Cerebral Palsy Overview

Cerebral Palsy

• Cerebral palsy (CP) is a neurodevelopmental condition starting in early childhood and lasting throughout life.

• Originally described by Little in 1861, initially called "cerebral paresis."

• CP is a non-progressive central nervous system (CNS) deficit.

• Lesions can be located in a single or multiple areas of the brain, leading to motor and potentially sensory abnormalities.

• Causes include factors in the womb (congenital CP), events during labor and delivery, or a combination of factors during early development (acquired CP).

• Bax (1964) defined CP as a movement and posture disorder caused by defects or lesions in the immature brain.

• Mutch and colleagues (1992) defined CP as a group of non-progressive (but sometimes changing) motor impairments due to brain lesions or abnormalities during early development.

• CP is characterized by permanent movement and posture disorders resulting from non-progressive disturbances in the developing fetal or infant brain.

• Symptoms often include sensory, perceptual, cognitive, communication, and behavioral challenges.

• Other complications often associated with CP include epilepsy and musculoskeletal problems.

• Disorders of posture and movement excluded from CP are those of short duration, caused by progressive diseases, or solely due to mental deficiency.

Incidence and Prevalence

• Approximately 550,000–764,000 Americans have a diagnosis of CP.
• About 9,750 new cases are diagnosed annually (UCP, 2003).
• The incidence of CP in developed countries is generally 2–2.5 per 1,000 live births (Scherzer, 2001).
• Prevalence has risen in industrialized countries.
• Spastic diplegia has become more common than athetoid types (Scherzer, 2001).
• CP incidence is slightly higher in premature infants and infants born small for gestational age.
• CP is slightly more common in males than females.

Risk Factors

• Antenatal: Prematurity, low birth weight, intrauterine infections, multiple gestation, pregnancy complications.
• Perinatal: Birth asphyxia, complicated labor and delivery, (10% of CP cases).
• Postnatal: Non-accidental injuries, head trauma, meningitis/encephalitis, cardiopulmonary arrest.
• Obstetrical Care: Magnesium sulfate, antibiotics, corticosteroids.

Genetic Causes

• Genetic factors account for only about 2% of CP cases.
• Some rare genetic syndromes, like Joubert, Marinesco-Sjogren, Gillespie, and Behr syndromes, are linked to CP. These syndromes often show ataxia.

Maternal Disorders

• Maternal conditions that restrict fetal oxygen supply, like bleeding during pregnancy, placental infarction, preeclampsia/toxemia, small size for gestational age or diabetes of the mother, and multiple pregnancies, can increase CP risk

Other Medical Conditions

• Meningitis and encephalitis are common infectious causes of CP.
• Late-onset hydrocephalus and neoplastic intracranial lesions (brain tumors), as well as intracranial hemorrhage from arteriovenous malformations, can be underlying conditions linked with Cerebral Palsy.

Types of Cerebral Palsy

• CP types are classified by muscle tone characteristics: spastic, dyskinetic, ataxic, hypotonic, and mixed.
• Spastic CP: Stiff muscles, slow movements, difficulties with speed and direction of movement.
• Dyskinetic CP: Involuntary, writhing movements, variable muscle tone, imprecise movements. Can underreach or overreach.
• Ataxic CP: Poor balance, coordination problems, difficulty controlling timing and accuracy.
• Hypotonic CP: Decreased muscle tone; weak muscles, excessive joint movement, delayed milestones.
• Mixed CP: Combination of two or more types of CP.

Acquired Cerebral Palsy

• Brain damage after early infancy, due to infection and/or head injury, can result in Acquired CP.
• Individuals with acquired CP have a more diverse profile than congenital CP patients, and these patients are often categorized based on their specific disorder (such as diffuse hypotonia, spastic quadriplegia).

Characteristics of Different CP Types

• Spastic: Stiff muscles, slow/reduced movement, and velocity-dependent resistance to passive movement.
• Dyskinetic: Uncontrolled/involuntary movements, variable muscle tone, inconsistent movements.
• Ataxic: Poor balance, imprecise coordinated movements.
• Hypotonic: Reduced muscle tone and weak muscle strength, excessively flexible joints.

Abnormal Oral Movement Patterns and Posture

• Lip Retraction: Tight lips, forced into a smile position, difficulty feeding.
• Jaw Thrust & Lack of Jaw Grading: Forceful downward jaw extension, fixed jaw position.
• Tonic Bite: Strong, forceful bite initiated by chewing stimulation, hard to release.
• Tongue Retraction: Tongue held tightly back in the oral cavity, limited range of motion, difficult manipulating utensils.
• Tongue Thrust: Retention of extrusion reflex, thick appearance of the tongue, issues with the transport of food.
• Nasal Regurgitation: Food/liquid flows backwards through the nose due to velar dysfunction (soft palate).