Cerebral Palsy (CP) is a term used to describe a group of disorders affecting body movement and muscle co-ordination. The medical definition of cerebral palsy is a "non-progressive" but not unchanging disorder of movement and/or posture, due to an insult to or anomaly of the developing brain. Development of the brain starts in early pregnancy and continues until about age three. Damage to the brain during this time may result in cerebral palsy.  

This damage interferes with messages from the brain to the body, and from the body to the brain. The effects of cerebral palsy vary widely from individual to individual. At its mildest, cerebral palsy may result in a slight awkwardness of movement or hand control. At its most severe, CP may result in virtually no muscle control, profoundly affecting movement and speech. Depending on which areas of the brain have been damaged, one or more of the following may occur: 

(1) muscle tightness or spasms 
(2) involuntary movement 
(3) difficulty with "gross motor skills" such as walking or running 
(4) difficulty with "fine motor skills" such as writing or doing up buttons 
(5) difficulty in perception and sensation 
 

These effects may cause associated problems such as difficulties in feeding, poor bladder and bowel control, breathing problems, and pressure sores. The brain damage which caused cerebral palsy may also lead to other conditions such as: seizures, learning disabilities or developmental delay. It is important to remember that limbs affected by cerebral palsy are not paralysed and can feel pain, heat, cold and pressure. It is also important to remember that the degree of physical disability experienced by a person with cerebral palsy is not an indication of his/her level of intelligence.  

Cerebral palsy is not a progressive condition - damage to the brain is a one-time event so it will not get worse - and people with cerebral palsy have a normal life-span. Although the condition is not progressive, the effects of CP may change over time. Some may improve: for example, a child whose hands are affected may be able to gain enough hand control to write and to dress him/herself. Others may get worse: tight muscles can cause problems in the hips and spine of growing children which require orthopaedic surgery; the aging process can be harder on bodies with abnormal posture or which have had little exercise. 

Medically it is important to remember that Cerebral Palsy:

(1) is NOT contagious
(2) is NOT hereditary 
(3) is NOT life-threatening

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(A) Classification By Number of Limbs Involved 

(1) Quadriplegia - all 4 limbs are involved.  
(2) Diplegia - all four limbs are involved. Both legs are more severely affected than the arms.  
(3) Hemiplegia - one side of the body is affected. The arm is usually more involved than the leg.  
(4) Triplegia - three limbs are involved, usually both arms and a leg.  
(5) Monoplegia - only one limb is affected, usually an arm.  

(B) Classification By Movement Disorder 

(1) Spastic CP- Spastic muscles are tight and stiff, and have increased resistance to being stretched. They become overactive when used and produce clumsy movements. Normal muscles work in pairs: when one group contracts, the other group relaxes to allow free movement in the desired direction. Spastic muscles become active together and block effective movement. This muscular "tug-of-war" is called co-contraction. 

Spasticity may be mild and affect only a few movements, or severe and affect the whole body. The amount of spasticity usually changes over time. Therapy, surgery, drugs and adaptive equipment may help to control spasticity. Damage to the brain's cerebral cortex is generally the cause of spastic cerebral palsy. 

(2) Athetoid CP- Athetosis leads to difficulty in controlling and co-ordinating movement. People with athetoid cerebral palsy have many involuntary writhing movements and are constantly in motion. They often have speech difficulties. Athetoid cerebral palsy results from damage to the basal ganglia in the midbrain. It was once common as a result of blood type incompatibility, but is now rarely seen. 

(3) Ataxic CP- Ataxic CP is the least common form of cerebral palsy. People with ataxic CP have a disturbed sense of balance and depth perception. They usually have poor muscle tone (hypotonic), a staggering walk and unsteady hands. Ataxia results from damage to the cerebellum, the brain's major centre for balance and co-ordination. 

(C) Combined Classifications

The classifications of movement disorder and number of limbs involved are usually combined (e.g. spastic diplegia). These technical words can be useful in describing the type and extent of cerebral palsy, but they are only labels. A label does not describe an individual.

