What is cerebral palsy?
Cerebral palsy is a group of problems that affect body movement and posture. It is related to a brain injury or to problems with brain development. It is one of the most common causes of lasting disability in children.
Cerebral palsy causes reflex movements that a person can't control and muscle tightness that may affect parts or all of the body. These problems can range from mild to severe. Intellectual disability, seizures, and vision and hearing problems can occur.
What causes cerebral palsy?
Cerebral palsy is caused by a brain injury or problem that occurs during pregnancy or birth or within the first 2 to 3 years of a child's life. It can be caused by:
- Problems from being born too early (premature birth).
- Not getting enough blood, oxygen, or other nutrients before or during birth.
- A serious head injury.
- A serious infection that can affect the brain, such as meningitis.
- Some problems passed from parent to child (genetic conditions) that affect brain development.
In many cases, the exact cause of cerebral palsy is not known.
What are the symptoms?
Everyone with cerebral palsy has problems with body movement and posture. But the physical problems are worse for some people than for others.
Some people who have cerebral palsy have a slight limp or a hard time walking. Other people have little or no control over their arms and legs or other parts of the body, such as the mouth and tongue, which can cause problems with eating and speaking. People who have severe forms of cerebral palsy are more likely to have other problems, such as seizures or intellectual disability.
Babies with severe cerebral palsy often have problems with their posture. Their bodies may be either very floppy or very stiff. Birth defects sometimes occur along with cerebral palsy. Examples of birth defects include a spine that doesn't have the normal shape, a small jawbone, or a small head.
The brain injury or problem that causes cerebral palsy doesn't get worse over time. But new symptoms may appear, or symptoms may change or get worse as your child gets older. This is why some babies born with cerebral palsy don't show clear signs of it right away.
How is cerebral palsy diagnosed?
Your child's doctor will do a physical examination and ask you about your child's medical history. He or she will ask about your child's growth and about any problems you may have noticed. The doctor may also ask about your child's development.
Tests, such as a CT scan or an MRI of your child's head, may also be done. Or the doctor may look at ultrasound pictures of the brain. These tests can sometimes help the doctor find the cause of cerebral palsy.
If your child has a severe form of cerebral palsy, a doctor may be able to pinpoint the problem within the first few weeks of your child's life. But parents are often the first to notice that their baby does not have the abilities and skills that are common in other children in the same age group. These developmental delays can be early signs of cerebral palsy.
Even when the condition is present at birth, the signs of cerebral palsy may not be noticed until a child is 1 to 3 years old.
How is it treated?
Even though cerebral palsy can't be cured, you and your child can do things to help deal with symptoms, prevent problems, and make the most of your child's abilities. Physiotherapy is one of the most important treatments. Medicines, surgery, and special equipment such as a walker can also help.
What can you do to cope?
Meeting the daily needs of a family member with cerebral palsy isn't easy. If your child has cerebral palsy, seek family and community support. It may help to join a support group or talk with other parents who have a child with special needs, so you don't feel alone.
You may also find counselling useful. It may help you understand and deal with the wide range of emotions you may feel. Your child will need help too. Providing emotional support for your child can help him or her cope with having cerebral palsy.
Learning that your child has cerebral palsy isn't easy, and raising a child who has it can be hard. But the more you know, the better you can care for and provide for your child.
Health Tools help you make wise health decisions or take action to improve your health.
Cerebral palsy (CP) is a result of an injury to the brain or abnormal development of the brain. In many cases, the exact cause isn't known. The damage or abnormality may occur during pregnancy or birth or within the first 2 to 3 years of life.
- Possible causes of CP during pregnancy or birth can include genetic problems, infections or health problems in the mother or baby during pregnancy, or problems related to labour and delivery. Health problems in a newborn, such as untreated low blood sugar, can also cause brain damage that leads to CP.
- Possible causes of CP related to an early birth (premature birth) are related to the brain's development. For example, babies born too early are at risk for bleeding in the brain.
- Possible causes of CP within the first 2 or 3 years of life are usually related to brain damage from a serious illness, injury, or lack of oxygen to the brain.
When cerebral palsy (CP) is severe, signs are often noticed at birth or shortly after birth. But some early signs of severe CP vary depending on the specific type of CP.
Common signs of severe CP that may be noticed shortly after birth include:
- Problems sucking and swallowing.
- A weak or shrill cry.
- Unusual positions. Often the baby's body is either very relaxed and floppy or very stiff.
Even when the condition is present at birth, the signs of cerebral palsy may not be noticed until a child is 1 to 3 years old. Doctors and parents may not see that a baby's movements are unusual until the movements become more obvious as the baby grows.
