Basics of Cerebral Palsy

Basics of Cerebral Palsy

What is Cerebral Palsy? It is often called CP for short. Let’s break it down.  “Cerebral” means having to do with the brain. “Palsy” means weakness or problems using the muscles.  It is a lifelong neurologic motor disorder with symptoms that may appear in infancy or preschool years. 

• CP occurs roughly 2 per 1000 live births 
• More than half of the children with CP were born at term (greater than 37 weeks gestation) 
• CP is usually not diagnosed until a child is 2-3 years of age1 

Cerebral Palsy is classified depending on which areas of the brain have been affected.  

Spasticity is the most common form, affecting 80% of all people with Cerebral Palsy. CP may affect the whole body, or it might be limited to one limb or one side of the body. According to Mayo Clinic, CP does not change with time, so the symptoms do not worsen with age. However, as the child ages, some symptoms might become more or less apparent. 2 

What causes Cerebral Palsy?

There are many different causes of cerebral palsy. A mom might have an infection during pregnancy. At one of the first prenatal visits, lab is drawn and urine is sent. Titers for Rubella (German Measles) are checked. It can be devastating to the fetus if mom develops Rubella during her pregnancy. She is also evaluated for any sexually transmitted diseases, and checked for urinary tract infections. Any type of infection may put the mom at risk for preterm labor and/or delivery (which increases the risk of CP). At 36 weeks gestation, mom is evaluated for Group B Beta Strep in her vagina. If the results are positive, antibiotics during labor are indicated. Once the amniotic sac is broken during labor, the chance of infection during labor increases. Prolonged labor may result in chorioamnionitis. Mom’s temperature should be closely monitored and antibiotics administered if indicated. After delivery, the infant may also need blood work and antibiotics.

Cerebral palsy may also result from insufficient oxygen to the fetus during labor. Oxygen to the fetus is delivered via the placenta. Blood flow is directly related to mom’s blood pressure. There are many events during a woman’s labor that affect blood flow through the placenta.

Babies who are born premature who weigh less than 3 1/3 pounds are up to 30% more likely to have cerebral palsy than full term infants. Incidence of CP has improved since the start of administering Magnesium Sulfate to mom within 24 hours of delivery.

There might also be an Rh incompatibility between the mom and her fetus. If mom is Rh negative, she is given Rhogam at 28 weeks gestation. If mom has any abdominal trauma or bleeding episode during her pregnancy, she will require additional doses of Rhogam. After delivery, if the baby is Rh positive, mom will receive another dose of Rhogam to protect any future pregnancies. Sometimes mom is Type 0, and the infant is Type A or B. This may increase the infant’s chance of developing jaundice (severe yellowing of the skin/whites of eyes). If untreated, the jaundice may result in permanent brain damage. Treatment involves phototherapy.

Cerebral palsy may be the result of genetics. The baby may have a brain malformation, a genetic disease, or other physical birth defects.

Cerebral Palsy may be acquired. About 10% of children with CP acquire it after birth due to brain injuries (head injuries) or infection (meningitis) that occur in the first 2 years of life

How is Cerebral Palsy diagnosed?

Cerebral palsy is diagnosed by evaluating how a baby or young child moves. As a parent, you may notice your child feels “floppy” or may feel like he/she has increased muscle tone and feel “rigid.” There are milestones the pediatrician may ask you about. Is your baby holding his/her head up, is he/she rolling over, or has he/she started crawling? The physician will check reflexes and may check to see if the infant has shown a dominance as to right or left handedness.

The pediatrician may order an MRI (magnetic resonance imaging) or a CT (computed tomography) or ultrasound. Sometimes, these tests may not show any abnormality which indicates the brain damage is small, and the infant/child may outgrow their symptoms.

Treatment

A team of health care professionals will be assembled to care for your child to assist him/her into developing to his/her maximum potential. The team will include your pediatrician, physical and rehabilitation physicians, physical and occupational therapists, speech/language pathologist, social workers, and psychologists.3

Goals for treatment of Cerebral Palsy are aimed at optimizing mobility and controlling pain. The team works at maximizing independence, a child’s learning potential and providing the highest quality of life possible.4 The treatment plan may include medication and orthopedic surgeries. Each child presents his/her own uniqueness and the plan of care is created accordingly.

Is Cerebral Palsy preventable?

It is important for a woman to seek prenatal care early in her pregnancy. Abstaining from alcohol, tobacco and illicit drugs is recommended. Identification and treatment of infections helps decrease the incidence of preterm labor. Preterm labor and possible preterm delivery are sometimes inevitable. Administering antibiotics, steroids, and magnesium sulfate prior to the delivery helps decrease the incidence of CP.

“When a child is born with Cerebral Palsy, the reasons are often because of preventable events that occur prior to birth, during the delivery process, or immediately after birth.”5 Careful monitoring of mom and baby throughout the birth process is imperative. It is not always possible to predict or prevent cerebral palsy from happening, but the goal for every healthcare provider is to deliver a healthy infant.