can cause the brain injury that leads to cerebral palsy. Sometimes a physician can be certain about the cause, but other times it may not be possible to know exactly what caused it. The following are some of the possible causes:
Genetic mutations can cause the brain to develop differently from typical brains and develop a lesion, or injured area.
Traumatic brain injury due to a fall, car accident, or other serious accident can cause cerebral palsy.
Infections in infancy, such as viral or bacterial meningitis or another condition with a severe, persistent fever, can cause inflammation in or around the brain and injure it. Severe or untreated jaundice, when the liver does not break down old red blood cells as it should, can also increase the likelihood of cerebral palsy.
Improper brain development during pregnancy, which can result from multiple possible causes.
Brain injury or inadequate oxygen during birth can cause cerebral palsy.
Inadequate blood supply to the fetal or infant brain, called a stroke, can also injure the brain.
A mother’s infection during pregnancy may cause problems that contribute to developing cerebral palsy in a growing fetus.
Some exposures or circumstances can increase the risk of cerebral palsy but may not necessarily be the sole cause of it. The following can all increase the risk of cerebral palsy:
Placenta problems during pregnancy, such as placenta previa, placental abruption, or placental insufficiency, raise the risk of cerebral palsy.
Several infectious diseases can increase risk of cerebral palsy if a mother has one while pregnant, including:
Chickenpox (varicella), a viral infection preventable with a vaccine
Cytomegalovirus (CMV), a common viral infection that harms a child only if a mother first has cytomegalovirus during pregnancy
Herpes, a sexually transmitted virus that can affect the placenta and cause inflammation that can damage the fetus’s nervous system
Rubella (German measles), a viral infection preventable with a vaccine
Syphilis, a sexually transmitted bacterial infection
Toxoplasmosis, caused by a parasite in contaminated food, dirt, and cat feces
Zika, a virus carried by mosquitos that can also cause microcephaly — an undersized head or brain — in a newborn
Exposure to toxic chemicals during pregnancy or early infancy, such as methylmercury or lead, raises the risk.
Pregnancy and birth complications can increase risk of cerebral palsy:
Premature birth (before 37 weeks), with risk increasing the earlier the baby is born, according to a 2021 paper.
Low birth weight (under 5.5 pounds, or 2.5 kilograms), with risk increasing the lower the weight.
Prolonged labor — typically defined as longer than 20 hours in first-time mothers, more than 14 hours for non-first-time mothers, or more than 16 hours for twins — may affect risk of cerebral palsy, though it’s not yet clear if it does.
Multiples in pregnancy, such as twins or triplets; risk increases with the number of fetuses a woman is carrying and if any of them die before birth.
Breech births, where the baby’s feet or buttocks — instead of the head — are closest to the birth canal when labor begins.
Pregnancy complications that involve respiratory or circulatory problems in the baby.
It’s unclear whether injuries from forceps or vacuum extraction are associated with cerebral palsy risk. Study findings are not consistent.
Difference in blood Rh factors between mother and child. The Rhesus (Rh) factor is a protein on red blood cells that most people have. If a mother does not have Rh but her fetus does, the mother’s immune system may create cells that attack her child’s blood cells.
In vitro fertilization (IVF) or certain infertility drugs may increase the risk of cerebral palsy, but the risk is extremely tiny.
In a Danish study involving nearly 590,000 children, only about 0.18 percent of babies overall developed cerebral palsy. Among more than 33,000 babies born via IVF, 0.33 percent of them had cerebral palsy.
A 2020 meta-analysis of 10 studies also concluded that children from assisted reproductive technology, such as IVF, are at a slightly higher risk of developing cerebral palsy.
Some of the increased risk from IVF or fertility drugs may be because these methods and medications also increase the risk of multiples, which in turn increases the risk of preterm birth.
Drugs that stimulate ovulation, such as clomiphene (Clomid), increase the likelihood of having multiples.
Other conditions in the mother may increase the risk of cerebral palsy, such as thyroid problems, high blood pressure, seizures, epilepsy, intellectual disability, or gestational diabetes.
Getting diagnosed with cerebral palsy usually requires multiple imaging and lab tests. If a doctor suspects a child has cerebral palsy, they will do a physical exam and may refer the child to a specialist.
Most children will undergo several tests:
Magnetic resonance imaging (MRI) uses radio waves in a large magnet to create an image of the child’s brain. It does not involve radiation.
A cranial ultrasound — an ultrasound of the head — can only be done in babies. Ultrasounds create images by sending sound waves into the body that bounce back.
A computerized tomography (CT) scan is a type of X-ray that creates cross-sectional images of the brain or other parts of the body.
A test called an electroencephalogram (EEG) records electrical activity in the brain to see if the person has seizures. It involves attaching electrodes to a person’s scalp.
Electromyography (EMG) and nerve conduction tests look for problems in the nerves or muscles.
Blood, urine, and skin tests are not always necessary. However, sometimes doctors order these tests to look for other possible conditions, such as genetic or metabolism problems.