Signs that occur over time
Some problems related to CP become more clear over time. Or they may develop as a child grows. These may include:
- Smaller muscles in the affected arms or legs. Nervous system problems prevent movement in the affected arms and legs. Not being active affects how the muscles grow.
- Abnormal sensations. Some people who have CP feel pain when touched lightly. Even everyday activities, such as brushing teeth, may hurt. Abnormal sensations can also make it hard to identify common objects by touch.
- Skin irritation. Drooling is common when facial and throat muscles are affected. Drooling irritates the skin, particularly around the mouth, chin, and chest.
- Dental problems. Children who have trouble brushing their teeth have a greater risk of getting cavities and gum disease (gingivitis). Seizure medicines may also lead to gum disease.
- Injuries. Falls and other injuries are a risk, depending on muscle control, joint stiffness, and general physical strength. And CP-related seizures can cause injuries.
All people who have cerebral palsy (CP) have some problems with body movement and posture. But many babies don't show signs of CP at birth. Parents and caregivers may notice the first signs of CP. For example, the baby may not roll over, sit, crawl, or walk at the expected ages.
Signs of CP may become more obvious as the child grows. Some developmental problems may not appear until after a baby's first year. The brain injury that causes CP doesn't get worse over time. But its effects can appear, change, or become more severe as the child gets older.
How CP may affect your child
How much a child is able to move around and do things depends on the type of CP the child has and how much of his or her body is affected. The way CP affects a child also depends on the child's level of intellectual disability, if any, and whether he or she has other complications or other medical conditions.
Most people who have CP have a type of spastic cerebral palsy. This can affect the whole body but may only affect parts of the body in some children. For example, a child with spastic cerebral palsy may have symptoms mostly in one leg or on one side of the body. Most children usually learn ways to adapt to their movement problems, like using special devices and equipment to move around.
Total body cerebral palsy causes the most severe problems. Many of those affected are not able to take care of themselves, either because of severe physical disabilities or intellectual disability. But some people can live on their own with the help of family members, health care aides, or both.
Complications of CP
Some children with CP may have complications, such as seizures. Other medical conditions, such as vision or hearing problems, are often associated with CP. Sometimes these conditions are known right away. In other cases, they aren't found until a child gets older.
Adults with CP are at risk for heart and lung disease. For example, severe CP causes problems with eating. If food is inhaled into the lungs, the risk of lung infection (pneumonia) increases.
Living with CP
Just like people who have normal physical development, people who have CP have social and emotional concerns throughout their lives. Because their physical limitations may add to these concerns, people who have CP need the awareness and consideration of others.
Most adults with the mild or moderate form—and some with the severe form—live independently and have jobs. Others live and work with some level of assistance. Opportunities for independent living and employment for adults with CP have improved, thanks to better home support services and advances in technology, such as computers to assist with speech, powered wheelchairs, and other devices.
What Increases Your Risk
Risk factors before birth
Babies born to teen mothers or to mothers age 35 and older have a higher risk for cerebral palsy (CP).
Also, a baby's risk for developing a brain abnormality or injury that leads to CP increases when the mother has certain problems during her pregnancy. These problems may include:
- Infections, such as rubella, cytomegalovirus infection (CMV), chorioamnionitis, and toxoplasmosis.
- Exposure to certain medicines, such as thyroid hormones, estrogen, or methotrexate.
- Use of alcohol or illegal drugs.
- Other problems, such as bleeding in the uterus during the sixth to ninth month of pregnancy, large amounts of protein in the urine (proteinuria), or high blood sugar levels.
Premature birth and low birth weight
A baby who is born prematurely usually has a low birth weight, less than 2.5 kg (5.5 lb). But full-term babies can also have low birth weights. Multiple-birth babies are more likely than single-birth babies to be born early or with a low birth weight.
Most children with CP had a disruption in the normal development of parts of their brain during fetal growth. Low-birth-weight, premature babies are more likely than full-term, normal-weight babies to have had developmental problems during fetal growth that can injure the brain. For example, a condition called periventricular leukomalacia, or PVL, which reflects injury to the white matter of the brain, is more likely in babies born prematurely than in those born at full term.
Risk factors for cerebral palsy at birth
In rare cases, some babies develop CP as a result of complications during the mother's pregnancy or at birth. Risk factors include:
- Premature birth. Premature babies are more likely to have bleeding in the brain (intraventricular hemorrhage, or IVH) or a brain injury called periventricular leukomalacia (PVL). Either of these problems may cause CP.
- Difficult or prolonged labour.