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  Causes of Cerebral Palsy

Any damage to the developing brain, whether caused by genetic or developmental disorders, injury or disease, may produce cerebral palsy. 
During pregnancy, anything which tends to produce a premature or low birth weight baby who is not developed enough to cope with the stresses of independent life will increase the likelihood of cerebral palsy. Factors which may cause cerebral palsy include:

(1) multiple births (e.g. twins, triplets)
(2) a damaged placenta which may interfere with fetal growth  
(3) sexually transmitted infectious diseases, e.g. AIDS, herpes, syphilis, gonorrhea 
(4) poor nutrition 
(5) exposure to toxic substances, including nicotine, alcohol and drugs  
(6) Rh or A-B-O blood type incompatibility between mother and infant  
(7) chromosome abnormalities  
(8) biochemical genetic disorders  
(9) chance malformations of the baby's brain 
(10) a labour which is too long or to abrupt can cause damage. Poor oxygen supply may destroy brain tissue.  
(11) German measles during pregnancy
(12) small pelvic structure
(13) premature delivery
(14) caesarian or breech delivery
(15) effects of anesthetics, analgesics

In early childhood, cerebral palsy can occur if a young child's brain is damaged by:

(1) infections such as meningitis
(2) brain haemorrhages
(3) head injury following falls, car accidents or abuse
(4) drowning accidents
(5) poisoning

Some measures of prevention are possible today. Pregnant women are tested for the Rh factor and, if Rh negative, they can be immunized within 72 hours of giving birth. This prevents any adverse consequences of blood incompatibility in a subsequent pregnancy. Newborns with jaundice can be treated effectively with phototherapy. 

Education programs stress the importance of optimal well-being prior to conception and adequate prenatal care. Safety campaigns give advice on protecting children from accidents and injury. These measures have undoubtedly prevented many children from developing cerebral palsy.

Diagnosis

CAT scans (Computerized Axial Tonography) and MRI (Magnetic Resonance Imaging), can help identify lesions in the brain. This technology may enable some children who are considered at risk of having cerebral palsy to be diagnosed very early. However, for the majority of people with CP it will be months, and sometimes years, before a diagnosis is confirmed. Many parents report that this waiting period, when they know their child is not developing at the same speed as her peers, but they do not yet know why, is particularly stressful. 

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Disability and Handicap

A person with cerebral palsy has to cope with disabilities and handicaps. A disability is a physical loss of function such as being unable to walk, having difficulty with hand control or speech. A handicap is the degree to which that disability puts you at a disadvantage in daily life. For instance, someone who is very short-sighted may be considered to have a disability, but she is unlikely to consider this a handicap if she has corrective lenses. A disability may prevent someone with CP from climbing stairs, but this will only be a handicap if the building she wants to enter is not wheelchair accessible.

CP is not a life-threatening condition and, in itself, is no barrier to leading a long and productive life. People with CP enjoy satisfying careers, university education, social life, and become parents. Some limitations are unavoidable, but very few people manage to achieve their dreams of becoming olympic athletes, concert pianists or brain surgeons.

Some key elements to minimizing the handicapping effects of cerebral palsy are: 

(1) Attitudes: It is very hurtful to have someone pat you on the head if you are sitting in a wheelchair, or to walk away because they cannot understand what you are trying to say to them. Prejudice and teasing can be very damaging. A good sense of self-esteem is required to cope with these negative attitudes. Children can also be handicapped if they are over-protected and become too dependent. People with disabilities are people first and should never be described by negative labels like "wheelchair-bound", "spastic", or "afflicted with cerebral palsy". All people share similar needs, desires, and responsibilities. 

(2) Access: You cannot lead an independent life if public buildings, washrooms and transportation are not accessible. To have a good career you need educational opportunities. To have a satisfying social life you need access to recreational facilities and opportunities to develop friendships. 

(3) Maintaining Physical Health: A lifestyle that involves regular exercise and proper nutrition is important for everyone, including those with disabilities. A good general fitness level will help with range of motion and flexibility, and exercise to improve cardiovascular fitness can improve endurance and help offset age-related changes that lead to fatigue. A nutritious, high-fibre, low-fat diet will help avoid problems with constipation and weight gain and will increase energy levels. Having cerebral palsy does not make you immune to other conditions. People with CP are as likely as anyone else to contract heart disease, cancer or diabetes. Sometimes a change in the body can be put down to an effect of CP when it is actually a different condition. 

(4) Aging and Cerebral Palsy: Most treatment and research programs concern children with CP and little research has so far been done on aging with a disability. CP affects individuals in different ways and it is hard to generalize about the effects of aging. Although people with cerebral palsy are considered to have a normal life span, the physical challenges of CP may intensify with age (such as increased spasticity, fatigue, loss of strength and declining mobility), and these physical challenges can in turn lead to increased stress and anxiety. Adults with cerebral palsy may consider a number of strategies to cope with the effects of aging. 

(5) Maintaining Mental Health: The importance of learning skills to increase independence and self-confidence throughout an individual's lifetime cannot be over-emphasized. The stresses associated with aging will be lessened if a person is able to maintain a positive personal attitude, if they are involved in meaningful activities, and if they have developed a supportive environment. They need confidence to seek information, to plan for age-related changes, and to be an active participant in their health care and lifestyle choices. 

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