Cerebral palsy is one of the most common disorders affecting children in the United States. Each year, between 8,000 and 10,000 people are diagnosed with some type of the disorder. That accounts for around 800,000 people currently suffering from some form of the disorder. Cerebral palsy is a complicated medical disorder, with various types and many signs and symptoms ranging from mild to severe.
Although it is a common disorder, parents, understandably, don’t want their children to develop cerebral palsy. If your child already has cerebral palsy or you suspect they may, it’s important to understand what the disorder is, what causes it, the signs to look for, and ultimately, the best treatment options.
What is Cerebral Palsy?
Cerebral palsy is a disorder that affects the brain and causes motor deficiencies. “Cerebral” refers to the part of the body affected, and “palsy” refers to paralysis, as there is an area of the brain that’s dormant or paralyzed. This leads to either partial or complete muscle paralysis. The brain damage usually happens before, during or shortly after birth and can end up being a lifetime disability for the child.
Cerebral Palsy is the most common motor disorder affecting children in the United States. While that certainly sounds significant, most people don’t really know just how prevalent the disorder is, or the impact this disorder has on families.
CP is a condition that affects infants, children and adults across the world. Population studies estimate that between 1.5 and four children out of every 1,000 live births will develop CP. That equates to one in every 323 children. Currently, estimates suggest that around 500,000 people under the age of 18 have CP.
- Boys – 3.6 per 1,000
- Girls – 2.5 per 1,000
Types of Cerebral Palsy
- 77 percent of all CP cases are spastic.
- Five percent of all CP cases are dyskinetic.
- Three percent of all CP cases are ataxic.
- 15 percent of all cases are a mixed variation.
By eight years old, around 60 percent of children with CP will be diagnosed with another form of intellectual disability:
- 40 percent of children will be diagnosed with intellectual delay.
- 35 percent of children will be diagnosed with epilepsy.
- 15 percent of children will be diagnosed with vision impairment.
- 9 percent of children will be diagnosed with Autism Spectrum Disorder (ASD).
- One in four children with CP has an intellectual disability and epilepsy.
Risk factors for CP include the following:
- Premature birth
- Low birth weight (primarily infants weighing less than 1,500 grams)
- Multiple births (twins, triplets, etc.)
- Fertility treatments
- Maternal infections
- Uterine blood flow problems/placental insufficiency
- Traumatic head injury
- Oxygen deprivation
- Hyperbilirubinemia (kernicterus)
- Periventricular leukomalacia (PVL)
Types of Cerebral Palsy
Cerebral palsy can manifest in many different ways. Some children have more trouble with seizures than spasticity, or some children have intellectual disabilities while other children do not. Sometimes cerebral palsy is a term that includes a number of different movement-and-brain-related disabilities. Those falling under this umbrella term include:
Spastic Cerebral Palsy
Spastic cerebral palsy is often diagnosed earlier than other forms of the disorder because the symptoms appear faster. Babies with a spastic type of the disorder experience stiff, rigid muscles. This leads to awkward movements, muscle spasms and random muscle contractions.
Hemiparetic or Hemiplegic
Often developing from a stroke or asymmetric periventricular leukomalacia, hemiparetic cerebral palsy occurs when a child experiences muscle stiffness or spasticity only on one side of the body. The child may have problems with one leg, or with an arm and a hand, and may also experience speech problems. Children with this form of disability are also more prone to seizures than children with other types.
Also referred to as spastic diplegia and Little’s Disease, this is the first form of cerebral palsy that was ever scientifically diagnosed and named. This type is marked by the child experiencing tense muscles and muscle spasticity mainly from the lower muscle groups – the upper body is less affected or not affected at all. The child might have difficulty walking because tight hip and leg muscles cause their legs to pull together, turn inward, and cross at the knees called scissoring.
Also referred to as tetraplegic cerebral palsy, this is a form of the disorder where the child experiences paralysis in all four limbs. Children with this form of the disorder experience more difficulties meeting developmental milestones. Some cannot reach certain milestones, such as crawling or walking. Some children with this disease also experience an incredible amount of pain which precludes them from wanting to learn how to walk. They are more likely to have associated impairments such as severe intellectual disability, communication impairment, visual impairment, epilepsy, feeding difficulties, and/or pulmonary disease.