- Brain infection or physical trauma can increase a baby's risk of getting CP.
- A lack of oxygen also increases a baby's risk. This isn't common.
- CP can itself cause a baby to have a difficult birth because of body movement and posture problems related to the condition.
- Abruptio placenta. The placenta usually separates from the wall of the uterus several minutes after the birth of the baby. But if it separates before the baby is born, the baby loses the blood and oxygen supply from the mother.
- Infections in the mother's uterus or vagina, such as strep infections, that transfer to the baby during birth.
Risk factors after birth
Risk factors for developing CP just after birth or within the first 2 or 3 years of life are related to brain damage. They include:
- A serious illness, such as severe jaundice, meningitis, or lead poisoning (very rare).
- A serious head injury from an injury or fall. This includes injury to a baby from shaking, throwing, or other force (shaken baby syndrome).
- Lack of oxygen to brain tissues, such as the result of a brain tumour or a near-drowning incident.
- Having some kinds of blood-clotting or genetic problems.
When To Call a Doctor
Call 911 or other emergency services if your child with cerebral palsy (CP):
- Is having problems breathing.
- Chokes during feeding and you are not able to dislodge the food.
Call a doctor right away if:
- Your child has a seizure for the first time.
If you have a child diagnosed with CP, call your doctor if your child has:
- A seizure (if it is the first time, call your doctor or seek care right away).
- Constipation that isn't relieved by home treatment.
- Skin irritation that isn't getting better, starts to bleed or weep fluid, or causes pain.
- Feeding problems that aren't relieved by home treatment, such as:
- A pattern of coughing and choking during feeding. If food is inhaled into the lungs, it increases the risk of pneumonia.
- Trouble chewing, along with weight loss or complaints of being hungry.
- Frequent injuries that threaten your child's safety.
- Other signs of complications. These may include bladder control problems, bleeding gums, or an increase in joint stiffness.
If you have cerebral palsy and you are pregnant, talk with a doctor about how CP can affect your pregnancy and delivery.
Who to see
A team of health care providers will be involved in your child's care. Your family doctor or general practitioner can diagnose and treat cerebral palsy. You may also be referred to specialists, such as:
- Pediatricians (some pediatricians specialize in developmental disabilities).
- Neurological surgeons.
- Physiatrists, physical medicine and rehabilitative physicians, and other doctors who specialize in therapeutic and long-term treatment issues.
Other specialists who may be involved in the care of people who have CP include:
- Orthopedic surgeons.
- Respirologists (pulmonologists).
- Ear, nose, and throat specialists (otolaryngologists).
- Psychiatrists, psychologists, social workers, and psychiatric nurses.
Other health professionals who may be involved in the care of people who have CP include:
- Occupational therapists.
- Dentists or orthodontists.
- Hearing specialists (audiologists).
- Speech therapists (speech-language pathologists).
- Registered dietitians.
Some health care clinics specialize in treating children with CP. Call your local health unit for the nearest clinic in your area.
Examinations and Tests
Diagnosing cerebral palsy
A doctor diagnoses CP based on:
- Questions about the child's medical history, including details about the mother's pregnancy.
- A physical examination to look for signs of CP. The doctor will look to see if the child retains newborn reflexes longer than normal. This can be a sign of CP. Postures and basic muscle function, hearing, and vision are usually checked.
- Screening tests. Developmental questionnaires and other tests may be done.
- MRI of the head. This test can find brain abnormalities.
If the diagnosis is unclear, more tests may be done. Sometimes these tests can help find out the severity of CP.
A doctor may closely monitor a newborn or child for signs of CP if he or she has known risk factors. These factors may be related to problems during pregnancy or birth, being born early (premature birth), or problems that occur within the first 2 or 3 years of life.
Doctors are careful not to diagnose CP too early, because some babies who have motor skill problems soon after birth never get CP.
Sometimes symptoms may not appear until the nervous system matures. It can take up to a few years before doctors can tell if a baby with body movement and posture (motor) problems has CP.
Evaluating and monitoring cerebral palsy
After CP is diagnosed, a child will also be checked for other medical conditions that can occur with cerebral palsy, such as:
- Other developmental delays in addition to ones already found. Developmental abilities will be checked to find out if new symptoms, such as speech and language delay, appear as a child's nervous system matures.
- Intellectual disability. This can be checked by intelligence testing.
- Seizures. An electroencephalography (EEG) is used to check for abnormal activity in the brain if a child has a history of seizures.
- Problems with feeding and swallowing.
- Vision or hearing problems.
- Behavioural problems.
