Cerebral Palsy FAQ

Doctors use the term cerebral palsy to refer to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination but aren’t progressive, in other words, they don’t get worse over time. The term cerebral refers to the two halves or hemispheres of the brain, in this case to the motor area of the brain’s outer layer (called the cerebral cortex), the part of the brain that directs muscle movement; palsy refers to the loss or impairment of motor function.

Even though cerebral palsy affects muscle movement, it isn’t caused by problems in the muscles or nerves. It is caused by abnormalities inside the brain that disrupt the brain’s ability to control movement and posture.

In some cases of cerebral palsy, the cerebral motor cortex hasn’t developed normally during fetal growth. In others, the damage is a result of injury to the brain either before, during, or after birth. In either case, the damage is not repairable and the disabilities that result are permanent.

The symptoms of cerebral palsy differ in type and severity from one person to the next, and may even change in an individual over time. Some people with cerebral palsy also have other medical disorders, including mental retardation, seizures, impaired vision or hearing, and abnormal physical sensations or perceptions.

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.

Cerebral palsy isn’t a disease. It isn’t contagious and it can’t be passed from one generation to the next.

There is no cure for cerebral palsy, but supportive treatments, medications, and surgery can help many individuals improve their motor skills and ability to communicate with the world.

The United Cerebral Palsy (UCP) Foundation estimates that nearly 800,000 children and adults in the United States are living with one or more of the symptoms of cerebral palsy. According to the federal government’s Centers for Disease Control and Prevention, each year about 10,000 babies born in the United States will develop cerebral palsy.

Despite advances in preventing and treating certain causes of cerebral palsy, the percentage of babies who develop the condition has remained the same over the past 30 years. Improved care in neonatal intensive-care units has resulted in higher survival rates for very low birth weight babies. Many of these infants will have developmental defects in their nervous systems or suffer brain damage that will cause the characteristic symptoms of cerebral palsy.

The early signs of cerebral palsy usually appear before a child reaches 3 years of age. Parents are often the first to suspect that their baby’s motor skills aren’t developing normally. Infants with cerebral palsy frequently have developmental delay, in which they are slow to reach developmental milestones such as learning to roll over, sit, crawl, smile, or walk. Some infants with cerebral palsy have abnormal muscle tone as infants. Decreased muscle tone (hypotonia) can make them appear relaxed, even floppy. Increased muscle tone (hypertonia) can make them seem stiff or rigid. In some cases, an early period of hypotonia will progress to hypertonia after the first 2 to 3 months of life. Children with cerebral palsy may also have unusual posture or favor one side of the body when they move.

Parents who are concerned about their baby's development for any reason should contact their pediatrician. A doctor can determine the difference between a normal lag in development and a delay that could indicate cerebral palsy.

There are many different causes. Birth complications, including asphyxia, are estimated to account for up to 10 percent of the babies born with cerebral palsy.

A small number of children have acquired cerebral palsy, which means the disorder begins after birth. In these cases, doctors can often pinpoint a specific reason for the problem, such as brain damage in the first few months or years of life, brain infections such as obstetrical malpractice, bacterial meningitis or viral encephalitis, or head injury from a motor vehicle accident, a fall, or child abuse.

Just as there are particular types of brain damage that cause cerebral palsy, there are also certain medical conditions or events that can happen during pregnancy and delivery that will increase a baby’s risk of being born with cerebral palsy. Research scientists have examined thousands of expectant mothers, followed them through childbirth, and monitored their children’s early neurological development to establish these risk factors. If a mother or her baby has any of these risk factors, it doesn’t mean that cerebral palsy is inevitable, but it does increase the chance for the kinds of brain damage that cause it.

Low birth weight and premature birth . The risk of cerebral palsy is higher among babies who weigh less than 5 ½ pounds at birth or are born less than 37 weeks into pregnancy. The risk increases as birth weight falls or weeks of gestation shorten. Intensive care for premature infants has improved dramatically over the course of the past 30 years. Babies born extremely early are surviving, but with medical problems that can put them at risk for cerebral palsy. Although normal- or heavier-weight babies are at relatively low individual risk for cerebral palsy, term or near-term babies still make up half of the infants born with the condition.

Multiple births. Twins, triplets, and other multiple births -- even those born at term -- are linked to an increased risk of cerebral palsy. The death of a baby’s twin or triplet further increases the risk.

Infections during pregnancy. Infectious diseases caused by viruses, such as toxoplasmosis, rubella (German measles), cytomegalovirus, and herpes, can infect the womb and placenta. Researchers currently think that maternal infection leads to elevated levels of immune system cells called cytokines that circulate in the brain and blood of the fetus. Cytokines respond to infection by triggering inflammation. Inflammation may then go on to cause central nervous system damage in an unborn baby. Maternal fever during pregnancy or delivery can also set off this kind of inflammatory response.