Dyskinetic Cerebral Palsy
This type of cerebral palsy is marked by involuntary movements that are especially noticeable when the person tries to move around. Unlike patients with spastic CP, those with purely dyskinetic syndromes usually do not develop contractures, unless they are positional. Sometimes dyskinetic cerebral palsy is a name given to a form of brain injury originating from bilirubin encephalopathy or hypoxic-ischemic encephalopathy (HIE).
Considered the second most common form of cerebral palsy, it is characterized by abnormal postures and movements due to poor muscle tone, movement control and coordination. The child is typically intellectually adept and feels trapped inside his or her body. The child often experiences drooling and a lack of control with oral muscles. Likewise, he or she may experience a lack of control with muscles all over the body which differ in tone (flabby or tight) and may often contract involuntarily.
Choreoathetoid cerebral palsy is defined by involuntary twitching, sometimes called choreiform and slow, writhing movements of the distal extremities, called athetosis. Choreiform movements are involuntary and are described as being repetitive or jerky. Athetosis is most apparent during reaching, as the fingers extend and abduct. Stress, excitement, or fever may exacerbate the chorea.
Babies with this form of cerebral palsy suffer from limbs that are floppy, often described like a rag doll. They put up little resistance to parents moving limbs, they generally don’t sit up or lift muscle groups at all, and when they do sit up, they have a very hard time holding up their head.
Ataxic Cerebral Palsy
Considered the least-diagnosed and rarest form, ataxic cerebral palsy only affects fine motor skills. The child may have balance issues related to the inner ear and therefore may have a speech impediment. Generally, the child has a hard time doing anything from tying shoelaces to buttoning a shirt or using a pencil. As the child tries to focus more on the finite skill, he or she may have tremors as the muscles are taxed by the effort. Speech, which is related to intellectual ability, typically is slow, jerky, and explosive.
Mixed Cerebral Palsy
Mixed cerebral palsy occurs when the child has damage to different parts of the brain. Therefore, they have a combination of symptoms. These symptoms may resemble those of spastic, dyskinetic or ataxic cerebral palsy.
Mixed cerebral palsy represents around 10 percent of all cases. Due to the complexity of brain damage and symptoms, children with mixed types of the disorder are generally diagnosed after three years of age. Their care requires a multidisciplinary team that can address the complex nature of mixed symptoms.
What Causes Cerebral Palsy?
The causes of cerebral palsy can vary greatly. In some instances, the cause is unknown. In others, the cause is due to brain damage caused by medical negligence, a congenital disorder or a birth injury. The best way to help your child manage his or her condition as successfully as possible, is to understand the cause of his or her disorder.
There are many cases of cerebral palsy that are caused by a physician’s failure to properly identify medical issues and/or failure to take the correct actions during birth to reduce risks. The most common reasons that cerebral palsy occurs because of medical negligence include a doctor, nurse or hospital’s failure to:
- Properly monitor and assess the fetal heartbeat during and after delivery.
- Schedule and provide a timely C-section.
- Detect and treat maternal infections.
- Properly use birth-assisting tools, such as forceps or a vacuum extraction tool.
- Correct umbilical cord problems, such as a prolapsed cord.
- Supply oxygen in a timely manner to an asphyxiated infant.
- Monitor respiratory and oxygen treatments.
Estimates suggest that thousands of cases of cerebral palsy each year occur as a result of medical negligence.
Is Compensation Available for Cerebral Palsy Caused by Medical Negligence?
If your child’s cerebral palsy was caused by medical negligence, you may be eligible for compensation. Before you file a birth injury compensation claim, make sure the following pertains to your case:
- Doctor/Patient Relationship: A doctor/patient relationship must be in place in order to have a valid claim. A doctor/patient relationship means that there was an agreement that the doctor would care for you during your pregnancy, including before and after delivery.
- The Doctor Must Have Been Negligent: There must be clear proof that the doctor was negligent in causing your baby’s injuries. That means identifying the standard of care and showing that the doctor violated it.