Most of the time, a doctor can predict many of the long-term physical effects of CP when a child is 1 to 3 years old. But sometimes such predictions aren't possible until a child reaches school age. That's when learning, communication skills, and other abilities can be checked.
Some children need repeated testing that may include:
- X-rays, to check for loose or dislocated hips. Children with CP are usually X-rayed several times during ages 2 to 5. Spinal X-rays also are done to look for curves in the child's spine (scoliosis).
- Gait analysis. This helps identify problems and guide treatment decisions.
Other tests may be needed, depending on a child's symptoms, other conditions, or medicines he or she takes.
Even though CP can't be cured, a variety of treatments can help people who have CP to make the most of their abilities and physical strength, prevent complications, and improve their quality of life.
Specific treatment varies by individual and changes as needed if new issues develop. In general, treatment focuses on ways to maintain or improve a person's quality of life and overall health.
Regular visits with your child's doctor and specialists are important for monitoring your child's condition.
Treatment for CP includes:
- Physiotherapy, which can help your child become as mobile as possible.
- Medicines, which can help control some of the symptoms of CP and prevent complications. For more information, see Medications.
- Certain kinds of surgery, which may sometimes be used for a child with severe problems. For more information, see Surgery.
- Devices and equipment, such as braces, casts, and splints.
- Pain management. For more information, see the topics Pain Management and Chronic Pain.
Physiotherapy and special equipment may be used together, such as for constraint-induced movement therapy, also called shaping. This encourages a child to increase movements by presenting interesting activities or objects and giving praise and rewards when a child attempts to use the less-functioning muscles.
Ongoing treatment for cerebral palsy (CP) focuses on continuing and adjusting existing treatments and adding new treatments as needed.
Working with others involved with your child's care, understanding your child's needs and rights, and taking care of yourself and other family members are all important parts of treatment. For more information, see Home Treatment.
Physiotherapy is an important treatment that begins soon after a child is diagnosed. It often continues throughout the child's life. It may begin before a definite diagnosis is made, depending on the child's symptoms.
Physiotherapy may help prevent the need for surgery. But its focus may change after surgery or for problems that are new or getting worse. After surgery, specialized physiotherapy may be needed for 6 months or longer.
Devices and equipment
Many people who have CP benefit from using something to maintain or improve joint mobility, help strengthen muscles and relax overactive (spastic) muscles, and assist with daily activities. These devices and equipment may include special crutches, orthotics, casts, standers, special seats, walkers, wheelchairs, special shoes, and other methods to help with specific problems.
The specific types of devices used depend on a child's needs. For example, a child may get a cast after surgery or to restrict movement in one area to strengthen muscles and tendons in another part of the body. If both legs are affected by CP, a child can learn to move around with the help of a scooter board (a device used to self-propel while lying down), a modified stroller, a wheelchair, or other special equipment.
Other therapies may also be needed, depending on specific needs.
- Occupational therapy helps teens and adults adapt to their limitations and live as independently as possible.
- Speech therapy helps control the mouth muscles. This therapy can be of great help to children with speech or eating problems. Speech therapy often starts before the child begins school and continues throughout the school years.
- A registered dietitian can provide nutritional counselling when a child has problems eating or is not gaining weight.
- Both massage therapy and hatha yoga are designed to help relax tense muscles, strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises are sometimes used to try to prevent lung infections. More research is needed to find out the health benefits of these therapies for people who have CP.
- Therapies to stimulate learning and sensory development may benefit babies and young children. Some also help people of other ages. These therapies cannot repair damaged parts of the brain. But they may be able to stimulate undamaged parts of the brain.
- Behavioural therapy may help some school-age children with CP learn better ways to communicate with others.
- Biofeedback may be useful as part of physiotherapy or on its own. Although it doesn't help everyone with CP, some people who use the technique learn how to control their affected muscles or reduce muscle tension.
You may hear about a wide range of controversial treatments, some of which may cause harm. Several controversial treatments exist for CP, such as electrical stimulation and special diets. Be sure to talk to your doctor about any type of treatment you are considering for your child.
Preparing for independent living
Many adults with CP get jobs if they have good support from their family and community. You can enroll your teen in occupational therapy as part of a gradual preparation for independent living. Your child may need extra help and encouragement to prepare for added expectations and responsibilities.
The cause of cerebral palsy (CP) sometimes isn't known. But links have been identified between CP and certain conditions during pregnancy, birth, and early childhood. Some of these can be prevented. Some cannot.
Before and during pregnancy
- Eat nutritious foods.
- Don't smoke.
- Avoid exposure to harmful substances.
