What is Cerebral Palsy?

The term cerebral palsy refers to any one of a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination but don’t worsen over time. Even though cerebral palsy affects muscle movement, it isn’t caused by problems in the muscles or nerves. It is caused by abnormalities in parts of the brain that control muscle movements. The majority of children with cerebral palsy are born with it, although it may not be detected until months or years later. The early signs of cerebral palsy usually appear before a child reaches 3 years of age. The most common are a lack of muscle coordination when performing voluntary movements (ataxia); stiff or tight muscles and exaggerated reflexes (spasticity); walking with one foot or leg dragging; walking on the toes, a crouched gait, or a “scissored” gait; and muscle tone that is either too stiff or too floppy. A small number of children have cerebral palsy as the result of brain damage in the first few months or years of life, brain infections such as bacterial meningitis or viral encephalitis, or head injury from a motor vehicle accident, a fall, or child abuse.

How common is cerebral palsy?

Cerebral palsy usually is not diagnosed until a child is about 2 to 3 years of age. About 2 to 3 children in 1,000 over the age of three have cerebral palsy. About 500,000 children and adults of all ages in this country have cerebral palsy.

What are the different types of cerebral palsy?

There are three major types of cerebral palsy, and some individuals may have symptoms of more than one type.

Spastic cerebral palsy. About 70 to 80 percent of affected individuals have spastic cerebral palsy, in which muscles are stiff, making movement difficult. When both legs are affected (spastic diplegia), a child may have difficulty walking because tight muscles in the hips and legs cause legs to turn inward and cross at the knees (called scissoring). In other cases, only one side of the body is affected (spastic hemiplegia), often with the arm more severely affected than the leg. Most severe is spastic quadriplegia, in which all four limbs and the trunk are affected, often along with the muscles controlling the mouth and tongue. Children with spastic quadriplegia often have mental retardation and other problems.

Athetoid or dyskinetic cerebral palsy. About 10 to 20 percent of affected individuals have the athetoid form, which affects the entire body. It is characterized by fluctuations in muscle tone (varying from too tight to too loose) and sometimes is associated with uncontrolled movements (which can be slow and writhing or rapid and jerky). Children often have trouble learning to control their bodies well enough to sit and walk. Because muscles of the face and tongue can be affected, there also can be difficulties with sucking, swallowing and speech.

Ataxic cerebral palsy. About 5 to 10 percent of affected individuals have the ataxic form, which affects balance and coordination. They may walk with an unsteady gait with feet far apart, and they have difficulty with motions that require precise coordination, such as writing.

What are the causes of cerebral palsy?

In about 70 percent of cases, cerebral palsy results from events occurring before birth that can disrupt normal development of the brain. Contrary to common belief, lack of oxygen reaching the fetus during labor and delivery contributes to only a small minority of cases of cerebral palsy, according to a 2003 report by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP). A small number of babies also develop brain injuries in the first months or years of life that can result in cerebral palsy. In many cases, the cause of cerebral palsy in a child is not known.

Some of the known causes of cerebral palsy include:

