Cerebral Palsy (CP) is a whole spectrum of disorders of movement and posture caused by a non-progressive injury to a developing brain. It is important to realize that it is a spectrum of disorders, not a specific disease, and consists of a wide variety of physical manifestations and degrees of severity, as well as a wide variety of causes. To make this even more confusing, in many cases the etiology (cause) is never found. Additionally, there is a spectrum of associated findings that are commonly found. Also, like many things in medicine, part of what we think we know about cerebral palsy changes over time as medical technology and information improves.
We will review the current understanding of cerebral palsy as far as etiologies, risk factors, classification systems and diagnostic work up. We will also discuss associated conditions, including seizure disorder, mental retardation, visual disturbances, hearing deficits, oral motor incoordination (including feeding and communication issues), sleeping disturbances, bowel and bladder issues, long-term problems of contractures, scoliosis, osteopenia and osteoporosis. We will also review therapeutic approaches including physical therapy, occupational therapy, speech therapy, medications, bracing and medical equipment. We will discuss social, school, work and age-related issues. We will review current medical treatment interventions that are relatively hot topics such as botulinum toxin and phenol injections, intrathecal Baclofen pumps and selective dorsal rhizotomy.
What is Cerebral Palsy?
Cerebral palsy has many definitions that have changed over time as more is learned about the disorder. There has been controversy over almost every aspect of its definition due to questions about the key physical findings in cerebral palsy, the associated physical findings, the time frame of diagnosis and of onset and whether it is truly non-progressive lesion or if, because of the changes that occur over time in child development and again in aging, if that part of the diagnosis can still be considered to be true.
Cerebral palsy is a group of movement disorders. It is quite variable in the degree of muscle involvement and in associated conditions. It is the most common motor problem in children. Even with about 2.5 per 1000 live births and 5 per 1000 children, this is relatively uncommon in the overall population. Because of this, it is frequently frightening for the family to hear the diagnosis of cerebral palsy. It is important for families to understand the vast spectrum of cerebral palsy. It is likely someone who first receives this diagnosis for someone they love will have preconceptions of cerebral palsy. Unfortunately, it seems for many the picture they have in mind is a scary one and certainly not what they would choose for their loved one. It is important to realize that cerebral palsy, besides not being one diagnosis but a spectrum of disorders, is a motor deficit from a nonprogressive lesion of a developing brain. Therefore, significant worsening of function is not always what the future holds.
