Cerebral palsy (CP) is an umbrella term referring to a nonprogressive disease of the brain originating during the prenatal, neonatal, or early postnatal period (when brain neuronal connections are still evolving) that results in disorders of movement and posture development.
CP is the most common cause of childhood disability, affecting around 2 per 1000 people in resource-rich countries.
All patients have motor impairment; 80% have spasticity. Other movement disorders observed are dystonia, athetosis, chorea (all of which are types of dyskinetic CP), and ataxia.
Other common problems for patients with CP include feeding difficulties, speech impairment, sialorrhea (drooling), intellectual disability, sleep disturbance, behavioral and mental health problems, epilepsy, urinary incontinence, and a variable sensory/proprioceptive loss.
Management is multidisciplinary and includes occupational, physical, and speech therapy; neurology and neurosurgery; psychiatry; urology; ophthalmology; and orthopedic, pediatric, dietary, and psychosocial services. Educational and vocational support is also needed.
Treatments for spasticity include oral medications, botulinum toxin and other injections, intrathecal baclofen, and selective dorsal rhizotomy.
Physical, occupational, and speech therapy address motor function, communication, and activities of daily living to prevent deformity and optimize independence and quality of life. Orthopedic interventions address contractures, scoliosis, hip subluxation, and extremity deformity.
Cerebral palsy (CP) is an umbrella term referring to a nonprogressive disease of the brain originating during the prenatal, neonatal, or early postnatal period (when brain neuronal connections are still evolving) that results in disorders of movement and posture development. Secondary effects of spasticity on growth may, however, be progressive. All patients with CP have motor impairment, with spastic, dyskinetic, ataxic, and mixed subtypes. Complications of CP include: additional disturbances of sensation, perception, cognition, communication, and behavior; neurogenic bladder/bowel; GERD; sialorrhea (excessive secretion of saliva); feeding and swallowing difficulties; and epilepsy.
History and exam
Key diagnostic factors
- early general movement abnormalities
- abnormal HINE scores
- delay in motor development
- delay in speech development
- delay in cognitive/intellectual development
- retention of primitive reflexes
- lack of age-appropriate reflexes
- selective voluntary motor control impairment
- toe walking/knee hyperextension
- crouched gait
Other diagnostic factors
- muscle weakness
- joint instability/dislocation
- neonatal hypotonia
- low birth weight
- fetal birth asphyxia
- multiple births
- maternal illness
- fetal brain malformation
- major birth defects
- familial metabolic/genetic disorder
- neonatal complications
- maternal teratogen exposure
- low socioeconomic status
- nonvertex presentation
- head injury
1st investigations to order
- MRI brain
Investigations to consider
- ultrasound/CT brain
- coagulation studies
- genetic testing
- metabolic screen
- x-ray of affected joint
- instrumented gait analysis
- Spinal muscular atrophy
- Muscular dystrophy/myopathy
- Familial/primary dystonia
- Prevention and management of respiratory disease in young people with cerebral palsy: consensus statement
- Indications for gastrocsoleus lengthening in ambulatory children with cerebral palsy: a Delphi consensus study
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