Cerebral Palsy

Question 1

What is it?

Answer 1

Cerebral palsy (CP) is the name given to the permanent neurological problems resulting from damage to the brain around the time of birth.

It is not a progressive condition, however the nature of the symptoms and problems may change over time during growth and development.

Question 2

Causes

Answer 2

Antenatal:

• Maternal infections
• Trauma during pregnancy

Perinatal:

• Birth asphyxia
• Pre-term birth

Postnatal:

• Meningitis
• Severe neonatal jaundice
• Head injury

Question 3

Types

Answer 3

Spastic: hypertonia (increased tone) and reduced function resulting from damage to upper motor neurones

Dyskinetic: problems controlling muscle tone, with hypertonia and hypotonia, causing athetoid movements and oro-motor problems. This is the result of damage to the basal ganglia.

Ataxic: problems with coordinated movement resulting from damage to the cerebellum

Mixed: a mix of spastic, dyskinetic and/or ataxic features

Spastic CP is also known as pyramidal CP. Dyskinetic CP is also known as athetoid CP and extrapyramidal CP.

Question 4

Clinical Features

Answer 4

Signs and symptoms of cerebral palsy will become more evident during development:

• Failure to meet milestones
• Increased or decreased tone, generally or in specific limbs
• Hand preference below 18 months is a key sign to remember for exams
• Problems with coordination, speech or walking
• Feeding or swallowing problems
• Learning difficulties

Question 5

Types of gait

Answer 5

Hemiplegic / diplegic gait: indicates an upper motor neurone lesion

Broad based gait / ataxic gait: indicates a cerebellar lesion

High stepping gait: indicates foot drop or a lower motor neurone lesion

Waddling gait: indicates pelvic muscle weakness due to myopathy

Antalgic gait (limp): indicates localised pain

Question 6

Gait in cerebral palsy

Answer 6

Patients with cerebral palsy may have a hemiplegic or diplegic gait.

This gait is caused by increased muscle tone and spasticity in the legs.

The leg will be extended with plantar flexion of the feet and toes.

This means they have to swing the leg around in a large semicircle when moving their leg from behind them to in front.

There is not enough space to swing the extended leg in a straight line below them.

Question 7

Complications

Answer 7

Learning disability
Epilepsy
Kyphoscoliosis
Muscle contractures
Hearing and visual impairment
Gastro-oesophageal reflux

Question 8

Management

Answer 8

management will involve a multi-disciplinary team approach:

• Physiotherapy is used to stretch and strengthen muscles, maximise function and prevent muscle contractures.
• Occupational therapy is used to help patients manage their everyday activities, such as getting dressed and using the bathroom. That can involve techniques to perform tasks despite disability. They can also make adaptations and supply equipment, such as rails for assistance or fitting a hoist for a patient who is entirely wheelchair bound.
• Speech and language therapy can help with speech and swallowing. When swallowing difficultly prevents them meeting their nutritional requirements they may require an NG tube or PEG tube to be fitted.
• Dieticians can help ensure they meet nutritional requirements. Some children may require PEG feeding through a port on their abdomen that gives direct access to the stomach.
• Orthopaedic surgeons can perform procedures to release contractures or lengthen tendons (tenotomy).

Paediatricians will regularly see the child to optimise their medications. This may involve:

• Muscle relaxants (e.g. baclofen) for muscle spasticity and contractures
• Anti-epileptic drugs for seizures
• Glycopyrronium bromide for excessive drooling

Social workers to help with benefits and support.

Charities and support groups provide opportunities to connect with others affected by cerebral palsy and learn and share information on the condition.