Cerebral Palsy

Cerebral palsy (CP) is the most common form of motor disability in children. CP refers to a group of non-progressive disorders of movement and posture that limit the child’s activity. CP is caused by a brain injury suffered during the development of the brain of a foetus or young child. This brain injury may occur during pregnancy, birth, or the early years of the child’s life. These motor disorders are often accompanied by sensory, perceptual, cognitive, and communication impairment and by epilepsy and secondary musculoskeletal problems.

The most common cause of CP is a lack of blood supply to a developing brain due to haemorrhages, inflammations, or strokes. Causes differ considerably, however, and they are unknown in many cases. (In 40% of cases, the cause of CP is unknown and may owe to deformities, brain injury suffered by the foetus because of infection or a lack of oxygen and blood supply, problems during childbirth, and postnatal secondary effects of meningitis, encephalitis, road traffic accidents, drowning, etc.).

By definition, the injury is stable (non-progressive), and the disorders are persistent yet change over time. Manifestations of CP depend on the extent and location of the brain injury and the brain’s capacity to adapt to the injury. Our constantly improving knowledge of neuroplasticity mechanisms suggests that neurodevelopment continues throughout our entire life. This knowledge also highlights the importance of intensive, specialized rehabilitation for patients with CP. In recent years, the prognosis for patients has improved because of new therapeutic tools and approaches.

Disorders of postural fixation
Failure to suppress primitive reflexes
Paresis, paralysis, or disorders of the functional patterns of
voluntary mobility
Spasticity and other muscle tone disorders
Involuntary movements
Trouble developing control of balance and posture

Early medical signs may appear at any time between birth and the age of 3 years. Some early medical signs (before the age of 3–4 months) that may suggest some kind of irregularity are:

Trouble swallowing and irregularities in newborns’ oromotor abilities
Lack of spontaneous movements at 2–4 months
Lack of social smiling at 3 months
Lack of eye tracking at 3 months
Complete lack of head control at 3 months
Serious hypotonia
Serious spasms or rigidity
Clear preference to move one part of the body

There are several classifications according to topography (the parts of the body affected at the motor level), neuropathology (the injured brain structures), and irregularities in tone and predominant movements (flaccid, spastic, dystonic, rigid, etc.). Currently, the aim of the classification is descriptive as well as being functional. In addition to motor disorder, all irregularities described here should be considered. Generally, classification takes place according to:

The part of the body affected: hemiplegia, diplegia, tetraplegia, monoplegia, triplegia
Irregularities in tone and/or movement: spastic (the most common: 80%), ataxic, dystonic, or mixed.

SPASTIC CEREBRAL PALSY

Spasticity means rigidity. People with this kind of cerebral palsy have trouble controlling some or all of their muscles, which tend to get stretched and weakened. These patients can usually support their arms, legs, and head. Spastic cerebral palsy normally occurs when the nerve cells of an external layer of the brain or cortex fail to work properly. Spastic cerebral palsy affects 60–70% of all individuals with cerebral palsy.

ATHETOID/DYSKINETIC CEREBRAL PALSY

This type of CP is characterized by slow, involuntary, uncoordinated movements (aggravated by fatigue, alleviated by rest, and absent during sleep), which hinder voluntary activity. People with this kind of CP typically have muscles that change rapidly from slack to tense. Their arms and legs move uncontrollably, and it can become difficult to understand them because of trouble controlling their tongue, breathing, and vocal chords. Athetoid/dyskinetic cerebral palsy is due to failure by the central part of the brain to function correctly.

ATAXIC CEREBRAL PALSY

People with ataxic cerebral palsy have trouble controlling their balance because of brain injury. Depending on the extent of the injury, these people may be able to walk, albeit with poor stability.

MIXED CEREBRAL PALSY

Mixed cerebral palsy occurs when the brain suffers injuries in several of its structures, which means that the patient does not exhibit the characteristics of just one kind of CP, but rather presents a mixture of the characteristics from different types of CP. Cerebral palsy can also be classified according to the part of the body affected, which yields a classification by topographic criteria:

HEMIPLEGIA

Occurs when the disability affects only the left or right half of the body.

PARAPLEGIA

Effects only appear in the lower members.

TETRAPLEGIA

Both arms and both legs are affected.

DISPLEGIA

Both legs are affected, and the arms are unaffected or only slightly affected.

MONOPLEGIA

Only one member is affected.

Finally, depending on the severity of the cerebral palsy, it falls into one of the following groups:

MILD CEREBRAL PALSY

The affected individual can perform the activities of daily living, although he or she has some kind of physical irregularity.

MODERATE CEREBRAL PALSY

The affected individual has trouble performing the activities of daily living and requires support and assistance.

SEVERE CEREBRAL PALSY

The affected individual requires assistance for practically all the activities of daily living.