Cerebral palsy

Definition

Cerebral Palsy (CP) is a group of permanent movement disorders that appear in early childhood. It is caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture. The symptoms of CP vary widely among affected individuals.

Aetiology

The exact cause of Cerebral Palsy is often unknown, but it can result from various factors:

Prenatal factors: Infections during pregnancy, maternal health issues, or genetic mutations.
Perinatal factors: Complications during birth, such as lack of oxygen (asphyxia), premature birth, or low birth weight.
Postnatal factors: Infections, head injuries, or severe jaundice in the neonatal period.

Pathophysiology

Cerebral Palsy results from damage to the developing brain. This damage can occur in various areas of the brain responsible for motor control. The type and extent of the movement disorder depend on the timing, location, and severity of the brain injury.

Risk Factors

Premature birth and low birth weight.
Multiple births (twins, triplets, etc.).
Maternal infections during pregnancy (e.g., rubella, cytomegalovirus).
Complicated labour and delivery.
Neonatal jaundice and kernicterus.
Genetic factors and familial predisposition.

Signs and Symptoms

Muscle stiffness or floppiness (hypertonia or hypotonia).
Delayed motor milestones (e.g., sitting, crawling, walking).
Abnormal gait and posture.
Involuntary movements (e.g., dystonia, chorea).
Difficulty with fine motor skills (e.g., grasping objects).
Speech and swallowing difficulties.
Intellectual disabilities and learning difficulties.

Investigations

Clinical history and physical examination, focusing on developmental and neurological assessment.
Neuroimaging: MRI or CT scan to identify brain abnormalities.
Genetic testing if a hereditary cause is suspected.
Metabolic and infectious workup to rule out other causes.
Assessment of associated conditions (e.g., vision and hearing tests).

Management

Primary Care Management

Initial assessment and referral to a paediatric neurologist or specialist for further evaluation and diagnosis.
Coordination of multidisciplinary care, involving physiotherapists, occupational therapists, speech therapists, and dietitians.
Supportive care and education for families and caregivers.

Specialist Management

Physical therapy to improve mobility and strength.
Occupational therapy to enhance daily living skills and independence.
Speech therapy to address communication and swallowing difficulties.
Medications to manage muscle spasticity and seizures (e.g., baclofen, diazepam, antiepileptics).
Surgical interventions: Orthopaedic surgery for contractures and deformities, selective dorsal rhizotomy for spasticity.
Use of assistive devices: Braces, walkers, wheelchairs, and communication aids.

Example Management for Cerebral Palsy

A child presenting with signs of Cerebral Palsy, such as delayed motor milestones and muscle stiffness, should be referred to a paediatric neurologist for a comprehensive evaluation, including neuroimaging. If diagnosed, the child may benefit from a multidisciplinary approach, including physical therapy to improve mobility, speech therapy to address communication difficulties, and occupational therapy to enhance daily living skills. Medications may be prescribed to manage spasticity, and assistive devices may be utilised to support mobility and independence. Regular follow-up is essential to monitor progress and adjust the care plan as needed.

References

NICE. (2024). Cerebral Palsy in Under 25s: Assessment and Management. Retrieved from NICE
NHS. (2023). Cerebral Palsy. Retrieved from NHS
Bax, M., et al. (2005). Proposed Definition and Classification of Cerebral Palsy. Developmental Medicine & Child Neurology.
Rosenbaum, P., et al. (2007). A Report: The Definition and Classification of Cerebral Palsy April 2006. Developmental Medicine & Child Neurology Supplement.
Novak, I., et al. (2012). A Systematic Review of Interventions for Children with Cerebral Palsy: State of the Evidence. Developmental Medicine & Child Neurology.