Cerebral Palsy in Children

At RWJBarnabas Health, we offer patient- and family-centered care for children with cerebral palsy (CP).

Caring for a child with a chronic illness like CP requires specialized, compassionate care across a spectrum of specialties. Our multidisciplinary team includes experts in complex care management, including physicians specializing in:

• Physiatry
• Neurology
• Developmental and behavioral pediatrics
• Psychiatry
• Orthopedics

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The therapists on our team are experts in treating children with developmental disabilities. They include:

• Physical therapists
• Occupational therapists
• Speech-language pathologists
• Psychologists

Our team will coordinate care among the specialists. To ensure that we maximize each child’s quality of life and independence, we coordinate care with the child’s school as well.

What Is Cerebral Palsy?

Cerebral palsy is a group of neuromuscular disorders that causes movement, balance, and posture problems, and it is the most common motor disability among children. Children may also have difficulty eating or speaking if the muscles that make these movements are hard to control.

CP is caused by a brain injury during pregnancy or shortly after birth, and it can affect children in many different ways. The severity of the condition is variable from one child with CP to the next, and some children may have a mild case and can learn to walk with minimal assistance and have no need for ongoing special care into their older childhood and adolescent years. Other children with CP may have a more severe case and use a wheelchair and need special care for life.

While there is no cure for cerebral palsy, treatment can substantially improve the lives of children who have the condition. Treatment programs should begin as early as possible.

Types of Cerebral Palsy

CP is categorized according to the main type of movement disorder the child has, which is influenced by which area(s) of the brain are affected.

Cerebral palsy is categorized in the following ways:

• Spasticity. About 80 percent of people with CP have spastic cerebral palsy, making it the most common type. Spasticity makes the muscles stiff and movements awkward because of increased muscle tone. The muscle tightness is present even at rest and can make it challenging to move the arms or bend the legs. Spastic CP has subtypes depending on which body parts are affected, and each subtype has unique risk factors.
• Diplegia affects the legs more than the arms.
• Hemiplegia affects one side of the body.
• Quadriplegia affects both the arms and legs.
• Dyskinetic cerebral palsy. Children with dyskinetic CP have uncontrollable fluctuations in muscle tone, as well as involuntary, sporadic movements. Their movements can be slow and twisting or rapid and jerky. A child with dyskinetic CP often has difficulty sucking, swallowing and talking.
• Ataxia. Ataxic CP is the least common type, affecting about 6 percent of those with CP. It causes balance and coordination problems, such as unsteadiness while walking. Children with this type of CP often have a hard time with fine motor skills or other movements that require a lot of control, such as writing by hand. They may also have difficulty controlling their hands or arms while reaching for objects.
• Mixed. Children may have symptoms that overlap one category to another, for instance, the most common type of mixed CP is spastic-dyskinetic.

What Causes Cerebral Palsy?

Cerebral palsy has many separate causes, all of which occur during pregnancy or shortly after birth. While there is no single test to diagnose CP, children are often diagnosed between 1 and 3 years of age.

Cerebral palsy risk factors include:

• Prematurity before 37 weeks of gestation
• Very low birth weight, especially under 3.3 pounds
• Bleeding in the brain before, during, or after birth
• Head trauma
• Seizures in infants
• Maternal infections
• Brain infections such as meningitis and encephalitis
• Genetic abnormalities
• Chemical or substance abuse pregnancy
• Lack of oxygen to the brain during pregnancy or shortly after birth

Motor delays are usually the first clue that a child may have cerebral palsy unless there was a known risk factor for early brain injury and early signs of the condition are noticed after birth.

Parents concerned about their child’s development should speak to a pediatrician to check for CP signs.

Cerebral Palsy Diagnosis

Diagnosing and addressing CP at an early age is very important, but it can take several steps, and no single test can diagnose cerebral palsy. Instead, full knowledge of the child’s medical history and observation of their symptoms is required. Diagnosing CP may include developmental monitoring, screening, and evaluations. While some children may be diagnosed shortly after birth if they had significant risk factors, most children aren’t diagnosed until they are at least 6 to 12 months old, and others with more mild cases may not be diagnosed until they are 3+ years old.

If your child’s pediatrician suspects your child has CP, they will review your child’s medical history, evaluate their symptoms, monitor their growth and development, and conduct a physical exam.

Early referral to a pediatric physiatrist for early diagnosis and treatment is critical.

While the diagnosis is based on a detailed history and physical exam of a specialist, such as a pediatric physiatrist, the following test may be helpful for further diagnosis and treatment depending on the individual.

• Brain scans. Magnetic resonance imaging (MRI), computed tomography (CT) scans, or cranial ultrasounds can identify brain lesions or abnormalities.
• Electroencephalogram (EEG). An EEG test is used to evaluate the electrical activity in your child’s brain if your child is suspected of having seizures.
• Laboratory tests. Genetic or metabolic problems may be present in blood, urine, or skin tests.
• Developmental tests. Your child’s pediatrician can track their growth and development over time and check for specific developmental delays like motor or movement problems.
• Gait lab analysis. This looks at the child’s walking pattern and helps guide decisions regarding tone management and bracing.

Treatment for Cerebral Palsy in Children

There is no cure for cerebral palsy, and it is a chronic (lifelong) condition, but effective treatment can substantially improve the lives of those who have it. There is no single treatment that is best for all children with CP, because the condition is so variable.

Treatment depends on the child’s symptoms, age, overall health, and severity of their condition.

The overall goal of your child’s health care providers is to prevent or reduce the challenges the child faces and helping them make the most of their abilities.

The treatment team often includes health care professionals across multiple specialties. A pediatric physiatrist, an expert in this condition, will help coordinate and lead the team that includes the pediatrician, pediatric neurologist, pediatric orthopedist, pediatric neurosurgeon, therapists, and equipment and bracing specialists.

Treatments may include:

• Medication. Certain medicines can ease muscle tension and tightness and improve functional abilities.
• Muscle or nerve injections. To treat tightening of specific muscles, Botox injections may be helpful and can be repeated as often as every 3 months. Botox temporarily paralyzes targeted muscles and can help children with CP relax tensed, tightened muscles.
• Muscle relaxants. Oral medication can relax tightened muscles. Careful attention must be paid that children do not become dependent.
• Therapies. Various therapeutic techniques play a role in the treatment of almost every child with CP. These treatments can improve strength, flexibility, balance, and improve independence in daily activities. For example, most children benefit from:
  • Physical therapy
  • Occupational therapy
  • Speech-language therapy
  • Recreational therapy
• Surgical procedures. Surgery may be necessary to correct bone abnormalities resulting from spastic muscles. Orthopedic surgery can correct the positions of the arms, hips, or legs. Other surgical procedures can lengthen the muscles and tendons that have been shortened by contractures.

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