Parents Zone

Cerebral Palsy

What Is Cerebral Palsy?
Cerebral Palsy is a condition in which the brain is permanently damaged, and affects movement.  This is not a hereditary disorder, however there are some genetic disorders which can cause brain damage and give a child symptoms similar to that of cerebral palsy.  While incurable at this stage and not something your child will simply outgrow,   you can be assured that they will not become worse over time.  The abnormal movements which are common with Cerebral Palsy are a result of the brain sending incorrect signals to the muscles, but with excellent care and therapy many children do improve.

What Are The Causes?
It is usually during pregnancy, labour, delivery or the initial days of early life when the brain is still developing, that your baby is at most risk.  1 in 400 Australian babies are born with Cerebral Palsy, and it is those born prematurely or with a low birth weight who are most at risk.  Cerebral Palsy can also occur later in life as a result of an injury or infection which has damaged the brain.

Many cases of Cerebral Palsy occur for no known reason, but most occur due to some of the prenatal factors mentioned below.

• Lack of oxygen or blood circulation to the brain – There are many reasons that may cause this to occur such as: loss of heartbeat, umbilical cord being wrapped tightly about the neck, the placenta's separation from the uterus wall, the mother's blood pressure dropping or rising, failure of bub to breathe well following delivery, secretions in baby's airway, or breathing and blood supply problems in the infant or child.

• Bleeding or lack of adequate blood flow in baby's brain – Premature babies are more likely to have abnormal bleeding or hemorrhages in the brain, which often occurs in the parts of the brain known as the ventricles where the cerebral spinal fluid circulates.  Cerebral palsy may also be a result of abnormal blood vessels in the brain or if the blood vessel supplying the brain becomes blocked.

• Abnormal or incomplete development of brain structures – A baby's head size is used by doctors and nurses to gauge the growth of the brain.  For some babies certain brain structures, such as agenesis of copus collosum is missing or abnormal which results in a small brain size and can further result in cerebral palsy.  A small head size usually signifies a small brain and is called microcephany or just simply small brain.

• Infection – Whether it be viral, fungal or bacterial, any infection either contracted by Mum during pregnancy or delivery, or by baby in infancy or childhood can result in cerebral palsy if the brain is effected.  Common infections for Mum are Rubella, Cytomegalovirus (a member of the herpes family) or Herpes, and for the child Meningitis or Encephalitis.

• Rh Incompatibility – A mother's immune system may attack a baby's tissues if baby has a specific blood protein that the mother lacks, if the incompatibility is left untreated. This can result in cerebral palsy. Prenatal testing can detect if this is a problem and steps can be taken to treat it. 

• Accidents – Cerebral Palsy can occur through accidents or injuries which result in brain damage.  Head injuries sustained in a car accident, during a fall or through child abuse put your child at risk in later life.  Electrocution, drowning, poisoning, suffocation, Hypothermia (extremely low body temperatures) or Hyperthermia (extremely high body temperatures) can also cause brain damage and cerebral palsy.

• Birth Complications -  Any complication during pregnancy, labour or delivery can increase the likelihood of brain damage in your child.  Abnormally long or short labours, forcep delivery, breech birth, premature labour or multiple births, all increase the chances.  In multiple births it is not uncommon for one baby to have cerebral palsy and the other/s not to.

Types Of Cerebral Palsy
The type of cerebral palsy your child has is dependent upon the area/s of the brain which have been damaged.  It is possible for your child to be diagnosed as having one or more types of the disorder which is usually a description of the response your child's body makes when they try to move, or you try to move them. 

There are 5 basic types of cerebral palsy, however your child may be diagnosed as having more than one.  Below are the 5 basic types.

1. Spastic – The part of the brain damaged in this type is typically the motor cortex or corticospinal tracts.  If your child has been diagnosed with Spastic cerebral palsy it usually means that one or more of their limbs are stiff and have difficulty moving smoothly.  It is common for them to hold a spastic body part in an unusual position, such as; they may be able to easily bend their knee, but have difficulty straightening it. 

2. Athetoid – A child with this type of cerebral palsy often alternates between being stiff and being floppy.  They often stiffen and arch backwards when moved suddenly or when they become excited, but will then collapse.  One minute you can have difficulty bending them they have become so stiff and tight, and the next they cannot hold their head or body up as they become floppy.  Frequently, those diagnosed as having athetoid cerebral palsy, have damage to the basal ganglia area of the brain.

3. Ataxic – This type is a result of the damage sustained to the cerebelum.  Your child will have frequent tremors or trembling when they attempt to move.  An attempt to sit up, walk or just to support themselves can result in their head and trunk to tremor. The trembling can worsen the more your child struggles with a particular movement or posture.  They often have a fear of falling and poor coordination.