- The Negligence Caused Cerebral Palsy: Once it’s been established that the doctor was negligent, there must be proof that the negligence is what caused your infant’s injury or condition. Generally, once the negligence has been established, the proof of injury follows.
How Much Compensation is Available?
The amount of compensation you are eligible for will depend on a variety of factors, including:
- How severe the medical negligence was
- What type of CP the infant has (some types of CP are more severe than others)
- The state you live in
- The needs of your child now, and in the future
The amount of compensation may also depend on the type of damages. There are two types of damages in birth injury lawsuits:
- Economic damages are damages that are easily quantifiable. These include medical expenses, lost income, medications, therapy and any other factors that cause economic loss because of the injury.
- Non-economic damages are damages like pain and suffering, loss of enjoyment of life, stress and anxiety caused by the injury and any other negative outcome because of the injury.
In some states, there is a non-economic damage cap, which limits how much plaintiffs can receive in a birth injury case. That means only a certain amount of compensation is allowed.
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If an infant develops cerebral palsy before or during childbirth, it’s considered congenital CP. These forms of the disorder are marked by development before birth. Per the Centers for Disease Control and Prevention (CDC), congenital cerebral palsy is the most common form of the disorder. The most common congenital causes include:
Infections such as cytomegalovirus (CMV), chickenpox and rubella may increase the chances of an infant developing cerebral palsy. These diseases increase cytokines – tiny proteins that aid cell-to-cell signaling during the immune response and stimulate cells to move towards infection or trauma. When cytokines are released in substantial amounts, it can lead to infant brain damage, which in turn can lead to more serious or long-term disorders.
Twins or Multiple Births
A pregnancy with more than one baby increases the chances of cerebral palsy. This is due to, in most cases, low birth weight or premature birth.
Low Birth Weight
Infants under five pounds are at an increased risk of developing cerebral palsy. Infants under three pounds have the highest risk. Since most infants who are born prematurely typically weigh five pounds or less, premature babies, generally, are at risk.
Since many infants born after infertility treatments tend to be born prematurely with low birth weights, the risk for CP is increased.
There is a common misconception that jaundice is a minor medical issue that won’t pose any long-term medical problems. However, if left untreated, jaundice can cause a host of serious problems, including brain damage and an increased risk of cerebral palsy.
Uterine rupture, placental problems and umbilical cord problems can all lead to an increased risk of the infant developing cerebral palsy due to loss of blood flow and oxygen to the baby.
Chorioamnionitis is inflammation of the fetal membranes and amniotic fluid caused by a bacterial infection. A study performed by San Diego’s University of California revealed that chorioamnionitis present in the womb during pregnancy increases the risk of an infant developing cerebral palsy by up to four times.
Incompatibility of blood types between a mother and infant can lead to Rh-factor diseases, increasing the risk of cerebral palsy. To prevent this problem, the mother who is Rh(-) blood type will be given a Rho (D) immune globulin injection starting at around the 28th week of pregnancy.
Acquired cerebral palsy occurs when an infant develops brain damage at least 28 days or more after birth. This type of cerebral palsy affects around 20 percent of all people who develop the disorder. The most common causes include:
- Low Birth Weight: Similar to congenital factors, low birth weight also increases the risk of acquired cerebral palsy.
- Blood Flow Problems: Blood flow problems, particularly to the brain, heighten the risk of acquired cerebral palsy. Common blood flow problems to brain can occur because of blood clotting, unformed blood vessels, sickle cell diseases and/or heart defects.
- Traumatic Head Injuries: Traumatic head injuries can happen when an infant is dropped, as in an accident or falls. If brain damage occurs after a traumatic brain injury, acquired cerebral palsy may follow.
Brain damage before, during or after birth can lead to cerebral palsy. In the past, many physicians believed that cerebral palsy was related to brain damage that occurred during birth because of asphyxiation. This in part is true, with at least one out of every 10 infants developing cerebral palsy after asphyxiation. However, recent research shows that brain damage that occurs before birth can also lead to some types of the disorder.
Mothers must be monitored frequently during pregnancy, especially if they have any infections or high blood pressure. Both infections and high blood pressure may lead to infant brain damage, which in turn can lead to cerebral palsy. In addition, abnormal brain development during pregnancy can lead to cerebral palsy.
