Cerebral Palsy (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Cerebral palsy definition and facts
- What is cerebral palsy?
- What are causes of cerebral palsy?
- What are symptoms and signs of cerebral palsy?
- What are the types of cerebral palsy?
- What is spastic cerebral palsy?
- What is dyskinetic cerebral palsy?
- What is ataxic cerebral palsy?
- What is dystonic cerebral palsy?
- What is choreoathetoid cerebral palsy?
- What is hypotonic cerebral palsy?
- What is mixed cerebral palsy?
- What other conditions are associated with cerebral palsy?
- How is a child evaluated for cerebral palsy?
- How is cerebral palsy treated?
- What are specific treatment plans for cerebral palsy?
- What is the long-term outlook for patients with cerebral palsy?
What are symptoms and signs of cerebral palsy?
The predominant symptoms and signs of cerebral palsy are related to motor difficulties, which are the consequence of the brain damage. The extension and severity of the brain lesion is the leading factor in the magnitude of the motor deficit. Many of the symptoms observed in these children are related to the primary problem that is impaired motor functions. For example, developmental motor delay, gait disorders, poor fine and gross motor coordination, swallowing disorders, or speech delay are all the result of the basic motor disorder. The way they present varies from child to child. For that reason, it is difficult to describe a clinical picture that will satisfy every child with cerebral palsy. The clinical presentation, even though with many common features, is very much unique for a particular child. In addition, the comorbid conditions add more to the uniqueness of the presentation of the child with cerebral palsy. For example some children may be blind, while others may have normal vision; or some children may have severe cognitive delay while others may have normal or near normal cognitive level.
What are the types of cerebral palsy?
Based upon the form of motor impairment, cerebral palsy can be divided into types:
- spastic cerebral palsy,
- dyskinetic cerebral palsy (according to the predominant symptoms dyskinetic CP may be either dystonic or choreoathetotic), which includes ataxic cerebral palsy, and
- hypotonic cerebral palsy.
These categories are not rigid, and the majority of patients most probably have a mixture of them.
What is spastic cerebral palsy?
Spastic cerebral palsy refers to a condition in which the muscle tone is increased, causing a rigid posture in one or more extremities (arm(s) or leg(s)). This rigidity can be overcome with some force, ultimately giving way completely and suddenly -- very much like the familiar jackknife (or clasp knife). The spasticity leads to a limitation of use of the involved extremity, largely due to the inability to coordinate movements. Often the spasticity occurs on one side of the body (hemiparesis), but it can also affect the four limbs (quadriparesis) or be limited to both legs (spastic diplegia). When the condition occurs in both legs, the individual often has a scissoring posture, in which the legs are extended (straightened) and crossed.
Besides the increased muscle tone there is also increased deep tendon reflexes, impaired fine and gross motor coordination, muscle weakness, and fatigability among other problems.
Spasticity is often the result of damage to the white matter of the brain, but it can also be due to damage of gray matter.
The degree of spasticity can vary, ranging from mild to severe. Children who are mildly affected may experience few limitations of their function while severely affected children may have little to no meaningful use of the affected limb(s). Spasticity, if not properly treated, can result in contractures, which are permanent limitations in the ability of joint movement. Contractures can be greatly limiting in the care of children with cerebral palsy. Spasticity can also be quite painful, requiring medication to relax the muscle tone.
The same fundamental processes that influence spasticity of the limbs can also result in abnormalities of movement and muscle tone in other body systems. In the muscles of the head and face, for example, cerebral palsy can greatly limit the coordination and production of speech, even when the child is perfectly capable of understanding speech. There can also be limitations of chewing, swallowing, and facial and eye movements. These symptoms can be particularly troubling for afflicted children and their families.
Many patients with spastic cerebral palsy cannot control their output of urine. This inability is not necessarily due to problems in thinking but is caused by heightened reflexes of the bladder. When the bladder fills in these children, it is just like tapping on it with a reflex hammer, thus making it contract more vigorously than normal and causing a spilling of urine. This incontinence can be quite embarrassing, especially in a cognitively intact child.
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