What IS Cerebral Palsy?

I found the following information on the Scope website. I have taken a few bits out, but not much! The specific type I have is spastic diplegia, and I do not have epilepsy although I do have the problems with spatial awareness mentioned to a slight degree. I was born six weeks premature and that would appear to be the cause of my cp

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If someone has cerebral palsy it means that part of their brain is not working properly or has not developed. This will have happened before they were born, around the time of birth or in early childhood. The affected area of the brain is usually one of the parts which control the muscles and certain body movements. In some people, cerebral palsy is barely noticeable. Others will be more severely affected.

Cerebral palsy is more common than people realise. It is believed that currently about one in every 400 children is affected by cp, i.e. about 1,800 babies are diagnosed with cerebral palsy in Great Britain each year. It can affect people from all backgrounds. It is often not possible for doctors to give a reason why part of a baby’s brain has been injured or failed to develop. Some possible causes are:

- the mother of the baby had an infection in the early part of the pregnancy.

- the baby had a difficult or premature birth, maybe they were unable to breathe properly.

- there could have been some bleeding within the baby’s brain.

- or perhaps, and this is very rare, the baby has a genetic disorder.

Cerebral palsy jumbles messages between the brain and the muscles. There are three types of cerebral palsy, depending on which messages are affected, called spastic, athetoid and ataxic. Many people with cerebral palsy have a combination of two or more types. One of the difficult things about cerebral palsy is that its effects vary so much from one person to another making it difficult for doctors to say what type of cerebral palsy a person has.

It is therefore complicated for a doctor to predict how a young child with cerebral palsy will be affected later in life. Cerebral palsy is not progressive, it does not become more severe as the child gets older, although some difficulties may become more noticeable. There is no cure for cerebral palsy. If children are positioned well from an early age and encouraged to play in a way that helps them to improve their posture and muscle control, they can be helped to develop and achieve more things for themselves. There are also a number of therapies, which may be suitable for some individuals.

Spastic cerebral palsy

‘Spastic’ means ‘stiff’ and this form of cerebral palsy stiffens muscles and decreases the range of movement in joints. This tightness is always there and means that someone with spastic cerebral palsy has to work harder to walk or move. This is the most common form of cerebral palsy, affecting different areas of the body. If the person is only affected on one side of their body the term used is hemiplegia. If their legs are affected but their arms are unaffected or only slightly affected the term is diplegia. If both arms and both legs are equally affected then the term is quadriplegia.

Athetoid cerebral palsy

People with athetoid cerebral palsy make involuntary movements, because their muscles rapidly change from floppy to tense in a way they can’t control. Their speech can be hard to understand because they have difficulty controlling their tongue, breathing and vocal cords. Hearing problems are also common.

Ataxic cerebral palsy

People with ataxic cerebral palsy find it very difficult to balance. They may have poor spatial awareness. This means it is difficult for them to judge their position relative to other things around them. Ataxia affects the whole body. Most people with ataxic cerebral palsy can walk but they will probably be unsteady. They may also have shaky hand movements and jerky speech.

Remember it can be difficult to say what type of cerebral palsy a person has and they may have a combination of two or more types. The most important thing to remember is that no two people with cerebral palsy are the same. Some people have cerebral palsy so mildly that its effects are barely noticeable. Other people may be extremely affected. Other associated difficulties

Other difficulties and medical conditions may occur more commonly in people with cerebral palsy. Just because a person has cerebral palsy does not mean that they will also have these difficulties. However it may help you to consider some of these:

- children with cerebral palsy may have problems with constipation or sleeping. The doctor or health visitor should be able to offer advice about this.

- people with cerebral palsy may have problems with speech which are associated with difficulties in chewing and swallowing, and problems understanding the spoken word. A speech and language therapist may be able to advise.

- some people with cerebral palsy have epilepsy. Often medication can help control this.

- some people with cerebral palsy may have difficulty distinguishing and comparing shapes. This is to do with visual perception, this means someone’s ability to interpret what they have seen, not a problem with their eyesight.

- people with cerebral palsy may have learning difficulties, which means they are slow to learn. The difficulties can be mild, moderate or severe. They may have a ‘specific learning difficulty’ that is a problem with a particular activity such as reading, drawing or arithmetic, because a specific part of the brain is affected.