If someone receives a diagnosis of cerebral palsy, additional tests will look for sensory or developmental problems caused by the condition:
Vision
Hearing
Speech
Movement
Mental or cognitive ability
Other development
Several types of cerebral palsy exist, based on what kind of movement problems a person has and where they are in the body. The most common type is spastic cerebral palsy, affecting about 70 to 80 percent of people with the condition. People with this type have increased muscle tone, which causes stiff muscles and awkward-looking movements.
People with dyskinetic, or athetoid, cerebral palsy (about 10 percent of cases) experience changes in muscle tone, causing rapid, jerky movements or slow, uncontrolled movements.
The last type, ataxic cerebral palsy (about 10 percent of cases), causes difficulty primarily with balance and muscle coordination.
People can also have a mixture of these three types.
Even within these categories, no two cases of cerebral palsy are alike. It may affect only one arm in one person and both arms and legs in another. It may affect the face, only the feet, or the entire body.
Functioning as a Family When a Child Has Cerebral Palsy
The whole family is affected when a child has cerebral palsy. Parents may go through a period of grief when a child is first diagnosed, and many experience a high stress level over time due to the pressures of caregiving. Siblings must navigate what it means to have a brother or sister with needs and abilities that differ from their own.
In spite of the challenges that come with having a family member with CP, couples and families who take the time to communicate with one another — and to care for themselves, as well as for the child with CP — are often able to thrive as a family.
Reaching out to extended family members for support, as well as to local groups and organizations, can help a family get the emotional and practical help they need.
Parents of children with cerebral palsy need to start educating themselves early about issues related to school. Many children with cerebral palsy qualify for an individualized education program (IEP), which spells out the instruction and services a student will receive in their public school.
Many students with cerebral palsy will also need assistive technologies to help with schoolwork and the support of specialists, such as occupational and speech therapists.
A child’s social life is important, too.
It’s important to begin conversations on these topics with the local school district before your child starts school, so teachers and other staff are prepared to best serve the needs of your child.
The life expectancy of people with cerebral palsy — how long they are expected to live on average — is different for each person. Those with more severe cases usually have a shorter life expectancy than the average person or people with mild or moderate cerebral palsy.
Other factors, such as early aging, a weakened immune system, overall disabilities, and musculoskeletal disorders can affect how long a person with cerebral palsy lives as well. The major factors affecting life expectancy are:
Severity of the condition
Number and severity of disabilities
Feeding difficulties
Intellectual or cognitive functioning
Respiratory functioning
Mobility difficulties
Seizures
Vision and hearing impairment
Quality of medical care and treatments
Cerebral palsy is a lifelong condition that has no cure. However, with appropriate management and the necessary support, people with cerebral palsy can live fulfilling lives.
Cerebral palsy will never get worse, but it will never go away either. The brain injury is permanent and cannot be healed or cured. Conditions related to cerebral palsy, however, may improve or worsen over a person’s lifetime.
Therapies (such as physical, occupational, and speech therapies), appropriate assistive devices and medical equipment, braces, surgery, medication, and other treatments can all help a person manage cerebral palsy. These treatments can increase their ability to do certain tasks and live independently.
Cerebral palsy causes death only in very rare severe cases in infants or very young children.
Treatment for cerebral palsy will depend on a person’s symptoms, disabilities, complications, and other medical conditions.
Most people with cerebral palsy will need an interdisciplinary team of healthcare providers, including a pediatrician, neurologist, mental health practitioner, orthopedic surgeon, physical therapist, speech therapist, occupational therapist, and others.
Speech therapy, physical therapy, and occupational therapy can help develop life and communication skills. And special education professionals and assistive technology experts can help people with cerebral palsy reach their educational and vocational goals.
Working with these clinical specialists early on and as their needs change throughout their lives will allow those with cerebral palsy to lead more independent lives and improve their quality of life.
A person with cerebral palsy may take medication to treat seizures or muscle problems, and they may also undergo surgery on their muscles, spine, brain, eyes, or abdomen.
Drugs called anticholinergics are used to help with uncontrolled movements. They work by blocking the chemicals in the brain that cause the movements.
Botulinum toxins are neuromuscular blocker medications made from bacteria. They can reduce uncontrolled movements in muscles for three to six months.
Medications used to stop or reduce seizures are called antiseizure medications (formerly called anticonvulsants or antiepileptic medications). Sometimes people may need to change their antiseizure medications if the one they are taking stops working.
Benzodiazepines are another group of drugs that are sometimes used short-term to treat a seizure. They are not usually taken long-term.
Muscle relaxers, called antispastics, can be prescribed to loosen stiff muscles, tremors, and similar symptoms. They can also increase range of motion in someone with cerebral palsy.
Anti-inflammatories can treat different types of pain that people with cerebral palsy may experience. This includes abdominal pain, muscle or joint pain, pain after surgery, and pain caused by other treatments, such as an injection or feeding tube placement.
Antidepressants are drugs used to treat depression or anxiety in people with cerebral palsy. Sometimes antidepressants are also used to treat pain even in those with cerebral palsy who do not have depression or anxiety.
