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Cerebral Palsy Causes and Physiotherapy Management

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Cerebral palsy (CP) is a group of neurological disorders caused by a brain injury or abnormality that happens before, during, or immediately after birth, while the brain is still developing, according to the National Institutes of Health.

A person cannot catch cerebral palsy or transmit it to someone else.

The disorder affects a person’s ability to control their motor, or movement, functions. “Cerebral” refers to the brain’s cerebrum, which controls movement. People with cerebral palsy have difficulty controlling certain body movements or cannot control them at all.

Cerebral palsy is a permanent condition, but many therapies and treatments can help people manage their condition and improve their quality of life.

Cerebral Palsy

Signs and Symptoms of Cerebral Palsy

The symptoms and early signs of cerebral palsy are a long list, but they nearly all involve some evidence that a person lacks control over their muscle movements. If parents notice their child missing important developmental milestones, they should be sure to let their pediatrician know. The Centers for Disease Control and Prevention (CDC) offers helpful milestone checklists.

Any of a person’s motor skills — skills related to any type of movement — can be affected, including fine motor skills, gross motor skills, and oral motor skills. Oral motor skills are related to anything you do with your mouth, such as eating, drinking, or chewing gum.

Fine motor skills refer to tasks that use small muscles from one area of the body, usually the hands, fingers, or toes. These skills include writing, eating with silverware, curling your toes, turning a doorknob, or buttoning your shirt.

Gross motor skills use many muscles throughout the body for large movements, such as jumping, running, swimming, bending, reaching, and carrying items.

Examples of symptoms include stiff muscles, jerky reflexes, tremors, poor coordination or balance, trouble speaking, seizures, incontinence, stiff or “floppy” muscles, slow movement, problems with sucking or swallowing, or trouble picking things up.

Cerebral palsy may also cause certain neural pathways — the paths in the body where nerve signals travel — to work improperly or slowly. The condition can also affect a person’s posture and balance, depending on the individual. However, more than half of people with cerebral palsy can walk on their own, notes the CDC.

Cerebral Palsy

Causes and Risk Factors of Cerebral Palsy

A wide range of exposures or incidents can cause the brain injury that leads to cerebral palsy. Sometimes a physician can be certain about the cause, but other times it may not be possible to know exactly what caused it. The following are some of the possible causes:

Genetic mutations can cause the brain to develop differently from typical brains and develop a lesion, or injured area.

Traumatic brain injury due to a fall, car accident, or other serious accident can cause cerebral palsy.

Infections in infancy, such as viral or bacterial meningitis or another condition with a severe, persistent fever, can cause inflammation in or around the brain and injure it. Severe or untreated jaundice, when the liver does not break down old red blood cells as it should, can also increase the likelihood of cerebral palsy.

Improper brain development during pregnancy, which can result from multiple possible causes.

Brain injury or inadequate oxygen during birth can cause cerebral palsy.
Inadequate blood supply to the fetal or infant brain, called a stroke, can also injure the brain.

A mother’s infection during pregnancy may cause problems that contribute to developing cerebral palsy in a growing fetus.

Some exposures or circumstances can increase the risk of cerebral palsy but may not necessarily be the sole cause of it. The following can all increase the risk of cerebral palsy:

Placenta problems during pregnancy, such as placenta previa, placental abruption, or placental insufficiency, raise the risk of cerebral palsy, according to MedlinePlus.

Several infectious diseases can increase risk of cerebral palsy if a mother has one while pregnant, notes the Mayo Clinic, including:

  • Chickenpox (varicella), a viral infection preventable with a vaccine
  • Cytomegalovirus, a common viral infection that harms a child only if a mother first has cytomegalovirus during pregnancy
  • Herpes, a sexually transmitted virus that can affect the placenta and cause inflammation that can damage the fetus’s nervous system
  • Rubella (German measles), a viral infection preventable with a vaccine
  • Syphilis, a sexually transmitted bacterial infection
  • Toxoplasmosis, caused by a parasite in contaminated food, dirt, and cat feces
  • Zika, a virus carried by mosquitos that can also cause microcephaly — an undersized head or brain — in a newborn
  • Exposure to toxic chemicals during pregnancy or early infancy, such as methylmercury or lead, raises the risk.