Can Cerebral Palsy Be Prevented?
Because there are many causes of cerebral palsy, prevention strategies may seem somewhat general. Your doctor should advise you to follow all instructions during pregnancy, such as:
- Attend all prenatal visits
- Take regular walks (if applicable)
- Eat nutritious food
- Keep your vaccinations up to date
- Abstain from drugs or alcohol
Cerebral palsy may be caused by factors outside your control, such as birth injuries due to negligent medical care, but the best thing you can do to reduce the risk of your child developing cerebral palsy is to take care of yourself during your pregnancy.
Cerebral Palsy Symptoms
One of the most common questions that parents ask is “what are the symptoms of cerebral palsy?” Cerebral palsy is marked by spastic movements, a lack of muscle control and sometimes the inability to use muscles. It is often determined by abnormal, slow, writhing movements that the child cannot control. Additionally, muscle tone varies between floppy and stiff, which also could result in the use of some muscles over others. Other signs that your child may have cerebral palsy includes missing developmental milestones and/or intellectual disabilities.
According to the CDC, some of the clinical signs and symptoms of cerebral palsy include:
Cerebral palsy is a brain injury that comes from injury to the brain. Some areas of the brain are dormant and cause an abnormal reaction in the muscles from the resulting messages that the brain sends out. As a result, there are a myriad of muscle-related symptoms associated with the disorder. It’s important to remember, however, that not all children will exhibit the same symptoms and the severity of each symptom will depend upon each individual child.
A child with cerebral palsy has limited muscle control, or may have a complete loss of muscle control. This in turn may make what seems like simple tasks extremely difficult. For example, sitting down, walking, tying shoes and grasping objects may prove to be exhausting and hard for those with cerebral palsy.
Common muscle-related symptoms include:
- Lack of muscle coordination.
- Shaky, spastic movements.
- Muscles may become extremely stiff or extremely loose.
- Difficulty in controlling certain body movements.
- Inability to grasp small objects.
- Using the arms to pull themselves around while the legs drag behind (most prominent after 6 months of age and into the toddler years).
- Slow, writhing movements.
- Excessive drooling due to the inability to control facial muscles.
- Favoring one side of the body over the other side.
People with cerebral palsy may have abnormal reflex responses such as asymmetrical or symmetrical tonic reflex, palmar grasp reflex, spinal galant reflex and the Moro reflex. These reflexes are defined as:
- Tonic Neck Reflex: A reflex causing the infant’s head to turn to one side with the arm on that side outstretched. The other arm is bent at the elbow. This is sometimes called the “fencing position.” This reflex generally resolves around 5-7 months old.
- Palmar Grasp Reflex: When the palm of the infant’s hand is stroked, the infant grasps his or her fingers around the object. This is commonly seen in infants who grasp a family member’s finger. This reflex generally resolves within 5-6 months.
- Spinal Galant Reflex: The spinal galant reflex causes an infant to curve their hip outward when their lower back is stroked. Generally, this reflex resolves by nine months, but it can be retained longer.
- Moro Reflex: Moro reflexes may be present in some infants with cerebral palsy. The Moro reflex refers to a reaction where your infant’s head shifts abruptly and his or her arms and legs extend quickly when startled. After extension, the infant brings his or her arms together and often cries loudly. The Moro reflex generally resolves in two months or so after birth.
Coordination and Control
Both coordination and control are limited in children who have cerebral palsy. Problems with coordination and control are usually more pronounced when the child is stressed or overwhelmed. Common issues with coordination and control include:
- Spastic movements
- Walking with a wide gait
- Walking with toes pointed inward or outward
- Dragging one leg while walking
- Waddling when walking
Oral Motor Problems
Many people with cerebral palsy experience difficulties with communication because of the spastic movements of face muscles. In fact, around 90 percent of preschool-age children with cerebral palsy experience difficult oral-motor problems, such as:
- Difficulty speaking
- Excessive drooling
- Difficulty chewing or swallowing
Cerebral palsy hardly ever involves only intellectual disabilities as its greatest symptoms involve muscle-related disabilities. However, if your child exhibits muscle-related disabilities, there is a chance that they may also exhibit intellectual disabilities as well. Typical types of intellectual disabilities associated with cerebral palsy include:
- Missed Milestones: Perhaps one of the most significant indications of cerebral palsy (as long as other symptoms are present) is missed developmental milestones. For example, if a child hasn’t started talking by two years of age or doesn’t understand basic grammar such as “she” or “he” by the age of five, this may be an indication of cerebral palsy. Keep in mind, though, that children hit developmental milestones at different ages, so a delay in milestones alone isn’t always an indicator of a more serious problem.
- Below Average IQ: According to the American Academy of Pediatrics (AAP), children with an IQ below 70 are considered “below average” intellectually. Again, having a below average IQ score is not an indicator of cerebral palsy unless other symptoms are also present. Children with low IQs may have problems with daily self-care skills, reasoning, problem-solving and learning.
Almost every child goes through behavioral stages, such as the “terrible twos,” being rebellious and being self-centered. However, with a disorder such as cerebral palsy, these behavioral issues may be heightened. Studies suggest that many children with cerebral palsy will exhibit behavioral symptoms such as:
- Excessive anxiety
- Mood swings
- Social withdrawal
- Prolonged crying
- Temper tantrums
Along with delays in cognitive abilities, developmental delays, in general, are usually the first indicator that your child may have cerebral palsy. The most common forms of developmental delays include:
- Failure to smile by six weeks of age.
- Not rolling over without assistance by four months of age.
- Not sitting up without assistance by six months of age.
- Failure to walk by age two.
- Inability to climb stairs by three years of age.
- Failure to stand on one foot (for a few seconds) by three years of age.
How Cerebral Palsy Affects Children
We’ve discussed the symptoms of cerebral palsy, but not exactly how the disorder affects children. Parents often will look for symptoms of an injury, but may not understand exactly how a disorder like cerebral palsy affects their child – and the numerous other children with a similar disorder. Here are some of the ways that this disorder affects children:
Ability to Walk
Due to neurological complications sending wrong messages to muscle groups, walking is very difficult for many people with cerebral palsy. According to the CDC, among children with cerebral palsy:
- Around 58 percent of children can walk independently.
- Three percent of children require mobility assistance devices.
- Around 30 percent of children have limited or no walking ability.
- Around 41 percent of children have limitations in their ability to crawl, run, walk or play.
- Thirty-one percent of children require special equipment like a walker or wheelchair.
- Black children are 1.7 times more likely to have limited or no ability to walk than white children.
No matter what type of cerebral palsy your child has, one thing that most sufferers have in common is pain. Three out of every four patients with the disorder report being in pain. This could be due to spasticity and may also be due to inconsistent muscle tone that causes a chain reaction of pain through other muscles. Overcompensation, the inability to achieve a consistent gait and spinal problems are usually the cause of this pain.
One out of every four people with cerebral palsy has the inability to talk. Children and adults alike often experience the following difficulties:
- Gag reflex problems.
- Problems with controlling the esophageal muscles.
- Spinal problems that affect the position of esophageal muscles.
- Excessive drooling.
Speech therapy can often help children exercise these areas and hopefully gain control. Unfortunately, some children never gain complete control and struggle with speech difficulties permanently.
Due to nerve damage, one out of every 10 people with cerebral palsy suffers from hearing loss. Around one in every 50 people with cerebral palsy are completely deaf.
One out of every five people with cerebral palsy has some variation of a sleep disorder. Sometimes this is because spasticity keeps them awake. Other times, it is because of the pain that the individual is in. In addition, abnormal muscle tone may affect the chest muscles, which in turn, makes it hard for some people to breathe deeply.
Behavioral and Emotional Problems
Children with cerebral palsy often have a number of special needs that require them to be home-bound or under constant supervision. One out of every four children with cerebral palsy has behavioral problems or problems socializing with others. The most common behavioral issues include:
- Emotional outbursts
- Poor social skills
- Poor decision-making skills
- The tendency to “blackout” when angered
Tests to Confirm Cerebral Palsy Diagnosis
Early diagnosis of CP begins with a detailed medical history and physical examination and involves standardized assessments of neurologic and motor development. Your pediatrician will review the prenatal and birth history of your child, which can identify risk factors for CP, birth assessment records and family history.