Blood type incompatibility. Rh incompatibility is a condition that develops when a mother’s Rh blood type (either positive or negative) is different from the blood type of her baby. Because blood cells from the baby and mother mix during pregnancy, if a mother is negative and her baby positive, for example, the mother’s system won’t tolerate the presence of Rh-positive red blood cells. Her body will begin to make antibodies that will attack and kill her baby’s blood cells. Rh incompatibility is routinely tested for and treated in the United States , but conditions in other countries continue to keep blood type incompatibility a risk factor for cerebral palsy.

Exposure to toxic substances. Mothers who have been exposed to toxic substances during pregnancy, such as methyl mercury, are at a heightened risk of having a baby with cerebral palsy.

Mothers with thyroid abnormalities, mental retardation, or seizures. Mothers with any of these conditions are slightly more likely to have a child with cerebral palsy.

There are also medical conditions during labor and delivery, and immediately after delivery, that act as warning signs for an increased risk of cerebral palsy. Knowing these warning signs helps doctors keep a close eye on children who face a higher risk. However, parents shouldn’t become too alarmed if their baby has one or more of these conditions at birth. Most of these children will not develop cerebral palsy.

This depends on the type of cerebral palsy. Acquired cerebral palsy, often due to head injury, is preventable using common safety tactics, such as using car seats for infants and toddlers, and making sure young children wear helmets when they ride bicycles. In addition, common sense measures around the household, such as supervising babies and young children closely when they bathe, can reduce the risk of accidental injury.

Despite the best efforts of parents and physicians, however, children will still be born with cerebral palsy. Since in many cases the cause or causes of cerebral palsy aren’t fully known, little can currently be done to prevent it. As investigators learn more about the causes of cerebral palsy through basic and clinical research, doctors and parents will know more about how to prevent this disorder.

The specific forms of cerebral palsy are determined by the extent, type, and location of a child’s abnormalities. Doctors classify cerebral palsy according to the type of movement disorder involved -- spastic (stiff muscles), athetoid (writhing movements), or ataxic (poor balance and coordination) -- plus any additional symptoms. Doctors will often describe the type of cerebral palsy a child has based on which limbs are affected.

The names of the most common forms of cerebral palsy use Latin terms to describe the location or number of affected limbs, combined with the words for weakened (paresis) or paralyzed (plegia).

For example, hemi paresis (hemi = half) indicates that only one side of the body is weakened. Quadriplegia (quad = four) means all four limbs are paralyzed.

Spastic hemiplegia/hemiparesis . This type of cerebral palsy typically affects the arm and hand on one side of the body, but it can also include the leg. Children with spastic hemiplegia generally walk later and on tip-toe because of tight heel tendons. The arm and leg of the affected side are frequently shorter and thinner. Some children will develop an abnormal curvature of the spine (scoliosis).
Depending on the location of the brain damage, a child with spastic hemiplegia may also have seizures. Speech will be delayed and, at best, may be competent, but intelligence is usually normal.
Spastic diplegia/diparesis. In this type of cerebral palsy, muscle stiffness is predominantly in the legs and less severely affects the arms and face, although the hands may be clumsy. Tendon reflexes are hyperactive. Toes point up. Tightness in certain leg muscles makes the legs move like the arms of a scissor. Children with this kind of cerebral palsy may require a walker or leg braces. Intelligence and language skills are usually normal.
Spastic quadriplegia/quadriparesis . This is the most severe form of cerebral palsy, often associated with moderate-to-severe mental retardation. It is caused by widespread damage to the brain or significant brain malformations. Children will often have severe stiffness in their limbs but a floppy neck. They are rarely able to walk. Speaking and being understood are difficult. Seizures can be frequent and hard to control.
Dyskinetic cerebral palsy (also includes athetoid, choreoathetoid, and dystonic cerebral palsies). This type of cerebral palsy is characterized by slow and uncontrollable writhing movements of the hands, feet, arms, or legs. In some children, hyperactivity in the muscles of the face and tongue makes them grimace or drool. They find it difficult to sit straight or walk. Children may also have problems coordinating the muscle movements required for speaking. Intelligence is rarely affected in these forms of cerebral palsy.
Ataxic cerebral palsy. This rare type of cerebral palsy affects balance and depth perception. Children will often have poor coordination and walk unsteadily with a wide-based gait, placing their feet unusually far apart. They have difficulty with quick or precise movements, such as writing or buttoning a shirt. They may also have intention tremor, in which a voluntary movement, such as reaching for a book, is accompanied by trembling that gets worse the closer their hand gets to the object.
Mixed types. It is common for children to have symptoms that don’t correspond to any single type of cerebral palsy. Their symptoms are a mix of types. For example, a child with mixed cerebral palsy may have some muscles that are too tight and others that are too relaxed, creating a mix of stiffness and floppiness.