Cerebral Palsy

Cerebral palsy is a condition involving a group of disorders that affects the child’s ability to control his or her own movement. “Cerebral” refers to the brain and “palsy” refers to muscle weakness and lack of control.

The effects, depending on which areas of the brain have been damaged, may include:

  • Mental Retardation;
  • Seizures;
  • Impairment of Speech, Hearing or Sight;
  • Abnormal Perception and Sensation;
  • Problems in Gait and Mobility;
  • Involuntary Movement; and
  • Muscle Spasm or Tightness.

In most cases, cerebral palsy is a lifelong disability.

A child may be affected by any of the following types of Cerebral palsy:

  • Spastic Cerebral Palsy which causes difficult and stiff movements;
  • Ataxic Cerebral Palsy which causes loss of depth perception and sense of balance;
  • Athetoid Cerebral Palsy which causes uncontrolled and involuntary movements; and
  • Mixed Cerebral Palsy which causes symptoms of more than one of the above three types.

Cerebral palsy results from injury to the cerebrum (the largest portion of the brain, involved with higher mental faculties, sensations, and voluntary muscle activities). It can be caused by injury to the brain before, during, or after birth. Any condition that impedes a child’s breathing could lead to Cerebral Palsy. The most significant birthing complication related to Cerebral Palsy is severe asphyxia. Asphyxia is the lack of oxygen to the brain. This can occur when:

  • The child’s breathing is restricted by the umbilical cord.
  • The baby becomes stuck in the birth canal and the placenta being prematurely sheared. When this happens, a doctor must make an immediate decision to order a C-section in order to prevent conditions that could lead to Cerebral Palsy.
  • The baby does not begin breathing immediately after birth. Without oxygen, the baby’s brain cells start to die causing brain damage. Half of the infants who suffered severe asphyxia during birth develop Cerebral Palsy. Thus, it is critical for doctors to prevent asphyxia and make sure that an infant’s breathing is normal.

Other complications that can result in cerebral palsy include:

  • Infection during pregnancy, including measles, rubella, cytomegalovirus and toxoplasmosis;
  • Jaundice in the infant that can damage the infant’s brain cells; and
  • Rh incompatibility that can lead to the production of antibodies by the mother’s body that destroy the fetus’s blood cells, and can lead to a form of jaundice in the newborn

Approximately 10 to 20 percent of children who have cerebral palsy acquire the disorder after birth. Cerebral palsy may occur during early infancy as a result of cerebral injury caused by such factors as:

  • illnesses, including encephalitis, meningitis, and herpes simplex infections;
  • head injury during birth resulting in subdural hematoma; and
  • blood vessel injuries.

Cerebral palsy can also be caused later in life by head injury following an accident.

There are certain risk factors that, if present, indicate an increased likelihood that the child will later be diagnosed with cerebral palsy. These risk factors include:

  • Fetal Distress – Complications during labor and delivery, such as vascular or respiratory problems of the baby during labor and delivery may result in brain damage causing permanent brain damage that results in cerebral palsy.
  • Breech presentation – Babies that present feet first, instead of head first, at the beginning of labor are at a higher risk of developing cerebral palsy.
  • Multiple births – Twins, triplets, and other multiple births have an increased risk of cerebral palsy.
  • Maternal bleeding or severe proteinuria (the presence of excess proteins in the urine)late in pregnancy result in a higher risk of having a baby with cerebral palsy.
  • Maternal hyperthyroidism, mental retardation, or seizures increase the risk for cerebral palsy.

When these or other warning signs are present, doctors and health care providers should take immediate steps to properly monitor the unborn baby, to treat the cause of any complication that has arisen, and, where necessary, to deliver the baby (usually by cesarean).

Once the baby is born, there are additional risk factors that indicate the baby is at risk of having or developing cerebral palsy and should be closely monitored and treated. These include

  • A Low Apgar score.
    The Apgar score is a numbered rating that reflects a newborn’s condition. To determine an Apgar score, doctors periodically check the baby’s heart rate, breathing, muscle tone, reflexes, and skin color in the first minutes after birth. They then assign points; the higher the score, the more normal the baby’s condition. A low score at 10-20 minutes after delivery is often considered an important sign of potential problems.
  • Low birthweight and premature birth.
    The risk of cerebral palsy is higher among babies who weigh less than 2500 grams (5 lbs., 7 1/2 oz.) at birth and among babies who are born less than 37 weeks into pregnancy. This risk increases as birthweight falls.
  • Nervous system malformations.
    Some babies born with cerebral palsy have visible signs of nervous system malformation, such as an abnormally small head (microcephaly). This suggests that problems occurred in the development of the nervous system while the baby was in the womb.
  • Seizures in the newborn.
    An infant who has seizures faces a higher risk of being diagnosed, later in childhood, with cerebral palsy.

Cerebral palsy continues to occur at a disturbing rate, with

  • Approximately 2 to 4 out of every 1000 new births having Cerebral Palsy;
  • At least 5000 infants and toddlers being diagnosed with cerebral palsy each year;
  • At least 1,200 – 1,500 preschoolers being diagnosed with cerebral palsy each year; and
  • Approximately 50,000 people in Canada have cerebral palsy.