How cerebral palsy affects people’s lives
Cerebral palsy describes a number of neurological conditions that affect movement and co-ordination. Caused by problems in the nervous system and parts of the brain that control the muscles, it occurs if the brain either develops abnormally or if it’s damaged before, during or quickly after birth.
Cerebral palsy can be caused by a number of factors, including:
- A premature or difficult birth
- If the mother catches an infection during pregnancy
- Changes or mutations in the genes affecting the brain’s development
- Bleeding on the baby’s brain
When is cerebral palsy typically diagnosed?
It may be diagnosed soon after birth in severe cases; however, in the majority of cases a diagnosis is made within the first two years.
For a child who has spastic diplegia, a common form of cerebral palsy, the average age of diagnosis is 18 months. In milder cases, diagnosis may take until the child is between three and five years old -when the brain is fully developed.
How is cerebral palsy diagnosed?
There is no specific test to confirm or rule out cerebral palsy. Initially, the parents may suspect something is wrong; usually if their child has missed the developmental milestones appropriate to their age – they may think their child is a “slow starter” and that he or she will “catch up”.
However, it is advisable to inform a GP of any concerns so that cerebral palsy can be ruled out or confirmed. Diagnosis can take several steps, one of which is monitoring the child for key indicators, such as:
- When he or she reaches development milestones
- Monitoring growth chart standards for their weight and height
- Checking the child’s reflexes
- Monitoring whether or not the child can hear and focus on other people
- Checking whether posture and movement appear to be abnormal
The child’s parents and a paediatrician can monitor these functions and doctors can test muscle tone, reflexes, muscle posture and co-ordination over time. If cerebral palsy is suspected, primary care physicians can consult medical specialists and arrange tests including cranial ultrasounds, MRIs and CT scans.
Other actions to assist diagnosis include:
- Reviewing pregnancy, labour and delivery records
- Reviewing the newborn screens conducted at birth
- Checking the Apgar score; an assessment of the baby’s wellbeing at birth
- Studying medical, growth and developmental records
- A physical examination of the baby, including a hearing test
- Tests for hemoglobinopathies, amino acids and fatty acids
- Neuroimaging tests to look for brain damage
- Electromyography (EMG) and electroencephalography (EEG) to analyse the nervous system’s functions
- Lab tests such as urinalysis, blood work and genetic testing
What are the signs of cerebral palsy?
As cerebral palsy has varying degrees of severity, the symptoms may be more pronounced in some more than others. The main symptoms include problems with:
- Speech, hearing and vision
- Mobility and gait
- Feeding and digestion
- Cognitive issues
What are the different types of cerebral palsy?
There are four main types of cerebral palsy:
Spastic cerebral palsy is characterised by weak, stiff muscles known as hypertonia, especially when moving quickly.
Dyskinetic cerebral palsy affects the unconscious ability to relax or contract muscles – muscle tone varies between floppiness and stiffness. This type is split into two categories: involuntary spasms and postures, known as dystonic cerebral palsy or uncontrolled, random body movements known as choreoathetoid cerebral palsy.
Ataxic cerebral palsy is diagnosed when someone has co-ordination and balance problems, causing jerky movements – another symptom is involuntary shaking or tremors in their hands.
Mixed cerebral palsy is diagnosed when someone has a number of different symptoms from any of the above.
How can cerebral palsy affect someone’s life?
The severity of the condition can affect a person’s life in different ways. It can affect balance and posture; the ability to move; communication abilities; sleeping; eating and learning skills.
In severe cases, the person may require 24-hour assistance, having little or no control over their speech or movements. One in three children with cerebral palsy can’t walk, while those with spastic quadriplegia may experience the most severe symptoms including impaired vision, epilepsy and the inability to sit unaided – they are likely to need care for the rest of their lives.
People with milder cerebral palsy may have lesser symptoms such as a weakness in one hand, for example. Although this can make simple tasks such as tying shoe-laces, fastening buttons or writing more challenging, they can often live an independent life.
In between are other symptoms of varying severity that will impact people’s lives in different ways. One in four people with cerebral palsy can’t talk, making everyday communication challenging. For some people pain is the problem, as it affects their ability to do ordinary things such as sleeping and enjoying social relationships.
What treatments are available to improve the lives of people with cerebral palsy?
The brain injury that causes the condition can never be healed. However, the resulting physical symptoms can be managed, enabling the person to live a fuller life. The goals of treatments are to optimise mobility, control pain and manage the primary conditions.
Treatments include therapy, adaptive equipment, medication and sometimes surgery. Some people, with their doctor’s assistance, also use alternative and complementary medicine.
A pediatrician will normally assess a child’s health to develop a treatment plan to meet their unique needs, taking into account the family circumstances and how much care is needed and available.