- it is important to remember that even someone severely physically affected by cerebral palsy may have average or above average intelligence.

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Cerebral palsy is a very diverse and complex condition, ranging from very mild to profound, with no two people being affected in precisely the same way.

There never has been a simple explanation. In 1984 P. Scrutton wrote, “The almost infinite variety (and the lack of a common language to describe this variety accurately) makes learning about it very difficult indeed.” (1)

Cerebral palsy does not have a clear-cut single cause; it is not a specific condition - unlike Down’s Syndrome for example - which is an identifiable chromosomal disorder.

In cerebral palsy the brain impairment is non-progressive - it does not get worse or improve. However, the effects on the body may become more (or less) obvious as time goes by. Cerebral palsy is not infectious.

Cerebral palsy, therefore, is a general term for a wide range of non-progressive cerebral (brain) disorders, which result in some sort of movement impairment, that becomes apparent during early childhood.

A Definition

Cerebral palsy can be defined as “a persistent (but not unchanging) disorder of movement and posture, as the result of one or more non-progressive abnormalities in the brain, before its growth and development are complete. Other clinical signs may be present as well.” (World Commission for Cerebral Palsy - Cerebral Palsy: Problems and Practice)

Explanation of this definition

· Cerebral…means that the cause of the difficulties is in the brain – not in the muscles themselves.

· Palsy…can be taken as meaning having difficulties with movement and posture - i.e. a ‘motor control’ impairment.

· Persistent…means that the effects of the brain impairment, on the person’s movement and posture, do not go away. Therefore, cerebral palsy is present throughout the person’s life.

· Not unchanging…movement patterns may change. This will occur as the baby/child develops, matures and/or as a result of therapeutic intervention, for example, physiotherapy.

The characteristics of the motor disorder and the way the person is affected may alter significantly, particularly during the early years of life. This is because babies and young children grow and develop skills at such a fast rate during this period of rapid brain development. For example, muscles may at first be floppy, often referred to as low tone or hypotonia. As time goes by, those same muscles may become tight (high tone, hypertonia or spasticity). Similarly in the first months any potential difficulties may not be immediately obvious. It is possible for some signs not to show until the child is between twelve and eighteen months or older.

· ‘Disorder of movement and posture’…refers to the difficulties a person may have in co-ordinating their muscles to produce and control the movement required – i.e. a ‘motor control’ disorder.

This may lead to being unable to position the body correctly, or in the way wanted, for example, when walking, sitting or whilst in bed.

· Non-progressive…refers to the fact that the brain impairment does not recover or deteriorate; the impairment is static – unchanging.

· Abnormality…means that the part(s) of the brain concerned with ‘motor control’ were damaged and/or have not developed in the usual way.

(The word ‘lesion’ is sometimes used to denote that an organ or tissue - the brain, in this instance - has been damaged and is not functioning correctly.)

The dysfunction of the motor control part(s) of the brain is present ‘before the brain’s growth and development are complete’.

This means the impairment or lesion occurred during pregnancy, birth or early childhood - before the brain's growth and development has reached a certain level of maturity. The following quote explains further how age may influence diagnosis:

"Insults to the brain that occur after eight years of age result in neurological impairments reminiscent of those observed in adults; similar insults prior to three years of age (including during the prenatal period), result in neurological impairments and motor outcomes - such as cerebral palsy - that are characteristic of injury to the immature brain. From three to eight, mixed patterns of neurological impairment are observed. An arbitrary upper age limit of five or six years has been suggested for assigning the diagnosis of cerebral palsy; however, in practice, the determination is typically made on a case by case basis." (2)

Other clinical signs may be present as well… growing babies and children have to learn to use many other muscles besides those concerned with the co-ordination and movement of arms, legs, trunk etc. For example, the brain ‘learns’ how to position and focus the eyes, make noises and sounds, chew food, control the muscles used when going to the toilet and those used for breathing. Therefore, there may also be difficulties for some children in these areas of function.