During an assessment, your doctor will look for variances in muscle density (some muscles being too stiff and others being too floppy), coordination development, motor development, posture, growth, signs of intellectual disability, and accompanying impairments (vision, hearing, attention, behavior or cognitive). Beyond the general assessment, your doctor will likely order one or more tests that can help confirm a diagnosis of cerebral palsy, determine the underlying cause, and rule out other diagnoses. Some of the tests that your doctor may order include:
One test that your doctor can perform is a PET scan. A PET scan is a Positron Emission Tomography (PET) exam that uses radiation to produce 3-dimensional color images of the functional processes of the human body. Tracking gamma rays, the PET scan observes communication between the brain and the rest of the body. It then determines if the messages from the brain are reaching the limbs.
When a child has cerebral palsy, there are often problems with the brain’s functional processes (most people inaccurately believe that cerebral palsy is a muscle-only-related disease), and the PET scan allows doctors to identify if the brain is transmitting instructions to the muscles as it should.
An EEG is an Electroencephalogram – a test that identifies if there are any abnormalities in the brain waves or electrical activity in the brain. It is useful in evaluating severe hypoxic-ischemic injury. Where a PET scan tracks the communication between the brain and the rest of the body through the central nervous system, the EEG exclusively tests the brain activity to be sure that it’s working properly. Sometimes when a child has cerebral palsy, there is a problem with the way that alpha, beta, delta and theta waves are transmitted in the brain. Some children also have dead or dormant places in their brain and the EEG can help to see that. EEG can confirm a clinical diagnosis of epilepsy. However, EEG is not indicated if seizures are not suspected along with cerebral palsy.
Magnetic Resonance Imaging (MRI) is a scan that can be conducted on the whole body to produce a density-related image of the body. When an MRI is used on the brain, it is generally to get an image of the brain to clearly see the cortical and white matter structures and to see if there is a hemorrhage, inflammation or anything abnormal. In the case of cerebral palsy, doctors use MRIs to examine and detect appropriate myelination – a white, fatty substance that creates a sheath around the axis cylinder or certain nerve fibers in the brain. The delayed development of myelin, according to age, is another indication of dead or paralyzed areas of the brain, and may indicate the cause of cerebral palsy.
Cognitive assessments and medical observations are also useful to help confirm a cerebral palsy diagnosis. Additionally, evaluations of the child’s mobility, speech and language, hearing, vision, gait, feeding and digestion are also useful to determine the extent of the disorder.
Keep in mind that sometimes a diagnosis of cerebral palsy takes time. Depending on factors like malformations and congenital issues, diagnosis can take up to several years after a brain injury occurs. Furthermore, there isn’t a single test that can completely confirm or completely exclude cerebral palsy. Instead, a combination of factors and a series of tests, observations, assessments and evaluations are the best way to confirm a diagnosis.
Cerebral Palsy Treatment
Although cerebral palsy has no known cure yet, there are many treatment options that are proven to be successful in helping children with the disorder live more productively and independently. If you’re the parent of a child or infant with CP, it’s important to understand what treatment options are available in order to determine what will work best for your child.
Cerebral palsy is a complex disorder that ranges from mild to severe. Treatment will depend upon your child’s individual circumstances. Some of the most common treatment options for children with cerebral palsy include:
According to the American Physical Therapy Association, getting a child with cerebral palsy involved in physical therapy is one of the most important things you can do. Physical therapy involves rehabilitating the child’s physical disabilities through a series of muscle training exercises.
Since each child’s situation is unique, a professional physical therapist will typically perform an assessment, and based upon those findings, will develop an individualized physical therapy plan. Common exercises included in physical therapy sessions include:
- Specialized strength exercises
- Therapeutic endurance exercises
- Stretching and joint mobilization training
- Balance practice
In some instances, children with CP will have swimming therapy during their physical therapy sessions. These sessions are done with careful assistance and caution, but are extremely important as it allows children to utilize muscle groups and do therapeutic exercises they otherwise aren’t able to do. In addition, depending on the severity of the disability, some children may engage in dancing and ball-throwing. For those who are unable to move without assistance, specialized computers may be available, as well as wheelchairs and braces.
