What Is Cerebral Palsy?

Cerebral palsy is a neurological disorder that affects the body’s movement and muscle coordination. According to the Centers for Disease Control and Prevention, cerebral palsy is the most common motor disability in childhood. In addition, data reveals that cerebral palsy is more common in boys than it is in girls, with many children, boys and girls, suffering from spastic cerebral palsy (stiff feeling and jerky movements).

Cerebral palsy is caused by damage to the area(s) of the brain which control motor related functions. In the word cerebral palsy, cerebral deals with the cerebrum part of the brain, (note the cerebellum can be affected with cerebral palsy too), and palsy refers to a type of paralysis or weakness. Therefore, it is common for children who have been diagnosed with cerebral palsy to have trouble with movement and posture, in addition to having trouble with depth perception. Swallowing and feeding are also other areas of challenge.

What Are The Signs & Symptoms Of Cerebral Palsy In Babies?

For many parents, the one thing that generates concern regarding their baby is when the child fails to meet certain neonatal milestones. This can be in the form of the baby not crawling, or not making sounds, or not eating (aversion to anything placed in the mouth), among other things. Because cerebral palsy is a brain injury, the condition does not get “worse” over time. When certain areas of the brain are injured, the injury can be permanent and there is nothing that can be done to “reverse” the damage. Below are some of the signs of symptoms of a baby who may be dealing with cerebral palsy:

If your baby is exhibiting the above, you may need to speak with your child’s pediatrician or other medical professional. Remember, cerebral palsy is a condition which can range from mild to severe. Motor deficiencies can range from minor all the way to virtually complete paralysis.

How And When Do Doctors Diagnose Cerebral Palsy?

Cerebral Palsy is diagnosed through physical examination and a review of the child’s medical records. Although the use of MRI and other imaging tests can determine whether a child has suffered a brain injury, these tests cannot by themselves determine the severity of a possible cerebral palsy diagnosis. When conditions such as hypoxic ischemic encephalopathy are present during delivery, certain imaging tests can be ordered to help time the injury.

Many doctors will not diagnose a child with cerebral palsy until around 20-24 months. As a result, a child can move through the early part of their life with their cerebral palsy condition missed. It is not until some of the early milestones (between ages 1-5) are not met that parents begin to suspect the need for medical intervention. The use of many specialists is usually needed when a cerebral palsy diagnosis is suspected. However, note the type of cerebral palsy suspected will determine the time frame of diagnosis:

What Types Of Tests Do Doctors Use To Test For Cerebral Palsy?

Because cerebral palsy is a type of neurological disorder, imaging and scan tests are frequently used. Not only can imaging tests assist with a cerebral palsy diagnosis, the tests can help pinpoint the causes of seizures. Below is a list of some of the tests which can be used to help test for cerebral palsy.

MRI: MRI stands for magnetic response imaging. An MRI can take a 3D image of the brain to help determine abnormalities in the brain which deal with motor function. An MRI can take around an hour to perform. MRI’s can help doctors determine the cause of the child’s cerebral palsy.

Cranial Ultrasound: A cranial ultrasound is a test that allows doctors to examine the brain tissue. Cranial ultrasounds are quick tests. However, they are not as detailed as MRIs or CT scans. Cranial ultrasounds can be helpful because they can capture changes in the white matter of the brain. White matter is typically damaged in a child who has cerebral palsy.

Computed Tomography: CT scans take cross sectional images of the brain. A CT scan can be performed in around 20 minutes. A CT scan can detect things such as brain bleeding and other brain conditions. In a cerebral palsy diagnosis, a CT scan can help confirm the diagnosis and assist with the timing of a brain injury. The film from a CT scan will look like an X-Ray.

Electroencephalogram: An EEG determines the electronic activity of the brain. Seizures have distinct patterns and EEGs can detect these patterns.

Umbilical Cord Gas Test: In certain instances, doctors during labor and delivery will order an umbilical cord gas test. This test can be triggered if there is meconium staining when a mother’s water is broken, and other factors present, like a non-reassuring fetal heart strip. The cord gas test looks to measure how much oxygen and carbon dioxide is in the baby’s blood. Oxygen and carbon dioxide impact the blood’s acidity, or pH. Acidity in the blood means that the blood cells are beginning a change which suggests that the baby has suffered a lack of oxygen. A lack of oxygen can trigger fetal hypoxia, or hypoxic ischemic encephalopathy, thus leading to cerebral palsy.

Developmental Testing: Developmental testing can be used to see if the child is meeting certain milestones. Because some children go through the early months with symptoms undetected, parents are alerted to potential problems due to the failure of their child to meet certain milestones (ex. Crawling).

Reflex Testing: Just as the name suggests. These tests look to the child’s reflexes. Remember, cerebral palsy affects the motor system, so a test of the reflexes is a good indicator.

Hearing Impairment Testing

Visual Impairment Testing

Speech Impairment Testing

How To Understand The 4 Types Of Cerebral Palsy

Cerebral palsy can be broken down into four major types, with the most common being Spastic. In the world of cerebral palsy, there are two terms to understand regarding how CP affects the muscle tone. They are the following:

Below is a breakdown and discussion regarding the types of cerebral palsy children face:

Spastic Cerebral Palsy

As mentioned above, spastic cerebral palsy is the most common type of cerebral palsy diagnosed. Around 80% of cerebral palsy cases will be of the spastic type. Spastic cerebral palsy includes hypertonia because the muscle movements are ridged and jerky.

Because cerebral palsy is due to injury to the motor functions in the brain, voluntary movement is impaired. These injured areas prevent the brain from sending out signals regarding the flexibility of the muscles, hence hypertonia.

