Cerebral palsy (CP) is a complex neurological condition that affects motor skills and muscle control. It is the most common physical disability in childhood, with a range of symptoms and severity. While CP is a lifelong condition, understanding its causes and implementing prevention strategies can significantly reduce its occurrence. The symptoms of CP vary from person to person. A person with severe CP might need to use special equipment to be able to walk, or might not be able to walk at all and might need lifelong care. A person with mild CP, on the other hand, might walk a little awkwardly, but might not need any special help. CP does not get worse over time, though the exact symptoms can change over a person’s lifetime.
All people with CP have problems with movement and posture. Many also have related conditions such as intellectual disability; seizures; problems with vision hearing, or speech; changes in the spine (such as scoliosis); or joint problems (such as contractures). Doctors classify CP according to the main type of movement disorder involved. Depending on which areas of the brain are affected, one or more of the following movement disorders can occur:
- Stiff muscles (spasticity)
- Uncontrollable movements (dyskinesia)
- Poor balance and coordination (ataxia)
There are four main types of CP:
Spastic Cerebral Palsy
The most common type of CP is spastic CP. Spastic CP affects about 80% of people with CP. People with spastic CP have increased muscle tone. This means their muscles are stiff and, as a result, their movements can be awkward. Spastic CP usually is described by what parts of the body are affected:
Spastic diplegia/diparesis―In this type of CP, muscle stiffness is mainly in the legs, with the arms less affected or not affected at all. People with spastic diplegia might have difficulty walking because tight hip and leg muscles cause their legs to pull together, turn inward, and cross at the knees (also known as scissoring). Spastic hemiplegia/hemiparesis―This type of CP affects only one side of a person’s body; usually the arm is more affected than the leg.
Spastic quadriplegia/quadriparesis―Spastic quadriplegia is the most severe form of spastic CP and affects all four limbs, the trunk, and the face. People with spastic quadriparesis usually cannot walk and often have other developmental disabilities such as intellectual disability; seizures; or problems with vision, hearing, or speech.
Dyskinetic Cerebral Palsy (also includes athetoid, choreoathetoid, and dystonic cerebral palsies)
People with dyskinetic CP have problems controlling the movement of their hands, arms, feet, and legs, making it difficult to sit and walk. The movements are uncontrollable and can be slow and writhing or rapid and jerky. Sometimes the face and tongue are affected and the person has a hard time sucking, swallowing, and talking. A person with dyskinetic CP has muscle tone that can change (varying from too tight to too loose) not only from day to day, but even during a single day.
Ataxic Cerebral Palsy
People with ataxic CP have problems with balance and coordination. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something.
Mixed Cerebral Palsy
Some people have symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP.
Early Signs
The signs of CP vary greatly because there are many different types and levels of disability. The main sign that a child might have CP is a delay in reaching motor or movement milestones (such as rolling over, sitting, standing, or walking). Following are some other signs of possible CP. It is important to note that some children without CP also might have some of these signs.
In a Baby Younger Than 6 Months of Age
- His head lags when you pick him up while he’s lying on his back
- He feels stiff
- He feels floppy
- When held cradled in your arms, he seems to overextend his back and neck, constantly acting as if he is pushing away from you
- When you pick him up, his legs get stiff and they cross or scissors
In a Baby Older Than 6 Months of Age
- She doesn’t roll over in either direction
- She cannot bring her hands together
- She has difficulty bringing her hands to her mouth
- She reaches out with only one hand while keeping the other fisted
In a Baby Older Than 10 Months of Age
He crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg He scoots around on his buttocks or hops on his knees, but does not crawl on all fours Tell your child’s doctor or nurse if you notice any of these signs.
Causes of Cerebral Palsy
Cerebral palsy primarily originates from brain damage or abnormalities that occur before, during, or shortly after birth. Here are some of the main causes:
Prenatal Factors: a. Infections: Certain maternal infections, such as rubella, cytomegalovirus (CMV), or toxoplasmosis, can increase the risk of CP. b. Genetic Factors: Although rare, genetic mutations or abnormalities can predispose a child to cerebral palsy. c. Maternal Health: Conditions like diabetes, high blood pressure, or thyroid disorders during pregnancy may contribute to CP risk.
Perinatal Factors: a. Premature Birth: Babies born prematurely, especially those born before 28 weeks of gestation, are at a higher risk of CP. b. Low Birth Weight: Babies with low birth weight are more susceptible to CP, often due to underdeveloped organs and a fragile nervous system. c. Multiple Births: Twins, triplets, or higher-order multiples are more likely to experience CP due to the increased risk of complications during pregnancy and childbirth.
Intrapartum Factors: a. Oxygen Deprivation: If the baby experiences prolonged oxygen deprivation during labor and delivery, it can result in brain damage and CP. b. Traumatic Birth: Injuries sustained during a difficult or traumatic birth can damage the baby’s brain and increase the risk of CP.
Prevention Strategies
While not all cases of cerebral palsy can be prevented, several strategies can help reduce the risk and mitigate its impact:
Prenatal Care: a. Regular Check-ups: Early and consistent prenatal care is crucial to monitor the mother’s health and address any potential complications promptly. b. Infection Prevention: Vaccinations and proper hygiene practices can help prevent maternal infections that may contribute to CP. c. Genetic Counseling: Families with a history of genetic conditions should consider genetic counselling to assess their risk and make informed decisions.
Managing Maternal Health: a. Controlling Chronic Conditions: Managing conditions like diabetes and hypertension through proper medication and lifestyle choices can reduce CP risk. b. Avoiding Substance Abuse: Refraining from smoking, alcohol, and drug use during pregnancy can protect the baby’s developing brain.
Reducing Premature Birth: a. Education: Providing education to expectant mothers on the importance of a full-term pregnancy and the risks associated with premature birth. b. Access to Healthcare: Ensuring all pregnant women have access to quality healthcare and support.
Improving Perinatal Care: a. Neonatal Intensive Care Units (NICUs): High-risk pregnancies and premature births can benefit from specialized NICUs equipped to handle complications. b. Monitoring Fetal Health: Regular monitoring of the baby’s well-being during pregnancy and labour can help identify issues early.
Enhanced Delivery Practices: a. Reducing Trauma: Implementing safe and gentle delivery techniques can minimize the risk of injury during birth. b. Timely Cesarean Section: In cases of fetal distress, a timely cesarean section may be necessary to prevent oxygen deprivation.
Cerebral palsy is a complex condition with multifactorial causes, making complete prevention challenging. However, by focusing on prenatal care, maternal health, reducing premature births, and improving delivery practices, we can significantly reduce the risk of cerebral palsy and improve the outcomes for both mothers and their babies. Ongoing research and medical advancements also hold promise for better understanding and preventing this condition in the future, offering hope to families and individuals affected by CP.