Constipation is common in children with cerebral palsy, so laxatives and stool softeners may be prescribed to help with bowel movements.
Alternative and Complementary Therapies
Some studies have suggested acupuncture can help people with cerebral palsy improve movement, but the evidence is not conclusive, according to a meta-analysis published in June 2018.
In addition to traditional physical therapy, people with cerebral palsy may benefit from animal-assisted therapy. Some research, such as a study published in May 2015, has shown improvement in children’s ability to move and communicate after working with a therapy dog. Therapy involving horses (hippotherapy) has also been shown to improve posture, sitting balance, and quality of life in children with cerebral palsy, according to a 2020 paper and a 2018 paper.
Additionally, aquatic therapy may improve motor function in children with cerebral palsy, even those with a more severe version of the condition, according to a 2015 paper.
Various other alternative and complementary therapies have been proposed for cerebral palsy but without solid evidence that they work.
Assistive technologies are any item or system used to maintain or improve the functioning of an individual with a disability.
People with cerebral palsy can benefit from a range of technologies, from high-tech, computerized devices that help with mobility or communication to low-tech equipment that helps with tasks of daily living.
Some people can also benefit from technology that improves hearing or vision.
It’s not possible to prevent all, or even most, cases of cerebral palsy. But it is possible to reduce risks for cerebral palsy, particularly during pregnancy.
The following are activities pregnant women can do to reduce risk:
Get appropriate prenatal care and attend all appointments, so your doctor is alerted early to problems such as preterm labor, placenta problems, and other risk factors.
Receive treatment for pregnancy complications, such as preeclampsia and placenta problems, notes the CDC.
Get all vaccines recommended, such as rubella, before or during pregnancy to prevent infections that may increase risk of cerebral palsy.
Avoid activities that increase risk of toxoplasmosis.
Use mosquito repellent and other protections (such as air-conditioning and long sleeves and pants) in areas affected by Zika.
Get Rh factor testing. If negative, get the recommended treatment, says the CDC.
Avoid smoking, drinking, illicit drugs, and unnecessary medication.
Avoid exposure to X-rays unless absolutely necessary.
Eat a healthy diet that includes all necessary vitamins and minerals.
After birth, parents and caregivers can reduce risk with the following behaviors:
Be sure your child receives all recommended vaccines, which prevent infections that could cause cerebral palsy.
Educate yourself about shaken baby syndrome, also called abusive head trauma., and have a support network in place to help you adjust to parenthood and understand your baby’s behavior.
Follow child safety guidelines, such as using a car seat, a bicycle helmet while riding, and similar safeguards, according to the CDC.
Cerebral palsy can lead to several complications resulting from the muscle and coordination difficulties it causes, including the following:
Severe muscle tightening and shortening, which can slow, interrupt, or deform the growth of bone
Malnutrition due to feeding difficulties, sometimes leading to growth and bone problems
Depression or other mental health problems related to coping with the effects of cerebral palsy
Lung disease from breathing problems
Additional movement or neurological disorders
Osteoarthritis, where cartilage and then bones break down over time
Low bone density, called osteopenia, which can increase risk of fractures
Imbalance of eye muscles
Those with cerebral palsy are also at an increased risk of respiratory complications from COVID-19, according to a 2020 paper, which is why it is important those with cerebral palsy get vaccinated against COVID-19.
Cerebral palsy is the most common cause of physical disability occurring in childhood. An estimated 764,000 people live with cerebral palsy in the United States, including about 1 in 323 children.
Cerebral palsy is typically thought of as a childhood disorder. But most children with cerebral palsy live into adulthood, and many of those adults work, have families, and are active in their communities.
Still, adults with cerebral palsy do not grow out of the neurological problems they had as children, and many contend with additional health problems, as well. Common health issues among adults with CP include weakness, chronic pain, and repetitive strain injuries. Depression is also common among adults with cerebral palsy.
Engaging with peer support groups and connecting with national patient organizations can help adults with cerebral palsy find the care they need and stay socially active with what can be an isolating condition.
Cerebral palsy occurs about 30 percent more often in Black children than in white children. This means for every three white children with cerebral palsy, there are four Black children with cerebral palsy. The higher risk of cerebral palsy in Black children appears to occur because of lower birthweights.
In addition, Black children with cerebral palsy were 1.7 times more likely than white children with cerebral palsy to have difficulty walking or to not be able to walk.
A variety of other conditions often occur in people who have cerebral palsy. For example, about 41 percent of children with cerebral palsy have epilepsy, and about 7 percent have an autism spectrum condition.
Other common co-occurring conditions include learning disabilities, chronic pain, attention deficit hyperactivity disorder (ADHD), mental health conditions, and vision, hearing, or speech problems.
Families in which a child has cerebral palsy, as well as adults living with cerebral palsy, can benefit by connecting to programs and services designed to meet their needs. But finding these programs and services can be a challenge.
National nonprofits such as the Cerebral Palsy Foundation and United Cerebral Palsy can help. So can medical professionals who treat cerebral palsy, clinics that specialize in cerebral palsy, special education professionals, and assistive technology experts.
