Cerebral
Palsy

Even though Cerebral Palsy affects muscle movement, it isn’t caused by problems in the muscles or nerves. It is caused by abnormalities in parts of the brain that control muscle movements.

The majority of children with Cerebral Palsy are born with it, though it may not be detected until months or years later. The early signs of Cerebral Palsy usually appear before a child reaches 3 years of age. 

Signs of Cerebral Palsy: 

• lack of muscle coordination when performing voluntary movements (ataxia)
• stiff or tight muscles and exaggerated reflexes (spasticity)
• walking with one foot or leg dragging
• walking on the toes
• a crouched gait or a “scissored” gait
• muscle tone that is either too stiff or too floppy.

A small number of children have cerebral palsy as the result of brain damage in the first few months or years of life, brain infections such as bacterial meningitis or viral encephalitis, or head injury from a motor vehicle accident, a fall, or child abuse. 

Cerebral Palsy doesn’t always cause profound disabilities. While one child with severe Cerebral Palsy might be unable to walk and need extensive, lifelong care, another with mild cerebral palsy might be only slightly awkward and require no special assistance. Supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world.

There are four main types of Cerebral Palsy:

• Spastic Cerebral Palsy: 

This is the most common form of Cerebral Palsy and affects 70% to 80% of all sufferers. It is characterised by stiffness and contractions (spasticity) of the muscles. The lower legs may turn in and cross at the ankle (scissor gait). Sometimes the long muscles on the back of the legs are so tightly contracted that the heels of the feet do not touch the ground and the child walks on tiptoe. Spastic Cerebral Palsy is usually caused by damage to the area of the brain that controls movement.

• Athetoid (Dyskinetic) cerebral palsy: 

This type of Cerebral Palsy affects 10% to 20% of all sufferers and is characterised by slow, uncontrolled, writhing movements. Muscles are weak and change from being floppy to being tense. Facial muscles may be affected causing distorted facial movements and drooling. Speech may be hard to understand because of difficulty with controlling the tongue, vocal cords and breathing. Uncontrolled movements may increase during times of stress, and may disappear when sleeping. Athetoid cerebral palsy is caused by damage to the middle part of the brain.

• Ataxic cerebral palsy:

This is the least common form of Cerebral Palsy, affecting 5% to 10% of all sufferers. It is characterised by poor co-ordination of movement and poor muscle tone. The sense of balance and depth perception is affected and there is a lack of co-ordination when standing and/or walking. Movements may be shaky and a tremor may be present. This type of Cerebral Palsy is the result of damage to the cerebellum at the base of the brain. 

• Mixed Cerebral Palsy:

This type of Cerebral Palsy affects about 10% of all sufferers. In this type of cerebral palsy several areas of the brain are affected, so the condition may involve several of the characteristics mentioned above.

Cerebral Palsy, particularly spastic Cerebral Palsy, can be further classified according to the part(s) of the body that are affected eg: If only one limb is affected, it is called monoplegia. If two limbs are affected, it is called diplegia. If the arm and leg on the same side are affected, the condition is called hemiplegia. If all four limbs are equally affected it is called quadriplegia.

Cerebral Palsy cannot be cured but it can be managed. A management plan aims to help the child achieve maximum potential in growth and development through the combined efforts of doctors, therapists, educationalists, parents and the child.

Motivation is an important factor in how well any management plan will succeed. Emphasis is placed on the integration of games and play into the programme.

• Physiotherapy: Physiotherapy plays an important role in the management of Cerebral Palsy. Exercises and activities are designed to increase the function of those parts of the body that are not affected by Cerebral Palsy and to maximise the function in parts that are affected. Physiotherapists often work very closely with our Orthotic team to provide adaptive orthotic solutions to aid the function and mobility of those body parts affected.
• Occupational Therapy: Occupational therapy helps with daily living needs. These include how to dress, hold a cup, clean teeth etc, as well as vocational training.
• Speech Language Therapy: Where speech is affected, speech language therapy aims to maximise communication skills. It can also be useful where there are swallowing difficulties.
• Educational Therapies: There are a number of different educational therapies that can be effective in the management of Cerebral Palsy. 

Examples of Educational Therapies include:

• Conductive Education: This educational system was developed by Professor Andras Peto in Hungary. It uses an holistic approach that encompasses all aspects of learning such as motor skills, cognitive development and social and emotional skills. The programme was developed specifically for children with movement disorders.
• Bobath: This educational therapy has a neuro-developmental approach. It is based on the premise that Cerebral Palsy is due to interference with the development of normal postural control against gravity. Management is aimed at increasing co-ordinated movement patterns.
• Feldenkrais: This therapy is a form of education that uses gentle movement and directed attention to improve movement and enhance functioning.