Cerebral Palsy

📖 Overview

Cerebral palsy (CP) is the most common physical disability in childhood. It is caused by damage to or differences in the developing brain, usually before, during, or shortly after birth. The brain damage is non-progressive — it does not get worse over time — but the effects on the body change as the person grows.

CP affects movement, muscle tone, and coordination. Every person with CP is different — the type, distribution, and severity of motor involvement varies enormously, as do intelligence, communication, and associated conditions.

TYPES OF CEREBRAL PALSY

Spastic Cerebral Palsy
The most common type, affecting approximately 80% of people with CP. Spasticity means increased muscle tone — the muscles are stiff or tight, making movement difficult and sometimes painful. Spastic CP is further described by which parts of the body are affected:
Spastic hemiplegia — one side of the body affected (arm and leg on the same side). Often the arm is more affected than the leg. Many people with hemiplegia walk independently but may have significant hand function difficulties.
Spastic diplegia — both legs primarily affected, with the arms less involved or unaffected. Common in premature babies. Many people with diplegia walk, sometimes with aids.
Spastic quadriplegia — all four limbs affected, usually severely. Often the most complex form, frequently involving speech, swallowing, and cognitive difficulties as well as motor.

Dyskinetic Cerebral Palsy
Dyskinetic CP involves involuntary, uncontrolled movements — writhing (athetosis), twisting (dystonia), or abrupt jerking (chorea). The muscle tone fluctuates, changing from floppy to stiff. Speech and facial movements are often significantly affected. Intelligence is frequently unaffected despite the severity of motor involvement — dyskinetic CP is one of the conditions where the greatest discrepancy between apparent and actual cognitive ability occurs.

Ataxic Cerebral Palsy
Ataxic CP affects balance and coordination. Movements are shaky and unsteady — the person has difficulty with tasks requiring precision, balance, and coordination. Walking may be broad-based and unsteady. The least common type of CP.

Mixed Cerebral Palsy
Many people have features of more than one type — most commonly spasticity with dystonia. Mixed CP is common in more severely affected individuals.

GROSS MOTOR FUNCTION CLASSIFICATION SYSTEM (GMFCS)
The GMFCS classifies CP from Level I (walks without limitations) to Level V (transported in a manual wheelchair, very limited self-mobility). This classification gives a better picture of functional ability than type alone.

ASSOCIATED CONDITIONS
CP is a motor condition but is frequently accompanied by: epilepsy (in around 30-40%), intellectual disability (in around 30-40%), speech and communication difficulties, vision impairment, hearing impairment, pain (particularly in adulthood), eating and swallowing difficulties (dysphagia), bladder and bowel difficulties, and mental health difficulties.

Pain in cerebral palsy is significantly underrecognised and undertreated. Musculoskeletal pain increases with age as the effects of abnormal muscle tone on joints and the skeleton accumulate. Adults with CP reporting pain are often dismissed or undertreated.

PROGRESSIVE DETERIORATION IN ADULTHOOD
While the brain injury itself is non-progressive, many people with CP experience deterioration of function in adulthood. This is caused by the cumulative effects of spasticity on joints (contractures, scoliosis, hip dislocation), the energy cost of mobility catching up, and pain increasing. Transition from paediatric to adult services — where CP expertise is much less common — is a high-risk period.

COMMUNICATION IN CEREBRAL PALSY
Speech is affected in many people with CP — either by the motor involvement of the muscles used for speech, or by associated communication difficulties. Unclear speech does not reflect intelligence. AAC is used by many people with CP and should be resourced and supported throughout life.

Eye gaze technology has transformed communication access for people with CP who cannot use their hands. Eye gaze can be extremely precise and enable full communication, academic participation, and independence for people with severe motor impairment.