Copyright 2013 American Academy of Orthopaedic Surgeons
Cerebral Palsy

Cerebral palsy (CP) is a disorder that affects a child's ability to control his or her muscles. It is caused by damage or abnormalities in the parts of the brain that are involved with movement and coordination.

In most cases, cerebral palsy begins before a baby is born. Sometimes, CP begins at birth or during the first years of life. Early signs of CP include delays in meeting milestones, such as learning to roll over, sit, crawl, or walk.

Although there is no cure for CP, the disorder does not worsen as a child grows. Early treatment, such as physical therapy, medication, braces, and other assistive devices, can significantly help children improve their functional capabilities.

Cause

In most children with CP, how the problems in the brain occur cannot be determined. After birth, infection and head injury may be contributing factors. Premature babies and those with low birth weight are at a greater risk for CP.

Description

The physical disabilities associated with CP can be mild, moderate, or severe. Some children can walk independently, while others need assistive devices, like crutches or walkers. Some children with CP require the use of wheelchairs for mobility.

(Left) When this young child with CP walks, she must use her arms to maintain balance. (Right) Using a walker helps the child improve balance and stability.
Credit: Reproduced with permission from Sussman MD: The orthopaedic management of cerebral palsy. Orthopaedic Knowledge Online Journal 2009. Accessed August 2013.

Types of Cerebral Palsy

There are four main types of cerebral palsy. Doctors can usually diagnose the type of CP when a child is about two years old.

  • Spastic. The most common form of cerebral palsy is spastic CP, in which a child has increased muscle tone/tightness. A child's legs, arms, and back are stiff and contracted, which makes movement difficult.
  • If both legs are affected (spastic diplegia), tight muscles in the hips and legs often cause the legs to turn inward and cross at the knees when walking, called "scissoring."

    If only one side of the body is affected (spastic hemiplegia), the arm is often more severely affected than the leg.

    If all four limbs and the trunk are affected (spastic quadriplegia or total body involved), independent walking may be difficult, or even not possible. In addition, the muscles of the mouth and tongue also may be affected making swallowing and eating difficult.

  • Athetoid (dyskinetic). A child with athetoid CP has low muscle tone/looseness, which makes limbs weak and floppy. Athetoid CP causes uncontrolled and involuntary movements of the entire body. It may be difficult for a child to sit up straight or walk.
  • Ataxic. This rare form of CP affects balance and depth perception. There is poor coordination, unsteady walking, and difficulty with precise movements, such as using a pen or buttoning a shirt.
  • Mixed. In mixed CP, there are symptoms of both spastic and athetoid CP. Some muscles are tight and others are loose. There is both stiffness and involuntary movements.

Other Impairments Associated with CP

In addition to affecting muscles and motor skills, CP may cause a range of other impairments in some children. These include:

  • Mental impairment (such as intellectual disability or learning disability)
  • Seizures
  • Vision difficulties
  • Shortened limbs
  • Curvature of the spine (scoliosis)
  • Dental problems
  • Complete or partial hearing loss
  • Problems with joints (contracture)
Doctor Examination

Medical History and Physical Examination

Give the doctor your child's complete medical history. This may help to rule out other disorders that can cause movement problems, such as genetic or muscle diseases, metabolism disorders, and tumors of the nervous system.

Your doctor will evaluate your child's muscle tone and reflexes, and may want to watch your child walk, crawl, sit, and lie down.

If your child is less than one year old, your doctor may need to wait a few months before confirming the diagnosis of cerebral palsy in order to see whether your child develops specific problems with movement.

During the physical examination, your doctor also may check for other conditions linked to CP, such as mental impairment, seizures, and vision problems.

Tests

There is no specific blood test or imaging study that can make the diagnosis of cerebral palsy.

However, your doctor may order a magnetic resonance imaging (MRI) scan of your child's brain. This test can show damage or abnormalities in the brain.

Treatment

Individuals who have cerebral palsy often need help from their families and medical specialists throughout their lives. Many types of healthcare professionals are involved in treating those with CP. Depending upon the type of CP your child has, as well as any additional impairments, the medical treatment team may include:

  • Orthopaedic surgeons to treat problems with bones, muscles, tendons, nerves or joints
  • Physical therapists to improve movement and strength
  • Occupational therapists to teach daily living skills, such as eating and dressing
  • Speech and language specialists to treat communication problems
  • Social workers to help locate community assistance and education programs
  • Psychologists to help patients and families cope with stress
  • Behavioral therapists to foster social and emotional development
  • Other medical specialists such as eye doctors, neurologists, and nutritionists

Nonsurgical Treatment

Physical therapy. Physical therapy may be recommended shortly after the diagnosis is made in order to help your child learn skills such as sitting, walking, or using a wheelchair. It also may help improve muscle strength, balance, and coordination, as well as prevent muscles from becoming too tight. Physical therapy may involve fun activities to tone muscles, like swimming and horseback riding.

(Left) A physical therapist teaches a child with CP to use walking sticks. (Right) A young child with CP learns how to use a harness walker.
Reproduced with permission from Sussman MD: The orthopaedic management of cerebral palsy. Orthopaedic Knowledge Online Journal 2009. Accessed August 2013

Braces, splints, and casts. Using braces, splints, or casts may improve range of motion in joints and joint stability, prevent contracture, and improve hand or leg function. Braces can compensate for muscle imbalance.

Botox. This drug can be injected into spastic muscles to loosen them. It is especially helpful for children younger than 5 years old, and when used in combination with casting.

Medication. Some medications that your doctor may prescribe can control or prevent seizures or muscle spasms, ease muscle stiffness, or reduce abnormal movements.

Surgical Treatment

If contractures are severe, surgery to lengthen affected muscles can improve a child's ability to move and walk. This surgery may also help if tightly contracted muscles cause stress to joints and lead to deformities or dislocations.

Some children with CP need surgery to correctly position their arms or legs, or to correct curvature of the spine (scoliosis).

Severe spasticity and muscle stiffness may be helped with an intrathecal baclofen pump. In this procedure, a small pump is surgically implanted under the skin to deliver doses of a muscle relaxant.

If other treatments cannot effectively manage severe spasticity, your doctor may recommend selective dorsal rhizotomy. During this surgery of the spine, specific nerves that control spastic muscles are cut to help the muscles relax, as well as to relieve associated pain. This particular type of surgery is done infrequently.

Coping Strategies

Parents of children with cerebral palsy or other disabilities often feel guilt and/or grief about their child's condition. Some tips to help parents cope:

  • Learn all you can about CP. You may want to join a family support group or get help from professionals. Stay informed about new treatments and technologies.
  • Work with professionals at your child's school to develop an individualized plan that meets his or her needs and abilities.
  • Love and encourage your child. Family support and personal determination are important factors in achieving long-term goals. Go places and have fun. Be patient, and keep hoping for improvement.
  • Get help from family and friends. Caring for a child with CP is hard work. Teach others how to do it so you can take breaks.
Last reviewed: September 2013

Reviewed by members of the Pediatric Orthopaedic Society of North America

AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist" program on this website.
Copyright 2013 American Academy of Orthopaedic Surgeons
Related Links
Scoliosis: Frequently Asked Questions (http://orthoinfo.aaos.org/topic.cfm?topic=A00626)
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