In some instances, surgery is a viable option in order to control pain, prevent deformities and improve mobility. There are several different types of surgeries that are useful in treating cerebral palsy symptoms. The most common forms of surgery include:
Hearing surgery treats ear blockages or infections that many people with cerebral palsy are prone to. This type of surgery also helps treat nerve fiber damage to the inner ear, another common problem among children with the disorder. Alongside surgery, hearing aids, sign language, computer visuals, lip cues and body gesture training are helpful to improve hearing function.
Surgery for Medicinal Needs
Children who rely on medication for consistent, chronic pain may benefit from a surgical procedure that allows the medicine to dispense continuously. A Baclofen (a muscle relaxer) pump is the most common method used to dispense medicine to those with severe pain associated with cerebral palsy.
Orthopedic surgery is the most common type of surgery for cerebral palsy patients. It is considered the least invasive compared with other forms of surgeries. Most children undergo orthopedic surgery in their lower extremities (legs, ankles, feet). However, depending on the type of cerebral palsy, some children benefit more from orthopedic surgery on their upper extremities (arms, shoulders, upper back).
Vision surgery helps patients with cerebral palsy have more control over eye movement. Surgery can also help repair vision loss and/or impairment. However, before surgery is offered physicians generally test eyeglasses or contacts first. If vision is still impaired, surgery may follow.
Medications used to treat cerebral palsy are meant to help patients control pain and reduce complications associated with the disorder. As with other forms of treatment, the type of medication your child needs will depend on the severity and complications related to the disorder. The most common types of medication for cerebral palsy include:
- Muscle Relaxants: Muscle relaxants like Valium and Baclofen promote muscle relaxation by reducing spasms and stiff muscles. Most muscle relaxants are given orally unless a special surgery is needed for continuous administration.
- Seizure Medication: Seizures are a common problem for many people who have cerebral palsy. Anti-seizure medication like Depakene helps control seizures. Anticonvulsant medications such as Trileptal and Lamictal are also useful.
- Anticholinergic Medication: For people who suffer from dystonic cerebral palsy, anticholinergic medication, such as Robinal, may be prescribed. These types of medications help those who drool often and have uncontrollable body movements.
It’s important to note that many doctors feel that giving muscle relaxant medication to growing children is harmful, specifically because the side effects may be more detrimental than the spasms and muscle stiffness. Some doctors, however, feel that the benefits that muscle relaxants give to children with CP outweigh the side effects.
Stem Cell Injections
Currently, researchers are developing many experimental treatments to alleviate or cure cerebral palsy, including stem cell therapy. In 2013 an 11-year-old boy from Detroit participated in a trial by the U.S. Food and Drug Administration (FDA) in which his cord blood stem cells were used to treat his cerebral palsy. His condition was so severe that he could not walk, talk or hold his head up for more than a few seconds.
According to reports, it took two rounds of stem cell injections between January and May of 2013 before he showed any sign of improvement. However, after the second round of injections began, he was able to sit up on his own for the first time in his life. His mother noted,
“It was incredible. I never thought I would see it, honestly, and to see if for the split second or the couple seconds that it was happening, made my day, made my week, my month. And then now, just a couple months later, you know, seeing him able to sit for minutes at a time, it’s incredible. I never thought that I would see that.”
Though the stem cell injection treatment improved Drew’s ability to control some of his movements, it did not cure his cerebral palsy. Stem cell therapy presents a promising treatment option for children with cerebral palsy. However, this treatment is still in its infancy and much research needs to be performed. Currently, there are clinical trials of this therapy happening in Georgia and Texas.
Alternative and Complementary Treatments
Although most alternative and complementary treatments for cerebral palsy have not been approved by the FDA, numerous parents and loved ones have seen positive results. Keep in mind, however, that not all treatment options work the same for each person.