• Infections during pregnancy. Certain infections in the mother, including rubella (German measles), cytomegalovirus (a usually mild viral infection) and toxoplasmosis (a usually mild parasitic infection) can cause brain damage and result in cerebral palsy. Recent studies suggest that maternal infections involving the placental membranes (chorioamnionitis) may contribute to cerebral palsy in full-term as well as preterm babies (those born before 37 completed weeks of pregnancy). A 2003 study at the University of California at San Francisco found that full-term babies were four times more likely to develop cerebral palsy if they were exposed to chorioamnionitis in the womb. Reproductive/urinary tract infections also may increase the risk of preterm delivery, another risk factor for cerebral palsy.
• Insufficient oxygen reaching the fetus. For example, when the placenta is not functioning properly or it tears away from the wall of the uterus before delivery, the fetus may not receive sufficient oxygen.
• Prematurity. Premature babies who weigh less than 3 1/3 pounds are up to 30 times more likely to develop cerebral palsy than full-term babies. Many of these tiny babies suffer from bleeding in the brain, which can damage delicate brain tissue, or develop periventricular leukomalacia, destruction of nerves around the fluid-filled cavities (ventricles) in the brain.
• Asphyxia during labor and delivery. Until recently, it was widely believed that asphyxia (lack of oxygen) during a difficult delivery was the cause of most cases of cerebral palsy. The ACOG/AAP report shows that fewer than 10 percent of the type of brain injuries that can result in cerebral palsy are caused by asphyxia.
• Blood Diseases. Rh disease, an incompatibility between the blood of the mother and her fetus, can cause severe jaundice and brain damage, resulting in cerebral palsy. Rh disease usually can be prevented by giving an Rh-negative woman an injection of a blood product called Rh immune globulin around the 28th week of pregnancy and again after the birth of an Rh-positive baby. Blood clotting disorders (thrombophilias) in either mother or baby also may increase the risk. Severe jaundice.
• Jaundice, yellowing of the skin and the whites of the eyes caused by the build-up of a pigment called bilirubin in the blood, occasionally becomes severe. Without treatment, severe jaundice can pose a risk of permanent brain damage resulting in athetoid cerebral palsy.
• Other birth defects. Babies with brain malformations, numerous genetic diseases and other physical birth defects are at increased risk of cerebral palsy.
• Acquired cerebral palsy. About 10 percent of children with cerebral palsy acquire it after birth due to brain injuries that occur during the first two years of life. The most common causes of such injuries are brain infections (such as meningitis) and head injuries.

Can cerebral palsy be prevented?

In many cases, the cause of cerebral palsy is not known, so there is nothing that can be done to prevent it. In spite of improvements in the care of pregnant women and sick babies, the number of babies with cerebral palsy seems to be increasing. This is due, in part, to the survival of an increasing number of very premature babies, who are at high risk of cerebral palsy.

However, some causes of cerebral palsy have been identified, and cases of cerebral palsy that result from them often can be prevented. Rh disease and congenital rubella syndrome used to be important causes of cerebral palsy. Now Rh disease usually can be prevented when an Rh-negative pregnant woman receives appropriate care. Women can be tested for immunity to rubella before pregnancy and be vaccinated if they are not immune. Babies with severe jaundice can be treated with special lights (phototherapy). Head injuries in babies, a significant cause of cerebral palsy in the early months of life, often can be prevented when babies ride in car seats properly positioned in the back seat of the car. Routine vaccination of babies (with the Hib vaccine) prevents many cases of meningitis, another cause of brain damage in the early months. A woman can help reduce her risk of preterm delivery when she seeks early (ideally starting with a pre-pregnancy visit) and regular prenatal care and avoids cigarettes, alcohol and illicit drugs.

• An Introduction to Cerebral Palsy
• Development Milestones for Babies
• Spastic Cerebral Palsy
• Spastic Diplegia Cerebral Palsy
• Ataxic Cerebral Palsy
• Athetoid Cerebral Palsy
• Severe Athetoid Cerebral Palsy
• Mixed Cerebral Palsy
• Hemiplegia and Quadriplegia and Cerebral Palsy
• Cerebral Palsy Statistics
• Diagnosing Cerebral Palsy
• Cerebral Palsy Treatment
• United Cerebral Palsy (UCP) of Philadelphia and Vicinity
• Types and Causes Of Cerebral Palsy
• Cerebral Palsy Declining in High-Risk Babies
• Coping with Cerebral Palsy
• Children With Cerebral Palsy Have Similar Quality Of Life To Other Children

• Birth Trauma
• Birth Injury Verdicts
• Prenatal Care
• Cerebral Palsy

• Birth Injury

• Birth Injury - EMedicine

Provides general information about birth injuries and other resources.

• Birth Injury - United Cerebral Palsy in Philadelphia

Homepage to the United Cerebral Palsy of Philadelphia organization.