4. Hypotonic – Damage has usually been sustained throughout the whole brain if your child has this type of cerebral palsy, a specific area of damage having been impossible to locate.  It is not uncommon for a child with Hypotonia to appear double-jointed and flexible.  They feel soft and pliable when you hold them and tend to be floppy all the time.  Holding the head up, rolling, sitting, crawling and even walking is extremely difficult, and they may tire easily and appear to be in a constant state of laziness or sleepiness.  Often they will try not to move, preferring to remain very still.  A child with hypotonic cerebral palsy is often described as being undemanding and happy.

5. Mixed – It is common for many children to have more than one type of cerebral palsy.  An example of this is: they may be spastic with a hypotonic trunk, where there has been several areas of the brain damaged, then a combination of types may be evident in one child.

Affected Body Parts
Commonly it is the shoulders, hips, back, chest and abdomen (trunk) which are affected by cerebral palsy.  These muscles are not as strong, balanced or coordinated as those not affected by the disorder. 

The classifications below help organise the treatment approach, but there are no two children who have cerebral palsy that are alike.  Their strengths and challenges are unique to them, just like no other child is exactly like yours.

• Monoplegia is uncommon with only one body part being affected.

• Diplegia is a common pattern in premature babies where the lower half of the body is affected more so than the upper – both legs, the pelvis and the hip muscles.  Although the legs are more severely affected, the arms are usually affected to a lesser degree and one side in particular more affected than the other.

• Hemiplegia is where an upper limb (arm) and a lower limb (leg) on the same side of the body is affected.  In most cases the hand is more severely affected than the foot.

• Quadriplegia has both the arms and both the legs as well as the trunk being affected.  Again the upper limbs (arms) are affected more severely than the lower (legs) but sometimes they can be affected equally.  It is also common for one side of the body to be more affected than the other.

Symptoms In Your Baby
The symptoms outlined below are some of the most common seen in kids and babies with cerebral palsy.  They may appear slowly over time while others are evident in the early stages of your infant's life.  Your child can show one, or several of the symptoms, but one thing is certain, every baby is different in the way they look, move, behave and function.
• Movement – Problems with voluntary or purposeful movement is always evident in a child with cerebral palsy.  Difficulties arise in most of the areas mothers and fathers anticipate their child accomplishing, such as, lifting or holding up their head, or rolling.  Instead baby may lay still in the cot or s/he may arch their back and move backwards, placing most of their weight on the back of the head which often results in a bald spot.
Baby may slump into your shoulder, or alternatively be unnaturally stiff when held.  You may have difficulty bending baby at the hips, or the legs may remain stiff causing problems when trying to change their nappy.  Their hands may remain tightly fisted with their thumbs tucked snuggly inside, and their toes may also remain curled.
At rest baby may be limp and floppy, but becomes stiff when trying to move.   After attempting movement baby may collapse limply again.  Expect your baby to perform movement skills in an unusual way and at a slower pace than is normal.

• Feeding – A weak suckle and difficulty coordinating mouth and throat muscles is also common in babies with cerebral palsy.  The time it takes for them to eat may be lengthy and tire them out.  Some children require special equipment or feeding methods in order to ensure they are receiving all the nourishment they need, while others have no feeding problems and eventually will join you at the table, sometimes requiring special utensils, sometimes normal ones.

• Behaviour – Babies with cerebral palsy tend to have difficulty staying alert or being calm.  They can become irritable and jumpy and tend to experience lengthier bouts of crying than a colicky baby, which can be accompanied by them stiffening up, arching or uncontrollable trembling. Although a lot of the symptoms mentioned here such as the jumpiness, crying, and trembling is quite normal for any baby, the episodes last longer in babies with cerebral palsy and is always coupled with movement problems.
Some babies are undemanding, sleeping a lot of the time, and often having to be woken to eat. Their alertness is very short-lived and they often become floppy or limp, and tend to remain in the position you place them.  Most will not react to sounds by turning their head or won't focus on a face or object.  Although babies without cerebral palsy often startle at loud noises or sudden movements for a while until they grow accustomed to them, babies with cerebral palsy don't seem to ever get used to them.  It is because of their movement problems and not because they are nervous babies.

What To Expect As Your Child Grows
As with any baby, infant or child it is impossible to predict how and when they are going to develop or pass each of the milestones.  The only thing known for sure is that some kids with cerebral palsy pass the milestones much slower than those without, and some reach a certain point and stop, seemingly unable to go any further.

It is said that location, type and the extent of the brain damage can give some sort of indication, although some children who have parts of their brain missing or have areas with severe damage can function very well.  While scans such as CT's and MRI's are relied upon to determine the brain's structure, they in no way can determine the integrity or how well a certain area of the brain works, and in some instances of a child with a severe disability they have been known to return completely normal results.