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. Cognitive ability cannot be inferred from the severity of motor or speech impairment. Some people with dyskinetic CP have typical intellectual ability while others have intellectual disability, so accessible assessment and communication are essential.

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 and intellectual disability (both common, with rates varying by CP type, severity and study), 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 is common in cerebral palsy and can arise from muscle tone, joints, positioning, procedures or unrelated health problems. Pain should be assessed directly and not assumed to be an unavoidable part of CP.

ADULTHOOD
The brain disturbance causing CP is non-progressive, but symptoms, pain, mobility and functional ability can change across the lifespan. Musculoskeletal complications, fatigue, ageing and access to healthcare can all affect adult function. Changes should be assessed rather than assumed to be inevitable deterioration.

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 systems can provide communication access for some people who cannot reliably use speech or their hands. Suitability and accuracy depend on vision, motor control, cognition, positioning, calibration and individual assessment.