Cerebral palsy

Cerebral Palsy (CP) is the umbrella term referring to a group of disorders affecting motor control or movement caused by damage to or faulty development of the motor areas of a child's brain. This disrupts the brain's ability to control movement and posture and the condition is usually diagnosed within the first year or two following birth, although this may occur later if the child's condition is very mild. 

CP is not a disease, is not communicable (it cannot be caught) and it is not progressive (it will not get worse over time, although it may fluctuate). Early signs of CP usually appear before three years of age, when infants are slow to reach developmental milestones such as rolling over, sitting up or crawling. Doctors will diagnose it by testing an infant's motor skills and reflexes, looking into the medical history and using specialist tests.

Types of CP

CP is often thought of as a condition caused by problems during labour and childbirth, whereas there are often other causes such as infections during early pregnancy, bleeding in the brain during pregnancy and delivery, as well as genetic factors. The most common cause of CP is factors that damages the brain at some stage in the pregnancy. It is often difficult to establish a clear reason for the disorder and no two individuals with CP will be affected in the same way. Some will be affected mildly, whereas in others the effects will be very obvious and observable early on.

Other causes of CP include:

• Head injury
• Jaundice
• Rh incompatibility - a condition that develops when a pregnant woman has Rh-negative blood and the baby in her womb has Rh-positive blood. During pregnancy, red blood cells from the unborn baby can cross into the mother's blood through the placenta

The signs of CP vary. There are signs that may be observed in a child where the condition is mild and who may not have been diagnosed. Alternatively, nurses may work with a child who already has a diagnosis of CP. 

Signs may include:

• Delayed motor milestones such as crawling and walking
• Weakness in the limbs or very rigid limbs
• Feeding problems such as slow feeding, gagging and vomiting
• Slow to develop speech
• Difficulties in dressing, with poor balance and coordination
• Hearing difficulties
• Epilepsy
• Difficulties in bladder and bowel control
• Breathing difficulties caused by postural weaknesses
• Skin disorders caused by pressure sores
• Poor self-esteem.

Many physical and mental conditions may demonstrate signs and symptoms that are difficult to differentiate in a potential diagnosis of CP. Medical conditions associated with CP clearly differentiate it from other possible diagnoses. Polyneuropathies are one such example, whereby patients with spinal cord impaction may experience sensory neuropathic symptoms across corresponding dermatomes (a band or region of skin supplied by a single sensory nerve) of the skin and may also experience issues of urinary or faecal incontinence.

These signs and symptoms are significantly different to those medical pathologies experienced by patients with CP (Johnston, 2007). Such possible differential diagnoses may result directly from upper and lower motor neurone injury in the brain or spinal cord. Even congenital malformations of the brain and spinal cord, such as myelomeningocoele, may closely resemble CP. Epileptic seizures may also be closely associated with a presentation of CP.

Another large group of children who may

There are a number of approaches to supporting a child with CP including:

• Physical therapy
• Occupational therapy
• Speech therapy
• Surgery
• Mechanical aids.

Medications may be used to control seizures and muscle spasms and counselling may be appropriate to help the child and family with the social and emotional aspects of CP.

In an early years setting, with good preparation, communication and planning, the child with CP can be integrated and supported so that their experience and transition is effective and successful.

The general aim of management in the child with CP is to optimise their functional outcome. Assets should be promoted, ‘handicap’ reduced and the family supported. Management plans therefore need to consider the specific and individual needs of the child and their family. These will change with development and growth so that management plans will need re-evaluating on a regular basis. Before instigating any specific intervention, all aspects of the child’s management need to be considered and the priorities agreed. 

Important areas include:

• Motor function, mobility and posture
• Communication and feeding
• Other medical problems
• Education
• Social and emotional support.

A number of management strategies may be used, including:

• Physical management (physiotherapy and orthotics)
• Pharmacological treatment (systemic or focal) 
• Surgery (orthopaedic surgery or selective dorsal rhizotomy) 
• Alternative therapies.

References

Hartley J. Physiotherapy in the management of cerebral palsy. Hospital Med. 2022;63(10):590-592. https://doi.org/10.12968/hosp.2002.63.10.1928

Hayes C. Cerebral palsy: challenges of a unique caseload for HCAs. 2013;6(3):116-121. https://doi.org/10.12968/bjha.2012.6.3.116

Holt A. Caring for children with cerebral palsy. BJSN. 2010;5(8):380-382. https://doi.org/10.12968/bjsn.2010.5.8.78909

Mountstephen M. Cerebral palsy. Practical Pre-School. 2013;2012(134):3-26. https://doi.org/10.12968/prps.2012.1.134.16

Poutney D. Identifying and managing cerebral palsy. Br J Neuroscience Nurs. 2010; 6(1): 20-23. https://doi.org/10.12968/bjnn.2010.6.1.46054