Athetoid Cerebral Palsy

Athetoid, or dyskinetic cerebral palsy, is another type of cerebral palsy in which injury to the motor functions of the brain have occurred. Usually, the area(s) of the brain damaged will be the basal ganglia and/or cerebellum. Hypoxic ischemic encephalopathy can also lead to this type of cerebral palsy.

Children suffering from athetoid cerebral palsy will experience both hypotonia and hypertonia. Due to this combination, low muscle tone and rigid/erratic movements will be present. Since injury to the basal ganglia and or cerebellum occurs with this type of cerebral palsy, children can have trouble with things such as eye movement, motor functions, and balance and coordination. When athetoid, or dyskinetic cerebral palsy is present, parents may see their child experience some of the following:

Mixed Cerebral Palsy

Children who suffer from mixed cerebral palsy generally have a brain injury that is not concentrated in one area of the brain. As a result, a child suffering from mixed cerebral palsy might display spastic cerebral palsy (rigid legs) and athetoid cerebral palsy (poor facial control). Mixed type cerebral palsy is present in about 10% of cerebral palsy diagnoses.

Ataxic Cerebral Palsy

Ataxic cerebral palsy is one of the rarest forms of cerebral palsy. It is usually accompanied by poor muscle tone, or hypotonia, causing the child impaired fine motor skills and other movements. Ataxic cerebral palsy affects the entire body and leads to abnormal body movements. A child’s arms, hands, body/trunk, and feet will be affected due to injury to the cerebellum. Parents may notice the following with their child if ataxic cerebral palsy is suspected:

Understanding The Classification Of Cerebral Palsy

There are multiple factors involved when classifying cerebral palsy. Because of the number of specialists involved, the classification system encompasses numerous factors. A doctor looking at the child’s limbs, such as an orthopedic specialist will need to focus on the challenges regarding this area of the body and possible treatment options. The same can be said for neurologists and other specialists. As a result, parents must remember to think about their child’s cerebral palsy classification from a global standpoint. In addition, medical professionals are moving to a universal classification to help with treatments for children who have been diagnosed with cerebral palsy. Below are some of the ways in which cerebral palsy can be classified:

Motor Function Classification

The motor function classification system for cerebral palsy examines the area of the brain which controls the baby’s motor functions. These functions involve your child using their muscles. When a child has a cerebral palsy diagnosis, muscle use becomes impaired, leading to hypotonia and or hypertonia (Mixed Cerebral Palsy if both are present). Under the motor function classification system, four types of cerebral palsy exist. They are the following:

Gross Motor Function Classification

Gross motor function is defined as your baby’s ability to use their arms, hands, legs, feet, or the entire body. Gross motor function is important because it is with gross motor functions a person can make large movements. When a child walks, crawls, runs, jumps, etc.…gross motor functions are on display. Injury to areas of the brain which control these functions can lead to impairment.

The Gross Motor Function Classification System has been developed to assess the gross level function of a child with cerebral palsy. The system pays close attention to actions such as walking, sitting, and wheeled mobility and grades out on a 5-level classification system, with the highest level denoting the most severe case of cerebral palsy. With this system, doctors and other medical professionals can better develop treatments and assisting devices to help children gain independence. Most practitioners use The Gross Motor Function Classification System in conjunction with other systems to find the best treatment options for children with cerebral palsy.

Gross Motor Function Classification System Level 1

Under the Level 1 classification system children can walk at home and in other places in the community. They can also use stairs without a railing. The child can mostly move without limitations, but speed, balance, and coordination may suffer a bit.

Gross Motor Function Classification System Level 2

Under the Level 2 classification system the child can walk in most settings and when using stairs, the assistance of the rail is needed. Walking over long distances may be problematic, especially when coupled with having to use balance on uneven surfaces or in crowded spaces. Physical devices or wheelchairs can help with long distance mobility. The ability to run and jump is impaired.

Gross Motor Function Classification System Level 3

Under the Level 3 classification system a handheld mobility device is used in many indoor settings. Climbing stairs can be done with the help of holding on to railings with assistance, or supervision. Wheeled mobility is needed for long distances and self-propelled devices are used for short distances.

Gross Motor Function Classification System Level 4

Under the Level 4 classification system methods of mobility require physical or motored assistance in most environments. When in settlings like school, and other parts of the community, children need wheelchairs or powered mobility. Regarding home life, the child might be able to walk around some, with the assistance of wheelchairs, powered mobility, or body support devices.

Gross Motor Function Classification System Level 5

Under the Level 5 classification system the child needs a manual wheel chair in all settings. In addition, head and limb movements are impaired (holding the head up and/or the limbs).

Severity Level Classification

Cerebral palsy is classified on a severity scale of mild, moderate, or severe. The severity classification is a way to generally classify the challenges a child might face with cerebral palsy, but the classification is not as specific as say the Gross Motor Function Classification System. Below is the severity level classification for cerebral palsy:

Topographical Distribution Classification

Topographical distribution classification focuses on the area of the body affected by the cerebral palsy diagnosis. A topographical distribution classification can be helpful when creating treatment options for a child. The following are the areas of concentration for topographical distribution classification:

Communication Function Classification System

The goal of the communication function system is to classify the everyday communication of a person diagnosed with cerebral palsy. The system is based on a five-level communication platform. When using the communication function classification system, a person who is familiar with the communication of the person diagnosed with cerebral palsy, helps with the classification. For many with cerebral palsy, the lack of “speech” does not mean that communication is absent. Gestures, facial expression, speech, etc.…are used in the communication function classification system. Below are the levels: