Pediatric Congenital Conditions Cerebral Palsy

Children with cerebral palsy suffer from brain damage that impairs their motor skills and muscle coordination. Over 500,000 Americans live with cerebral palsy, making the disease one of the most common congenital childhood disorders.

The level to which cerebral palsy affects children widely varies. While children with cerebral palsy may only exhibit mild signs of the condition, others with more severe cases may be confined to wheelchairs or may suffer from severe mental retardation.

Causes of Cerebral Palsy

Cerebral palsy is a congenital disease usually caused by pregnancy complications. Although exact causes of cerebral palsy are often unknown, premature birth and low birth weights are high risk factors. A premature baby with a birth weight of less than 3.3 pounds has 30 times the normal risk of developing cerebral palsy.

However, cerebral palsy is not a common birth complication: In spite of their increased risk, premature babies with low birth weights only have a 10 percent chance of developing cerebral palsy. While premature delivery and low birth weights are risks, they are not actually causes of cerebral palsy. Children delivered at full-term and at healthy birth weights can also have cerebral palsy.

Although the exact causes of cerebral palsy are unknown, certain risk factors are associated with children with cerebral palsy. In addition to premature delivery and low birth weights, children with cerebral palsy may have:

  • birth defects
  • brain damage
  • central nervous system disorders
  • congenital heart, kidney or spinal defects
  • encephalitis (a condition caused by a virus that results in brain inflammation)
  • herpes simplex infections
  • intracranial bleeding
  • lack of oxygen to the brain
  • meningitis (a serious condition that causes the tissues around the brain and spinal cord to become inflamed).

Similarly, the following pregnancy complications can contribute to the development of cerebral palsy in newborns:

  • gestational diabetes
  • labor complications (This is estimated to cause about 10 percent of the cases of cerebral palsy.)
  • maternal hypertension
  • maternal infections
  • multiple births (twins, triplets, etc.)
  • nutritional deficiencies during pregnancy.

Types of Cerebral Palsy

Cerebral palsy can develop in different forms, each one of which affects a child’s mobility and muscle control differently:

  • Athetoid cerebral palsy, also known as dyskinetic cerebral palsy, accounts for 20 percent of all cases and results in uncontrolled and involuntary muscle movements.
  • Ataxic cerebralpalsy affects 10 percent of children and causes disturbances in balance and depth perception.
  • Spastic cerebral palsy affects 50 percent of children with cerebral palsy and causes movement difficulties and stiffness.

The remaining 20 percent of cerebral palsy cases are mixed, displaying symptoms from all three types of cerebral palsy.

Cerebral Palsy Symptoms

The most common symptoms associated with cerebral palsy are caused by damage to the cerebellum, the largest part of the brain that plays a role in voluntary muscle movement. One of the most important factors to remember about cerebral palsy is that the symptoms aren’t contagious and don’t typically get progressively worse. Simply stated, cerebral palsy does not worsen over time.

The most noticeable and common symptom of cerebral palsy is an inability to control the muscles. Muscle control for children with cerebral palsy can range from mild impairment to complete immobility. Along with the intensity, the area of the body that suffers from muscle immobility can also vary. Brain damage can render any part of the body impaired or immobile.

Some of the more severe cases of cerebral palsy can trigger muscle impairments, including:

  • diplegia, both legs are uncontrollable due to cerebral palsy
  • hemiplegia, one arm and leg are affected by the symptoms of cerebral palsy
  • quadriplegia, both legs, arms, neck and trunk are immobile or spastic due to cerebral palsy.

Other signs of cerebral palsy include:

  • behavioral problems
  • blindness
  • breathing difficulties
  • continence problems
  • delayed development of motor skill milestones
  • difficulty eating
  • gastroesophageal reflux
  • learning difficulties
  • osteoporosis
  • seizures
  • sleep disorders
  • speech difficulties
  • tooth decay
  • vision problems.

Children with cerebral palsy can have feeding difficulties, including food aspiration (when food is diverted into the respiratory passages). Food aspiration can result in lung infections and pneumonia.

Cerebral Palsy and Mental Retardation

While cerebral palsy patients can have normal or high intelligence, they are also subject to severe mental retardation. Approximately one-third of children with cerebral palsy have normal ranges of intelligence, one-third live with mild mental retardation and the remaining one-third have severe mental retardation.

Cerebral Palsy Treatment

Cerebral palsy treatment helps children reach their maximum physical and mental potential. Here is an outline of various factors that comprise a comprehensive treatment regimen for cerebral palsy:

  • Medications: Depending on the patient’s symptoms, a variety of medications may be prescribed. For example, while doctors may prescribe anticonvulsants to prevent seizures, other medications (administered either orally or through a pump inserted under the skin that delivers consistent levels of medication) can reduce muscle spasms and, therefore, enable mobility.
  • Physical Aids: Physical aids are often part of cerebral palsy treatment, especially when physical impairment limits the effectiveness of exercises for cerebral palsy. Braces, crutches and wheelchairs may be required. Hearing aids and glasses also improve the functioning of children with cerebral palsy.
  • Physical Therapy: Exercise for cerebral palsy attempts to strengthen muscular control and help children live as independently as possible.
  • Therapy: In addition to exercises for cerebral palsy for movement and muscle control, children with cerebral palsy may receive therapy for learning disorders, speech problems and emotional difficulties.
  • Surgery: Because cerebral palsy can cause physical impairments in patients, surgery may also be necessary. Children with cerebral palsy may suffer from dislocated hips, spinal curvature (scoliosis) and gastroesophageal reflux, all of which respond well to surgery.Similarly, children with spastic cerebral palsy may develop joint contractures, a progressive disease in which muscles, tendons and ligaments of joints tighten and become inflexible. Surgical correction of joint contractures may also be a central part of cerebral palsy treatment.

Resources

National Institute of Neurological Disorders and Stroke. (updated July 13, 2007). NINDS Cerebral Palsy Information Page. Retrieved September 19, 2007 from the NINDS Web site: http://www.ninds.nih.gov/disorders/cerebral_palsy/cerebral_palsy.htm.

U.S. National Library of Medicine. (updated 4 July 2004). Contracture deformity. Retrieved June 5, 2005 from the NLM Web site: www.nlm.nih.gov/medlineplus/ency/article/003185.htm.