Pregnancy and birth complications can increase risk of cerebral palsy:

Premature birth (before 37 weeks), with risk increasing the earlier the baby is born
Low birth weight (under 5.5 pounds, or 2.5 kilograms), with risk increasing the lower the weight

According to the American College of Obstetricians and Gynecologists (ACOG), prolonged laborright up arrow, typically defined as longer than 20 hours in first-time mothers, more than 14 hours for non-first-time mothers, or more than 16 hours for twins, may affect risk of cerebral palsy, though it’s not yet clear if it does

Multiples in pregnancy, such as twins or triplets; risk increases with the number of fetuses a woman is carrying and if any of them die before birth.

Breech births, where the baby’s feet or buttocks — instead of the head — are closest to the birth canal when labor begins

Pregnancy complications that involve respiratory or circulatory problems in the baby
It’s unclear whether injuries from forceps or vacuum extraction are associated with cerebral palsy risk. Study findings are not consistent.

Difference in blood Rh factors between mother and child. The Rhesus (Rh) factor is a protein on red blood cells that most people have. If a mother does not have Rh but her fetus does, the mother’s immune system may create cells that attack her child’s blood cells, notes ACOG

In vitro fertilization (IVF) or certain infertility drugs may increase the risk of cerebral palsy, but the risk is extremely tiny, per the March of Dimes.

In a Danish study involving nearly 590,000 children, only about 0.18 percent of babies overall developed cerebral palsy. Among more than 33,000 babies born via IVF, 0.33 percent of them had cerebral palsy.

Some of the increased risk from IVF or fertility drugs may be because these methods and medications also increase the risk of multiples, which in turn increases the risk of preterm birth, notes past research.

Drugs that stimulate ovulation, such as Clomid (clomiphene citrate), increase the likelihood of having multiples

Other conditions in the mother may increase the risk of cerebral palsy, such as thyroid problems, high blood pressure, seizures, epilepsy, intellectual disability, or gestational diabetes, according to the Mayo Clinic.

Cerebral Palsy

How Is Cerebral Palsy Diagnosed?

Getting diagnosed with cerebral palsy usually requires multiple imaging and lab tests. If a doctor suspects a child has cerebral palsy, they will do a physical exam and may refer the child to a specialist.
Most children will undergo several tests:

Magnetic resonance imaging (MRI) uses radio waves to create an image of the child’s brain. It does not involve radiation.

A cranial ultrasound — an ultrasound of the head — can only be done in babies. Ultrasounds create images by sending sound waves into the body that bounce back.
A computerized tomography (CT) scan is a type of X-ray that creates a 3D image of the brain or other parts of the body.

A test called an electroencephalogram (EEG) records electrical activity in the brain to see if the person has seizures. It involves attaching electrodes to a person’s scalp.

Electromyography (EMG) and nerve conduction tests look for problems in the nerves or muscles.

Blood, urine, and skin tests are not always necessary. However, sometimes doctors order these tests to look for other possible conditions, such as genetic or metabolism problems.

If someone receives a diagnosis of cerebral palsy, additional tests will look for sensory or developmental problems caused by the condition:

  • Vision
  • Hearing
  • Speech
  • Movement
  • Mental ability
  • Other development
Several types of cerebral palsy exist, based on what kind of movement problems a person has and where they are in the body, notes the CDC. The most common type is spastic cerebral palsy, affecting about 70 to 80 percent of people with the condition. People with this type have increased muscle tone, which causes stiff muscles and awkward-looking movements.

People with dyskinetic, or athetoid, cerebral palsy (about 10 percent of cases) experience changes in muscle tone, causing rapid, jerky movements or slow, uncontrolled movements.

The last type, ataxic cerebral palsy (about 10 percent of cases), causes difficulty primarily with balance and muscle coordination.

People can also have a mixture of these three types.

Even within these categories, no two cases of cerebral palsy are alike. It may affect only one arm in one person and both arms and legs in another. It may affect the face, only the feet, or the entire body.

