Cerebral palsy

Cerebral palsy is a permanent physical condition that affects movement and posture. It is caused by damage to, or lack of development in a part of the brain that controls movement. Cerebral palsy is the most common physical disability in childhood. It affects 1 in every 500 babies. Cerebral palsy is often called ‘CP’ for short.

It can cause a range of movement problems such as:

• limited mobility
• weakness of arms and/or legs
• stiffness or floppiness
• clumsiness or poor coordination
• difficulty starting and controlling movement and reduced smoothness (fluidity) of movements
• shakiness and poor balance

As your child grows, complications such as tightness of joints and hip problems can happen. Your child's paediatrician or orthopaedic surgeon will advise you if and when your child needs monitoring for hip or spine problems.

Cerebral palsy is classified by:

• the parts of the body affected
• the types of movement patterns seen
• the effect of the CP on your child's ability to perform tasks, such as general mobility and manipulation of objects.

Parts of the body affected

• Quadriplegia – when both arms and both legs are affected. The muscles of trunk, face and mouth can also be involved.
• Hemiplegia – when one side of the body is affected.
• Diplegia – when mainly the lower limbs are affected.
• Monoplegia – when only one arm or leg is affected.

Types of movement patterns 

Many children have a mixture of the following movement patterns:

Spastic CP – This is the most common type of CP. The muscles are spastic or stiff because the damaged parts of the brain sends scrambled messages to the muscles.

Dyskinetic CP – When there are abnormal involuntary movements or postures such as dystonia (frequent twisting or repetitive movements, or abnormal postures) and athetosis (uncontrolled extra movement particularly in the arms, hands and feet, and around the mouth).

Ataxic CP (or ataxia) – This is the least common type. Children with ataxia have unsteady shaky movements or tremor and problems with balance.

Effect on the ability to perform tasks

Your therapist or doctor may use a standardised scale to help you and others understand your child's level of functioning.

As well as movement problems, children with CP often have:

• problems with speech, hearing or vision
• epilepsy
• intellectual or learning difficulties
• perceptual difficulties such as judging the size and shape of objects
• gastro-oesophageal reflux
• orthopaedic problems (with bones, muscles and joints)
• constipation
• feeding and swallowing difficulties
• saliva control problems
• repeated chest infections
• behavioural difficulties and frustration.

There is a wide range of intellectual ability in children with CP. Children with a very severe physical disability can have completely normal intelligence.

There are many different causes. A problem with the brain can happen at different stages early in a child's life.

During pregnancy – If the brain does not form or grow properly, or as a result of another problem such as infection.

During labour – If a baby doesn't get enough oxygen during labour, this can result in brain damage. Some babies may have difficulty during labour because of problems with the placenta that happened earlier in pregnancy. Only a small proportion (about 10 percent) of CP results from problems in labour. Children born extremely prematurely are at greater risk of developing CP.

Early in life – Some conditions early in life can lead to brain damage. These include severe infections such as meningitis, bleeding into part of the brain (a stroke) or a head injury.

Unknown cause – In some children, despite a careful review and various tests, the cause of CP remains unknown. With advances in knowledge and technology, doctors and scientists are identifying more causes.

Managing CP focuses on the problems of muscle control and movement, and the treatment of other health issues. Empowering, supporting and educating families is the most important part of care. A range of health professionals may be involved in caring for your child. They will talk with you about ways to help your child.

Speech and language therapy – Speech and language therapists help with communication problems and provide help with eating, drinking or saliva problems.

Physiotherapy and occupational therapy – Physiotherapists and occupational therapists encourage development of motor function and motor control and work to limit complications (such as contractures).

Splints (orthoses) – Your child might need these to help with walking, standing and hand function.

Equipment and housing alterations – Your therapist may talk with you about equipment to help your child take part in everyday family activities and childhood tasks. Equipment can include:

• mobility equipment – walking frames, wheelchairs
• adaptive equipment – bath seats to help with safe bathing
• changes to homes and educational buildings so your child can access them. 

Medical and surgical treatments – These can include:

• botulinum toxin A (Botox®) injections to relax tight muscles
• oral medicines including baclofen and diazepam
• orthopaedic surgery, such as soft tissue surgery to release tight muscles, or bony surgery to realign bones and joints.

Nutrition

It is important that children with CP receive adequate nutrition. This may involve help from a dietitian, speech language therapist, occupational therapist or the child's paediatrician. Some children need to have their feeding by mouth supplemented with tube feeding.

Hearing and vision

It is important to check your child's hearing and vision.

Epilepsy

Children who also have epilepsy may need to take medicine to control epilepsy.

Educational support services

Children with CP have the same rights to education as all other children. All children have a right to education and to enrol at their local mainstream school or early childhood centre. Your child will benefit from accessing educational support services in their preschool years as a foundation for future learning.

Children with CP are all different. The level of support they will need in an educational setting will vary. Physical disabilities and learning difficulties can both create significant barriers for children with CP in accessing education.

Some children manage well in a mainstream environment with no support. Other children will need one on one support or significant changes to the curriculum to support both their physical and learning needs. Some children will need support from physiotherapists, occupational therapists, and speech language therapists in school. These professionals will work closely with families and schools to make sure your child's educational needs are met.

You may choose to enrol your child in your local mainstream school or in a specialist school. Specialist schools have specialised teaching and therapy staff who work to deliver adapted curriculum programmes.

Intrathecal baclofen (ITB) – Children receive this medicine into the space around the spinal cord by a continuous pump. This procedure is not usually available in New Zealand.

Selective dorsal rhizotomy (SDR) – This procedure to treat spasticity involves cutting spinal nerve rootlets. It is appropriate for carefully selected children with CP. It is not available in New Zealand. Parents considering SDR for their child should talk to their paediatrician. The paediatrician may discuss this with a paediatric rehabilitation specialist.

Some parents want to look at complementary and alternative treatment approaches. If you are considering stem cell therapy or hyperbaric oxygen therapy for your child with CP, please read some information about these.

You can read information about coping with a diagnosis, early intervention, financial support, needs assessment and special education.

Videos of inspiring stories from children with cerebral palsy. These videos may take a few moments to load.

Video: Personal story of Winnie

Winnie is a gutsy 9-year-old who gives everything a go. She usually gets around in a wheelchair because of her cerebral palsy, but her favourite mode of transport is on a horse!

(Attitude Live, NZ)

Video: Personal story of Destiny

Destiny is an 8-year-old with cerebral palsy. In her own words,: “CP is a thing in the legs, the brain doesn't tell your legs what to do”. Although her legs get tired sometimes, she won't let that get in the way of her dream job of becoming a vet.


(Attitude Live, NZ)

To view more videos of the same series, visit Attitude Live: Kids with disabilities(external link)(external link) (Attitude Live, NZ)

Video: Being me: Cory

The award-winning 17-year-old, who was born with cerebral palsy, now looks ahead to leaving the comfort zone of home and school.

(Attitude Live, NZ)

Video: Personal story of Katie

Cerebral palsy may have taken away Katie's ability to speak, but she proves it can’t take away her voice.

(Humankind, NZ, 2015)