In addition, because other areas of the brain may also have been affected there is a possibility of ‘associated’ or ‘related’ difficulties such as sensory or perceptual impairment. Other associated difficulties may include learning difficulties or epilepsy (seizures). Risk Factors Associated with Cerebral Palsy A risk factor is not a cause; it is a variable which, when present, increases the chance of something occurring -- in this case, cerebral palsy. Just because a risk factor is present does not mean cerebral palsy WILL occur; nor does the absence of a risk factor mean that cerebral palsy will NOT occur.

In a study in the United States (3), a group of investigators found the following factors are associated with an increased risk of cerebral palsy:

- Mother 40 yrs or older - Mother under 20 yrs - Father under 20 yrs - First child or child born fifth or more - Child one of twins (particularly if one twin died) - Baby of low birth weight (less than 2.5 lbs.) - Premature birth (less than 37 weeks)

More than one risk factor can be present at the same time (e.g. low birth weight and being a twin), the combination of which can further increase the probability of cerebral palsy occurring.

Types of Cerebral Palsy Three different parts of the brain working together initiate and control the muscles that affect movement and posture. The part of the brain that is impaired determines how a person with cerebral palsy will be affected. There are three main types of cerebral palsy:

· Spastic cerebral palsy (spasticity) is caused by impairment in the cerebral cortex (the outer layer) of the brain. Disordered control of movement.

· Athetoid cerebral palsy (athetosis) is caused by impairment in the basal ganglia area of the brain. Involuntary spasms, jerky arm and leg movements.

· Ataxic cerebral palsy (ataxia) is caused by impairment in the cerebellum part of the brain. Lack of balance & spatial awareness. Unsteady walking/gait.

It is, however, quite common for people to have a combination of the above types.

Cerebral palsy can be categorised further, by referring to the parts of the body affected.

The three main categories are as follows:

· Diplegia is where both legs are affected more than the hands and arms.

· Hemiplegia occurs where one side of the body (including arm and leg) is affected.

· Quadriplegia/Tetraplegia means that all four limbs are involved together with, usually, the trunk and neck.

Occasionally you may come across these categories:

· Monoplegia - used when only one limb is involved.

· Triplegia means that three limbs are affected – usually both legs and one arm.

However, you may find different categories may be used by different professionals.

Spastic cerebral palsy (Spasticity) Spasticity is caused by impairment in the cerebral cortex (the outer layer) of the brain. This is the most common form of cerebral palsy. It is characterised by constant increased muscle tone and weakness in the parts of the body affected. This increased muscle tone (hypertonia) creates tightness (stiffness) in the muscles, leading to a decreased range of movement in the joints. The effects may increase with anxiety or increased effort, leading to excessive fatigue.

Athetoid cerebral palsy (Athetosis) Athetosis is caused by impairment in the basal ganglia area of the brain. It is characterised by involuntary and uncontrollable muscle tone fluctuations, sometimes involving the whole body. The muscles alternate between being floppy and tense. There will often be difficulty in maintaining posture. The person usually has full range of movement in their joints, but not the stability or co-ordination to control their movements.

Unwanted movements may be small, rapid, irregularly repetitive, random, jerky movements - sometimes referred to as choreic movements. The unwanted movements may also be of a long slow, writhing nature.

Someone experiencing athetosis will often appear restless and constantly moving; being still only when fully relaxed – sometimes only when asleep. The movements will often become worse when the person is excited or is attempting to do something.

Speech is nearly always affected to some degree, because of difficulty in controlling the tongue, breathing and vocal chords. Similarly there may be difficulties eating and, the person may drool (saliva coming out of the mouth).

Ataxic cerebral palsy (Ataxia) This relatively rare form of cerebral palsy, which affects less than ten percent, is caused by impairment to the cerebellum, which is in the base of the brain. The cerebellum co-ordinates the actions of groups of muscles and is responsible for, amongst other things, balance. As with athetoid cerebral palsy, all four limbs and body are usually involved.

This impairment can lead to a general poor sensation of balance, unsteadiness and staggering when walking. Tremors may also be present when the person is attempting a task.

Many people with cerebral palsy will have a combination of two or more types and will not fit neatly into any one category so you may hear the term "mixed cerebral palsy." Examples of this would be:

· A child with spastic diplegia will have mostly spastic muscle difficulties, with the legs affected more than other parts of the body. However the child might also have a smaller involvement of athetosis and balance problems.

· A child with athetoid quadriplegia might have some ataxia and spasticity present as well.

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