If you are interested in more natural and holistic ways to help your child, consider the following:
- Hyperbaric oxygen therapy
- Therapeutic electrical stimulation (TES)
- Alternative learning, such as conductive education
- Equestrian therapy
- Massage therapy
- Energy-channeling therapy
Cerebral Palsy Prognosis
Many infants and children diagnosed with cerebral palsy have a normal lifespan. However, it’s important to note that the prognosis is different for each person depending on the severity of the disorder and any additional conditions.
Although cerebral palsy is not a progressive condition and many children can lead productive and fulfilling lives, there are certain factors that every parent should take into account when dealing with the prognosis and life expectancy of a child with a disorder that is so complex. Understanding these factors will help parents reduce health risks and help their children maintain the best quality of life as possible with their given situations:
Amount of Impairments and Disabilities
The more impairments and disabilities a child with cerebral palsy suffers from, the more likely the prognosis will be negatively affected. Yet, the severity of each impairment also plays a significant role in the prognosis. For example, a child with severe seizures and acute cognitive impairment may have a more grim prognosis when compared to a child who only has occasional mild seizures and mild cognitive impairment.
Another important aspect of a child’s prognosis is mobility issues. The risk of other health-related issues heightens with the seriousness of limited mobility. For instance, a child who is severely impaired, such as a quadriplegic, will have a different prognosis than a child who can walk without assistance. Children with severe mobility impairments are often more likely to:
- Have physical and emotional health problems due to lack of exercise.
- Get sick more often than others with less severe manifestations of the condition. Since they are unable to exercise their muscles, their immune systems are weaker and they are more susceptible to infections and viral diseases.
- Suffer from pressure ulcers. If left untreated, pressure ulcers can fester and lead to life-threatening conditions.
Furthermore, physical inactivity affects the mind-body connection. A lack of exercise often causes a child to suffer from learning disabilities and psychological problems such as depression. The inability to move independently and join other children in leisure activities isolates children with severe forms of cerebral palsy and places limits on their social skills that are not present in children with milder varieties of the disability.
Isolation not only prevents a disabled child from being able to make friends and develop social relationships, it also shortens life expectancy.
Children who are able to feed themselves are more likely to have a better prognosis as opposed to those who are dependent upon others for nutrition. Children who cannot feed themselves are more prone to problems, such as:
- Lung inflammation
Parents of children who cannot feed themselves have options such as feeding tubes, but diet and nutrition must be closely monitored. It’s recommended that parents and loved ones work with a certified nutritionist who specializes in diet plans for special needs children.
Studies are still being conducted as to whether vision problems affect the prognosis of a child with cerebral palsy. Researchers and scientists are unsure whether the visual problems alone reduce life expectancy or if a brain injury that leads to vision impairment affects the prognosis at all.
How to Optimize Your Child’s Prognosis
Even though problems related to cerebral palsy create many challenges for disabled children, their families and caregivers, there are several ways to improve your child’s prognosis. Keep in mind that not every case of cerebral palsy is the same. Furthermore, you and your child’s healthcare team must tailor a care plan around your child’s specific needs. This requires everyone involved to be aware of the child’s physical and cognitive issues, provide the necessary treatments and promptly address issues that require attention.
Setting goals is also an important factor in the success of your child’s comprehensive care plan. To optimize a prognosis, you and your child’s healthcare team should:
- Determine and consistently follow goals to treat your child’s physical disability.
- Start physical therapy and other forms of treatment as soon as possible to ensure positive results.
- Be mindful of any complications that may arise. These complications can be life-threatening, but being observant and reporting them to your child’s physician can lessen their negative effects.
Strategies for Optimizing Quality of Life
An effective life care plan for a child with cerebral palsy should include strategies for:
- Improving your child’s ability to move
- Instilling a sense of independence for your child as much as possible
- Encouraging self-care
- Encouraging your child to interact with others
- Cultivating and maximize learning skills
- Finding solutions to common health problems
- Learning about pain management and which methods work best for your child
Living with cerebral palsy takes adjustments, planning and patience. It is important to remember that a diagnosis of cerebral palsy does not mean that the individual will not have a fulfilling life. Yes, it is a challenging disorder. However, there are options for therapy and treatments that can help overcome some challenges and promote a healthy and full life.