Cerebral palsy, the most common childhood physical disability, is caused by damage to the brain before birth or in infancy. People living with cerebral palsy can have neurological and musculoskeletal problems that affect posture, sensory perceptions, communication, movement and other functions.

Cerebral Palsy: What You Need to Know

• Injuries to the brain before, during or after birth can cause cerebral palsy.
• Symptoms of cerebral palsy are usually first noticed in infants and toddlers.
• Almost half the children affected by cerebral palsy develop hypertonia (excessive muscle tension) or spasticity (excessive muscle tension with increased tendon reflexes).
• There is currently no cure for cerebral palsy, but treatment can address associated neurologic, orthopaedic and medical conditions.

What is cerebral palsy?

Cerebral palsy (CP) is a condition that affects movement and muscle tone. The exact cause, in many cases, is unknown, but the disorder occurs when there is abnormal development or damage to areas in the brain that control motor function. CP develops in approximately three out of every 1,000 live births.

What causes cerebral palsy?

Several types of injuries can damage the parts of the brain that control motor function, including:

• Preterm birth: the most common cause in the United States
• Head injuries including shaken baby syndrome
• Infections of the brain or spinal cord
• Obstructed oxygen flow to the brain, such as in near-drowning experiences
• Events that block blood flow to the brain, such as stroke
• Malnutrition
• Heavy metal ingestion

What are the symptoms of cerebral palsy?

Children with CP usually show signs of motor delay before age two. CP is often not formally diagnosed until age 2 or 3. Babies with cerebral palsy are often slow to reach developmental milestones, such as learning to roll over, sit, crawl or walk. They may also have certain reflexes present that normally disappear in early infancy. 

The symptoms of CP may resemble other conditions. Although each child exhibits a unique pattern of deficits, there are some common signs. 

You may notice that your child is showing exaggerated reflexes or floppiness in the trunk or limbs. Another sign is spasticity, which may show up as shaking or stiffness in the trunk, arms or  legs or clenched fists. Uncontrolled movements and abnormal gait may be part of the picture as well. 

Children with CP may have additional problems, including the following:

• Seizures
• Vision, hearing and/or speech problems
• Learning disorders and behavior problems
• Intellectual or developmental disabilities
• Respiratory problems
• Gastrointestinal and nutrition issues
• Bowel and bladder problems
• Bone abnormalities, including scoliosis (a sideways curvature and rotation of the back bones) and hip dysplasia (dislocation)

What are the different types of cerebral palsy?

Cerebral palsy is classified according to which part of the body is affected. The spasticity of CP can present itself in three ways:

• Spastic diplegia involves the legs more than the arms. This type is more likely to affect babies born preterm, before 32 weeks.
• Spastic quadriplegia involves all four limbs more or less equally. Full-term or preterm babies with CP may have this type.
• Spastic hemiplegia involves one side of the body, and may occur in children who have had one or more bleeding episodes in the brain’s ventricles.

Cerebral Palsy Treatment

There is no cure for CP, but there are many treatment options to help with the problems associated with the condition.

Baclofen—Baclofen is a muscle relaxant that can be given orally or directly into the cerebrospinal fluid in the spine through a baclofen pump surgically placed into the abdomen.

Therapeutic electrical stimulation (TES) —TES is a type of electrical stimulation that increases blood flow to weakened muscles.

Selective Dorsal Rhizotomy (SDR) —Selective dorsal rhizotomy is a surgical procedure that involves cutting some of the lumbar and sacral sensory nerve fibers that come from the muscles and enter the spinal cord. The operation may reduce spasticity when used in conjunction with an intense course of physical therapy following surgery.

Orthopaedic Issues Associated with Cerebral Palsy

Hip Dysplasia

Hip dysplasia is a deformity of the hip that can be found on one or both hips in children with an underlying neuromuscular condition such as CP. Increased or decreased tone in the muscles can lead to migration of the femoral head out of the hip socket, requiring additional treatment, such as proximal femoral osteotomy or acetabular osteotomy.

Neuromuscular Scoliosis

Neuromuscular scoliosis is a condition of the spine associated with an underlying neuromuscular condition, such as cerebral palsy, muscular dystrophy or spinal cord injury. The underlying condition typically causes changes in the muscles, leaving them unable to support the spine adequately. This leads to a curvature of the spine. The typical presentation is an abnormal S- or C-shaped curvature. The spine can also have rotation, creating a multidimensional curve. The curvature can be progressive, especially with growth spurts. Treatment may include bracing or spinal fusion surgery.

Talipes Equinovarus Foot (Clubfoot)

Clubfoot is commonly seen in children with CP. Due to muscle imbalance, the deformity can make weight-bearing activities challenging. Surgical procedures your doctor may recommend include split anterior tibial tendon transfer or calcaneal osteotomy

Neuromuscular Flatfoot

This is a deformity of the foot due to an underlying neuromuscular condition. The abnormality of the muscles in the feet leads to a flat foot with minimal or no arch. This condition is commonly seen in children with hypotonia or low muscle tone. Braces or orthotic devices may provide arch support and decrease pain, or surgery may be recommended to address the problem.

Toe Walking

Toe walking is a condition in children with an underlying neuromuscular disorder that leads to high tone or muscle tightness in a child’s ankles, and can cause them to walk on the toes or balls of the feet. Physical therapy can be beneficial, as can a series of casts that gradually reposition the foot and ankle. Your doctor may recommend surgical lengthening of the Achilles tendon or gastrocnemius if these approaches are not effective.

Limb Length Inequality

Limb length inequality is a difference in the lengths of a child’s lower extremities (legs). The difference in length can be found in children with hemiplegic CP. For slight discrepancies of leg length, a shoe lift may be helpful. For more pronounced differences, surgical treatment may be recommended to shorten the longer leg and provide more balance in leg length as your child grows.

Torsional Disorders

Some children with CP develop an inward or outward twist in the bones of their lower extremities, including internal tibial torsion. When this is excessive, it can interfere with their gait pattern. A surgical procedure called rotational osteotomy can correct the deformity.

Muscle Contracture

Children with a neuromuscular disorder can exhibit increased muscle tone that leads to a contracture of the muscle, preventing it from stretching well. The hamstrings, adductors, hip flexors and gastrocnemii can be affected by contracture. Physical therapy, bracing, botulinum injections or tendon lengthening surgery may be necessary to provide relief.