Cerebral Palsy

Disease Process

Cerebral Palsy (CP) is a disorder that appears in the first few years of life that is characterized by changes in the ability to control and move the body. Some people with CP also have other medical problems such as seizures or mental impairment, but it is important to note that CP does not always cause severe handicap. Signs of CP are usually noticed before 2 years of age. Infants with CP tend to be delayed in reaching their developmental milestones such as learning to roll over, sit, crawl, smile, or walk. In CP, there is damage to the brain that causes this inability to control movement and posture. CP is a non-progressive disease. There are 4 types of CP:

1. Spastic – 50% of all cases – increased muscle tone.
2. Dyskinetic – 20% of all cases – abnormal twisting and jerking of movements.
3. Ataxic – 10% of all cases – tremors, unsteady gait, loss of coordination.
4. Mixed – 20% of all cases – a combination of the above.

CP is caused by injury to the cerebrum (largest part of the brain). Possible reasons for this to occur include:

• Fetal hypoxia (low levels of oxygen).
• Premature babies have a slightly higher chance of developing CP.
• In early infancy as a result of:
  • Illness (encephalitis, meningitis, herpes simplex inflection).
  • A head injury.
  • A Blood vessel injury (results in decreased blood flow to the brain).

The classic finding of CP is spasticity (an increase in muscle tone) that may affect:

• One single limb.
• One side of the body (hemiplegia).
• Both legs (diplegia).
• Both arms and both legs (quadriplegia).
• CP may also affect hearing, vision and cognition (mental capabilities).

Signs that the health care provider will look for in diagnosing CP include:

• Delay in development of motor skills.
• Mental retardation.
• Difficulty with hearing and talking.
• Spasticity.
• Progressive loss of motion in the joints (contracture) which leads to a decrease in range of motion (ROM).
• Difficulty sucking or feeding.
• Irregular breathing.

Current Treatment

There is no cure for CP. The goal of treatment is to maximize independence with all activities. Treatment will vary from person to person and is determined by the symptoms that are displayed. Treatment may include physical, occupational or speech therapy. They will be able to further determine the individual needs and can help asses the need for bracing, special equipment and wheelchairs. They can help teach the parents or caregivers how to help care for the person with CP. Other health care providers may be consulted to determine the need for glasses, hearing aids and medication (to decrease tremors, spasticity and seizures). Sometimes surgery to increase movement is necessary if significant joint contractures have developed. A newer technique for decreasing spasticity is the use of “bo-tox” injections directly into the affected muscles.

How Can Physical Therapy Help

Physical Therapy plays an important role in the life of a person with CP. As an infant or child, the physical therapist will:

• Evaluate the developmental milestones to see how the patient is progressing.

• Evaluate and treat limitations in range of motion, flexibility and strength.
• Evaluate the quality of gait and work towards making it more efficient.
• Work on safe transfers to all surfaces.
• Work on balance.
• Evaluate for and fit with adaptive equipment, assistive devices, braces and wheelchairs as needed.
• Work with caregivers and family members on how to assist and care for the patient.

Patient Resources

United Cerebral Palsy
National Institute of Neurological Disorders and Stroke
American Academy of Orthopedic Surgeons
Normal developmental milestones in the first year (from iVillage).
Developmental Milestones (University of Michigan).

Megan Hubbard, DPT © 2005   |  disclaimer   |