What is cerebral palsy?
For most parents, when they receive a diagnosis of cerebral palsy for their child they experience
confusion and strong emotions. There are often more questions than there are answers.
Every parent searches for the best way of supporting their child. We know that each child with
cerebral palsy is unique and every child can be supported to fulfil their individual potential,
goals and aspirations.
There are many interventions or supports that can help reduce the impact of cerebral palsy
on the body and improve the individual's quality of life.
Here Prue Golland talks about cerebral palsy -- what it is, how it is caused and how it
is generally described.
Prue is our Senior Phsyiotherapist and has more than 10 years experience working with
people living with cerebral palsy and their families.
Cerebral palsy is an umbrella term for a group of disorders that affects a person's ability
to move. This means that not everyone with cerebral palsy looks the same.
There is a meaningful future for every child, adolescent and adult living with cerebral palsy.
For every person there is a positive way forward through treatment and support, provided in
partnership with individuals and their families.
Cerebral palsy is caused by an injury to the brain that usually happens during pregnancy
but sometimes it may happen shortly after birth.
Cerebral palsy affects people in different ways because different parts of the brain
can be injured, however it always has some impact on the person's movements and this
is because the messages coming from the brain to the muscles are affected.
Cerebral palsy is the most common physical disability in childhood with 1 in
500 children born in Australia each year.
One of the first questions parents ask is 'why does my child have cerebral palsy?'
For many parents the answer to this question is not straight forward.
In fact for most children the cause of cerebral palsy remains a mystery.
How any individual baby sustains a brain injury is often difficult to work out.
A great deal of research is happening in this field and what we currently know is that there
are a number of risk factors that alone or in combination may result in injury to the brain.
The most significant of these include prematurity (babies born less than 37 weeks) and babies
who are born with low birth weight - this sometimes happens with twins or triplets.
Other factors may include the presence of blood clotting problems (for either mother
or baby), problems with the placenta during pregnancy and some bacterial and viral infections
such as German measles may be contributing factors.
Contrary to what was believed for many years, lack of oxygen at birth plays a part for only
a very small percentage of infants with cerebral palsy.
In babies who acquire cerebral palsy after 1 month of age
stroke is the most common cause.
I am often asked if cerebral palsy is genetic.
Unlike Down Syndrome for instance, researchers have not identified a gene that directly causes
cerebral palsy. Rather, they now believe that a genetic predisposition to certain risk factors
may be part of the picture. In other words, a genetic condition, such as a blood clotting
disorder or heart problems, may result in an event, or series of events, that when combined
can cause or increase the risk of injury to the developing brain.
Cerebral palsy can be diagnosed at any time from birth, with the average age for diagnosis
being 18 months. For some infants their movement difficulties will be seen very early on. For
other children, these difficulties may not be clear until they are a little older and
it becomes clear that they are not progressing like other children of the same age.
Some of the signs that indicate a baby or child may have cerebral palsy include:
They feel floppy when they are picked up They cannot hold up their head
Their muscles are stiff, They display unusual postures with their body,
Their developmental milestones (such as rolling, sitting up, walking and talking) are delayed
As I mentioned earlier, cerebral palsy affects people in different ways and this is largely
due to the location of the injury in the brain. Therefore, cerebral palsy is described in
a number of ways including the parts of the body affected and the way in which it affects movement.
Where the whole body is affected
that is both legs and both arms and the trunk
this is called Quadiplegia.
Where both legs are mainly affected this is called Diplegia.
People with diplegia often have difficulty with fine movements
of their hands.
When one side of the body is affected
for example, the left arm and the left leg,
this is called Hemiplegia.
The next way of describing cerebral palsy is to talk about the way it affects movement
and the type of movement difficulties experienced by people with cerebral palsy.
Spasticity is probably the most commonly known term.
Spasticity is present in about 86% of people with cerebral palsy. It results in muscles
that become stiff and tight which can make it difficult for someone with spasticity to
use their muscles easily.
It is difficult for someone with spasticity to turn their muscles on and off when they
want to in order to move their arm or leg to do a task or to use their mouth and face
muscles to eat and talk.
Some people have a little bit of spasticity, other people have a lot of spasticity. The
impact of spasticity on movement will vary enormously between individuals.
You might also have heard the terms dystonia or athetosis. Dystonia and athetosis describe
movements seen in dyskinetic forms of cerebral palsy.
Dyskinetic or dyskinesia refers to movements that are involuntary. These involuntary movements
can become more noticeable when a person tries to move or when they become excited, agitated
or tired.
Dystonia results in unusual twisting postures, repetitive movements or both. Dystonia can
present in one part of the body (such as the arm or foot) or throughout the whole body.
With athetosis we see slow, continuous, involuntary, writhing movements that are present at rest
and made worse by attempts to move.
Around 6% of people with cerebral palsy have dyskinesia with dystonia more common than
athetosis.
One of the less common forms of cerebral palsy is ataxia. Ataxia means 'without order' or
'incoordination'.
Ataxic movements are characterised by clumsiness, imprecision, or instability. Movements are
not smooth and may appear disorganised or jerky.
The in-coordination seen with ataxia occurs when a person attempts to perform voluntary
movements such as walking or picking up objects. Ataxia causes an interruption of muscle control
in the arms and legs, resulting in a lack of balance and coordination.
Sometimes people have a mixed type of cerebral palsy. For example some people have both spasticity
and dystonia.
Knowing what type of cerebral palsy your child has will help you, your family and the people
who support you to understand your child's unique needs.
Your health professionals will be able to conduct an assessment to identify if spasticity,
dyskinesia or ataxia is present and how this impacts on movement.
There is a positive way forward for every individual with cerebral palsy.
There are many interventions or supports that can help reduce the impact of cerebral palsy
on the body and improve the individual's quality of life. Interventions are varied and serve
different purposes. Some interventions help to establish new skills, some modify the task
demands to support the child's performance, some techniques alter the environment to increase
success, while other interventions aim to prevent secondary impairments from occurring.
Some interventions are targeted towards a particular type of cerebral palsy. Therapists
at Cerebral Palsy Alliance can help you to make sense of the interventions that might
help your individual situation.
Other questions that I am frequently asked by parents are
'will my child walk?' and 'will my child talk?'
One way of helping to answer these questions
is to be guided by a number of categories of cerebral palsy
the GMFCS which stands for Gross Motor Function Classification System.
This looks at whether a person is likely to walk independently or
will need a wheelchair
The second is the MACS.
This stands for Manual Ability Classification System.
The MACS identifies how much assistance someone might need using their hands.
The last category is the CFCS.
This stands for the Communication Function Classification System.
This looks at how people with cerebral palsy communicate with others.
These three classification systems are explored in more detail on our website.
www.cerebralpalsy.org.au
It is usually helpful to ask your health professional what these
classification systems mean for your child.
This has been a brief introduction to cerebral palsy,
and what it might mean for you and your family.
We hope you have found it informative.
You may find it useful to speak with your medical and therapy team
about how this information relates to your child and their individual needs.