Cerebral palsy refers to several different conditions. They are caused by prenatal injury to the brain and affect a person's ability to move.
KEYWORDS
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Cerebellum
Movement disorders
Spastic paraplegia
"Why Isn't Our Baby Walking?"
Rob and Carol were the first to notice that something was wrong with their eleven-month-old daughter Nancy. Nancy was an alert, happy baby. But unlike other children they knew, she did not reach for her toys at five or six months, and now she was barely sitting up on her own. When Carol would bend down to hug Nancy, she noticed that the child remained stiff. Left on her own in her crib, or on a blanket on the floor, Nancy did not crawl around like other children do. Rob and Carol scheduled a visit with Nancy's pediatrician (a doctor who specializes in treating children). They described Nancy's behavior, and asked the doctor whether she might have cerebral palsy.
How Brains and Muscles Communicate
Every gesture we make, from scratching our nose to jumping down the stairs, is the result of a complex set of messages that travel between our brains and our muscles. When we decide we want to do something, our brains tell our muscles how to do it. Brushing our teeth, throwing a ball, crossing the street, and even talking are different kinds of movements that are all controlled by special centers in the brain.
What Is Cerebral Palsy?
Sometimes the centers in the brain that control movement become damaged. When that happens, the messages from the brain to the muscles seem to be "scrambled." For children with this condition, which is called cerebral palsy, ordinary movements may be difficult or impossible. About 500,000 Americans have cerebral palsy.
Are There Different Types of Cerebral Palsy?
Every person with cerebral palsy will be affected differently, depending on which part of the brain was injured and how much damage occurred. A person's movements may be spastic (SPAS-stik), which means that the person moves in a stiff or jerky way. Other people may not be able to control their movements, and they must struggle just to hold themselves upright or to hold things. Some people with cerebral palsy move very shakily. One-fourth of people with cerebral palsy have a mix of these problems. Cerebral palsy may affect both arms and both legs or only one side of the body. Sometimes only the legs are affected. People with severe cerebral palsy may need a wheelchair to get around; others who are more mildly affected may be able to walk and run with only a slight limp.
Do People with Cerebral Palsy Have Other Difficulties?
Cerebral palsy can cause weakness in other muscles in the body. For example, people with cerebral palsy may have trouble talking or swallowing food, and sometimes they drool. Some may also suffer from seizures, which are storms of electrical activity in the brain that may cause a person abruptly to stop what they are doing, lose control of their body movements, and sometimes become confused or unconscious. About one-fourth to one-half of children with cerebral palsy have some kind of learning problem. This is because the damage to the brain that causes problems in controlling the muscles can also affect the parts of the brain that control how a person learns. One child might simply have trouble with reading or math; another might need special learning help. But most people with cerebral palsy have normal intelligence, even when their physical disabilities are severe.
150 Years Ago: Lame Duck"
William John Little (1810-1894) developed a deformity in his foot at a young age as a result of polio infection. His schoolmates nicknamed him "lame duck." At the age of 16, Little decided to pursue a career in medicine, hoping to find a cure for his condition. Although Little never found his cure, his research did lead to the description of another disease.
In 1853, Little published On the Deformities of the Human Frame, in which he first described cerebral palsy. Little's medical practice focused on the musculoskeletal system, and his research contributed to advances in both neurology and orthopedics.
"Little's Disease" is the name now used to designate a congenital form of cerebral palsy.
What Causes Cerebral Palsy?
Cerebral palsy is mostly a condition that people are born with, caused by injury to the developing brain. It is not contagious, like a cold or measles. Cerebral palsy does not get worse, but it also does not go away. In some cases, ill health in the mother while she is pregnant may lead to cerebral palsy in the newborn infant. Infants who are born prematurely have a higher risk of developing cerebral palsy. And sometimes a serious accident, such as almost drowning, might cause brain damage and cerebral palsy in a small child. Although many believe that injury to the brain occurring during the birth process is a common cause of cerebral palsy, that is not the case. In 80 percent of cases, there is no identifiable cause for cerebral palsy. There is no way to test for cerebral palsy before a baby is born.
How Is Cerebral Palsy Diagnosed?
It is not always easy for doctors to tell whether an infant or young child like Nancy has cerebral palsy. When parents bring their child in, the doctor will ask the parents questions about the child, and will look for anything unusual about the child's muscles and movements. The doctor will especially check the child's reflexes to see if the child's brain and nervous system are functioning properly. For example, the doctor will tap the child's knee with a small rubber mallet to test for reflexes in the legs. If a child does have cerebral palsy, a team of specialist doctors and therapists will work with the parents to set up a program of treatment.
How Is Cerebral Palsy Treated?
Having cerebral palsy does not mean that a person cannot have a happy life. It does mean that people with cerebral palsy may face more challenges in day-today living than other people without cerebral palsy. Treatment, also called therapy, may help children with cerebral palsy to cope with everyday tasks that the rest of us take for granted. Each child is different, so the mix of therapies will vary from child to child. For instance, therapy can be given to strengthen parts of the body needed for walking and climbing stairs, to strengthen the mouth muscles needed for talking, and to help a child to master ordinary but important activities like getting dressed and eating. Medications (such as those used to control seizures), surgical techniques, and special equipment (such as wheelchairs, braces, and communication devices), are also available to help people with cerebral palsy lead more normal lives. Parents of children with cerebral palsy and people with the condition themselves must work closely with their doctors, therapists, and teachers to decide on the best treatment plan for each individual.
Is It Possible to Prevent Cerebral Palsy?
Since the cause of cerebral palsy is unknown in the majority of cases, there is no way to prevent it. An expectant mother can increase the chances that her baby will be healthy by eating properly, getting regular checkups, and not smoking, drinking, or abusing drugs. Protecting infants from accident or injury can help to avoid the brain damage that sometimes causes cerebral palsy after birth. But for now there is no real solution to the mystery of cerebral palsy. The hope of overcoming it lies in continuing medical research.
Tools That Help
Many different kinds of equipment are available to help people with cerebral palsy to do everyday things. Wheelchairs with and without motors help those who cannot walk to get around. People who can walk but who are unsteady on their feet can use walkers, which look a little like four-wheel cycles with no seat. Spoons, toothbrushes, and pencils with special handles and shapes make it easier to hold and to use things. Alphabet boards make it possible for people who have trouble speaking to spell out words. There is even a computer that talks for people who cannot.
Living with Cerebral Palsy
Children who have cerebral palsy may not be able to do all the things that other children do, or at least, not in the same way. But most children with cerebral palsy can:
Go to school
Have friends
a Go on class trips and to summer camp
Listen to music
Play on the computer
Read books
Enjoy sports
Many people with cerebral palsy will eventually be able to go to college, hold a job, get married, and raise families.
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