Functioning as a Family When a Child Has Cerebral Palsy

The whole family is affected when a child has cerebral palsy. Parents may go through a period of grief when a child is first diagnosed, and many experience a high stress level over time due to the pressures of caregiving. Siblings must navigate what it means to have a brother or sister with needs and abilities that differ from their own.

In spite of the challenges that come with having a family member with CP, couples and families who take the time to communicate with one another — and to care for themselves, as well as for the child with CP — are often able to thrive as a family.

Reaching out to extended family members for support, as well as to local groups and organizations, can help a family get the emotional and practical help they need.

School and Cerebral Palsy

Parents of children with cerebral palsy need to start educating themselves early about issues related to school. Many children with cerebral palsy qualify for an individualized education program (IEP), which spells out the instruction and services a student will receive in their public school.

Many students with cerebral palsy will also need assistive technologies to help with schoolwork and the support of specialists, such as occupational and speech therapists.

A child’s social life is important, too.

It’s important to begin conversations on these topics with the local school district before your child starts school, so that teachers and other staff are prepared to best serve the needs of your child.

Learn More About Helping Your Child With Cerebral Palsy Succeed at School

Prognosis of Cerebral Palsy

The life expectancy of people with cerebral palsy — how long they are expected to live on average — is different for each person. Those with more severe cases usually have a shorter life expectancy than the average person or people with mild or moderate cerebral palsy.right up arrow
Other factors, such as early aging, a weakened immune system, overall disabilities, and musculoskeletal disorders can affect how long a person with cerebral palsy lives as well. The major factors affecting life expectancy are:

  • Severity of the condition
  • Number and severity of disabilities
  • Feeding difficulties
  • Intellectual or cognitive functioning
  • Respiratory functioning
  • Mobility difficulties
  • Seizures
  • Vision and hearing impairment
  • Quality of medical care and treatments

Duration of Cerebral Palsy

Cerebral palsy is a lifelong condition that has no cure. However, with appropriate treatment and the necessary support, people with cerebral palsy can life fulfilling lives.

Cerebral palsy will never get worse, but it will never go away either. The brain injury is permanent and cannot be healed or cured. Conditions related to cerebral palsy, however, may improve or worsen over a person’s lifetime.

Physical therapy, movement aids, surgery, medication, and other treatments can all help a person manage cerebral palsy. These treatments can increase their ability to do certain tasks and live independently.

Cerebral palsy does not cause death except in very rare severe cases in infants or very young children.

Cerebral Palsy

Medication Options

A wide range of medications are used to treat different symptoms or complications of cerebral palsy:

Drugs called anticholinergics are used to help with uncontrolled movements. They work by blocking the chemicals in the brain that cause the movements.

Botulinum toxins are neuromuscular blocker medications made from bacteria.

They can reduce uncontrolled movements in muscles for three to six months.

Medications used to stop or reduce seizures are called anticonvulsants. Sometimes people may need to change their anticonvulsant medications if the one they are taking stops working.

Benzodiazepines are another group of drugs that are sometimes used short-term to treat a treat a seizure. They are not usually taken long-term.

Muscle relaxers, called antispastics, can be prescribed to loosen stiff muscles, tremors, and similar symptoms. They can also increase range of motion in someone with cerebral palsy.

Anti-inflammatories can treat different types of pain that people with cerebral palsy may experience. This includes abdominal pain, muscle or joint pain, pain after a surgery, and pain caused by other treatments, such as an injection or feeding tube placement.

Antidepressants are drugs used to treat depression or anxiety in people with cerebral palsy.

Constipation is common in children with cerebral palsy, so laxatives and stool softeners may be prescribed to help with bowel movements.


  • Physical therapy
  • Occupational therapy
  • Speech and language therapy
  • Recreational therapy

Surgical procedures

  • Orthopedic surgery. Children with severe contractures or deformities might need surgery on bones or joints to place their arms, spine, hips or legs in their correct positions.
  • Cutting nerve fibers (selective dorsal rhizotomy). In some severe cases, when other treatments haven't helped, surgeons might cut the nerves serving specific spastic muscles in a procedure called selective dorsal rhizotomy.
Cerebral Palsy
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