Parkinson's Disease & Related Movement Disorders Association of SOUTH AFRICA

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CEREBRAL PALSY

What is Cerebral Palsy?

It is a group disorders associated with developmental brain injuries that occur during foetal

development, birth, or with the first 2 to 3 years of life.

It is characterized by a disruption of motor skills with symptoms such spasticity, paralysis,

mental retardation, seizures, vision or hearing problems

It is no longer considered as a disease but rather as a chronic non-progressive neurological

disorder. The incidence is estimated to be 1.5 to 4 per 1000 births.

Causes

The exact cause of the brain injury is not known; can be due to complications related to

prematurity as a result of mother’s general health and behavioural factors during pregnancy

such as smoking, alcohol intake, exposure to chemical toxins or harmful substances, or a

baby can be deprived of blood, oxygen or other nutrients before or during birth. After birth

Cerebral Palsy can be due to head injury (trauma) or infectious diseases such meningitis or

cerebral malaria. A small percentage could be hereditary or familial.

Signs and Symptoms


	Delayed or abnormal movements of body part /s or whole body
	Stiffness or floppiness
	Un-coordinated movements or slight limp
	Birth defects e.g. irregular shaped spine, small head, stiff jaw, drooling, crying, poor
	sucking or swallowing reflexes etc.

The above signs and symptoms depend on the severity of the brain insult or injury and may

be progressive in appearance or may become more pronounced as the child grows older.

Treatment

There is no cure for CP, hence treatment is often needed throughout life to help manage

symptoms, prevent complications and maximize abilities. Medication, sometimes surgery,

specialized equipment and devices and therapy for stimulation to prevent complications is

highly recommended. The mother or caregiver of a CP child must be an integral part of the

therapy team which may include: a Physiotherapist, Occupational Therapist, Speech

Therapist, Audiologist, Social worker /Psychologist, Medical Doctor. Therapy may be

provided at a hospital, CHC, Clinic or through a support group.

Prevention

It is of paramount importance that a pregnant woman attends prenatal and antenatal

clinics regularly. Pregnant women must also avoid predisposing factors such as drinking

alcohol, smoking, exposure to toxic chemicals (Pollution), and must eat healthy food to

prevent prematurity or under-weight babies.

Pregnant mothers must ensure that they give birth under supervision of a doctor or mid-

wife nurse. Baby’s immunization schedule must be up-to date

Cerebral Palsy Causes

Cerebral palsy results from damage to certain parts of the developing brain.

This damage can occur early in pregnancy when the brain is just starting to form, during

the birth process as the child passes through the birth canal, or after birth in the first few

years of life.

In many cases, the exact cause of the brain damage is never known.

At one time, problems during birth, usually inadequate oxygen, were blamed for cerebral

palsy.

We now know that fewer than 10% of cases of cerebral palsy begin during birth (perinatal).

In fact, current thinking is that at least 70-80% of cases of cerebral palsy begin before

birth (prenatal).

Some cases begin after birth (postnatal).

In all likelihood, many cases of cerebral palsy are a result of a combination of prenatal,

perinatal, and postnatal factors.

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The Parkinson's Diease & Related Movement Disorders Association of South Africa - Cerebral Palsy

Risk factors linked with cerebral palsy include the following:


	Infection, seizure disorder, thyroid disorder, and/or other medical problems in the mother
	Birth defects, especially those affecting the brain, spinal cord, head, face, lungs, or metabolism
	Rh factor incompatibility, a difference in the blood between mother and fetus that can cause brain damage in the fetus
	(Fortunately, this is almost always detected and treated in women who receive proper prenatal medical care.)
	Certain hereditary and genetic conditions
	Complications during labor and delivery
	Premature birth
	Low birth weight (especially if less than 2 pounds at birth)
	Severe jaundice after birth
	Multiple births (twins, triplets)
	Lack of oxygen (hypoxia) reaching the brain before, during, or after birth
	Brain damage early in life, due to infection (such as meningitis), head injury, lack of oxygen, or bleeding

Cerebral Palsy Symptoms

The signs of cerebral palsy are usually not noticeable in early infancy but become more obvious as the child’s nervous system

matures. Early signs include the following:


	Delayed milestones such as controlling head, rolling over, reaching with one hand, sitting without support, crawling, or walking

	Persistence of “infantile” or “primitive” reflexes, which normally disappear 3-6 months after birth

	Developing handedness before age 18 months: This indicates weakness or abnormal muscle tone on one side, which may be
	an early sign of CP.

	Problems and disabilities related to CP range from very mild to very severe. Their severity is related to the severity of the
	brain damage. They may be very subtle, noticeable only to medical professionals, or may be obvious to the parents and other
	caregivers.

	Abnormal muscle tone: Muscles may be very stiff (spastic) or unusually relaxed and “floppy.” Limbs may be held in unusual or
	awkward positions. For example, spastic leg muscles may cause legs to cross in a scissor-like position.

	Abnormal movements: Movements may be unusually jerky or abrupt, or slow and writhing. They may appear uncontrolled or
	without purpose.

	Skeletal deformities: People who have cerebral palsy on only one side may have shortened limbs on the affected side. If not
	corrected by surgery or a device, this can lead to tilting of the pelvic bones and scoliosis (curvature of the spine).

	Joint contractures: People with spastic cerebral palsy may develop severe stiffening of the joints because of unequal pressures
	on the joints exerted by muscles of differing tone or strength.

	Mental retardation: Some, although not all, children with cerebral palsy are affected by mental retardation. Generally, the more
	severe the retardation, the more severe the disability overall.

	Seizures: About one third of people with cerebral palsy have seizures. Seizures may appear early in life or years after the brain
	damage that causes cerebral palsy. The physical signs of a seizure may be partly masked by the abnormal movements of a person
	with cerebral palsy.

	Speech problems: Speech is partly controlled by movements of muscles of the tongue, mouth, and throat. Some individuals with
	cerebral palsy are unable to control these muscles and thus cannot speak normally.

	Swallowing problems: Swallowing is a very complex function that requires precise interaction of many groups of muscles. People
	with cerebral palsy who are unable to control these muscles will have problems sucking, eating, drinking, and controlling their
	saliva. They may drool. An even greater risk is aspiration, the inhalation into the lungs of food or fluids from the mouth or nose.
	This can cause infection or even suffocation.

	Hearing loss: Partial hearing loss is not unusual in people with cerebral palsy. The child may not respond to sounds or may have
	delayed speech.

	Vision problems: Three quarters of people with cerebral palsy have strabismus, which is the turning in or out of one eye. This is
	due to weakness of the muscles that control eye movement. These people are often nearsighted. If not corrected, strabismus
	can lead to more severe vision problems over time.

	Dental problems: People with cerebral palsy tend to have more cavities than usual. This results from both defects in tooth
	enamel and difficulties brushing the teeth.

	Bowel and/or bladder control problems: These are caused by lack of muscle control.

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CEREBRAL PALSY continued - When to Seek Medical Care

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