- See your doctor regularly.
For babies and young children
Help prevent CP in your young child by minimizing your child's risk for getting a brain injury.
- Take steps to prevent injuries.
- Make sure you are familiar with the signs of jaundice in newborns.
- Know how to prevent lead poisoning.
- Keep your child away from people who have serious contagious illnesses, such as meningitis.
- Make sure your child's immunizations are up-to-date. For more information, see the topic Immunizations.
If your child has not been diagnosed with CP, pay attention to whether your child is reaching early developmental milestones. Report anything you notice to your doctor at regularly scheduled well-child visits or anytime you have concerns.
Family members working together with doctors can use home treatment to provide the best possible care for a child with cerebral palsy (CP).
Tips for parents and family members
- Learn about the condition. Being informed can help you understand how best to help your child. Local or national cerebral palsy organizations can help, especially in dealing with the impact of daily emotional and lifestyle issues. Talk with your doctor or call your local hospital for suggestions. For more information, see the Other Places to Get Help section of this topic.
- Learn about your child's educational rights. Contact your provincial and local education departments for specific information about your child's educational rights. Also, vocational training may benefit some teens and young adults.
- Work with teachers and school officials. Work with your child's teachers, school administrators, special learning consultants, and school boards to develop the best educational plan for your child. A cooperative team approach helps your child realize his or her potential.
- Provide emotional support. The needs of a child with CP change over time. As children grow and become more aware of their physical limitations, they need to be able to talk about their feelings and how they are treated. It is sometimes easier for them to talk with someone who isn't a family member. Ask your doctor about whether emotional counselling would benefit your child. Also, include your child when making decisions about his or her health care.
- Take care of yourself. Get proper rest, eat well, exercise, and learn ways to cope with the challenges of raising a child with CP. You will be better equipped to help your child when you have physical energy and emotional strength.
- Help each other. The entire family is affected when one member has CP. Helping family members cope with this situation is important, especially for siblings. You can help prevent other children from having unrealistic fears and concerns, feeling left out, or becoming overwhelmed.
You and your family and friends can help your child reach his or her highest potential. Focus on your child's strengths. And build self-esteem by helping your child learn to do things by himself or herself.
Helping with daily routines
Each person with CP has unique strengths and areas of difficulty. But most people who have CP need ongoing help with:
- Using the toilet. Some people who have CP have poor bladder control or problems that make using a toilet difficult. Special undergarments and training by an occupational therapist may help.
- Bowel elimination. People who have CP often become constipated, making stools difficult to pass. For information about preventing and treating constipation, see the topic Constipation, Age 11 and Younger or Constipation, Age 12 and Older.
- Dressing. Provide clothing and shoes that are easy to put on and take off, such as those that zip or button in the front or that have large buttons, ties, or Velcro fasteners.
- Speaking. Problems with jaw and mouth muscles, and also hearing loss, can make it difficult to form words. Speaking slowly and reading with your child often are examples of ways to help your child communicate.
- Keeping active. Your child needs to move his or her limbs to help keep muscles strong and joints flexible. Have him or her move and play as much as possible. Involve other family members too. Ask the doctor, physiotherapist, or other parents for ideas.
- Safety. People who have CP are prone to falls and other injuries, especially if they have seizures. You can take safety measures at home—such as having sturdy furniture—to help your child avoid injuries. Use common sense and care around sharp objects. And never leave a person who has CP alone while he or she is bathing.
Feeding and grooming
- Feeding and eating. Children with CP may have problems being able to chew, suck, and swallow. Using special utensils and serving soft foods may help. A registered dietitian can suggest ways to help your child eat healthy foods and make food easier to chew and swallow. A person with severe CP may need a feeding tube in order to eat.
- Bathing and grooming. People who have CP who do not have control of their hands or arms usually cannot groom themselves. Some children can be taught some self-grooming with practice.
Dental and skin care
- Dental care. CP can cause problems with the jaw muscles, teeth, mouth, and tongue. And it can make it hard to use a toothbrush. Regular cleanings and special equipment, such as a teeth-cleaning water spray, can help.
- Skin care. Drooling can cause skin irritation around the chin, mouth, and chest. You can help protect your child's skin by blotting rather than wiping drool, using cloths to cover the chest, and applying lotions or cornstarch to areas that get irritated.
As your child approaches the teen years and young adulthood, be aware of his or her changing needs.
- Give teens and adults with CP plenty of emotional support and understanding. Family members and friends can help them deal with the daily challenges of having CP.
- Gradually prepare your child for independent living. Usually teens have learned to use their talents and strengths. But they may need extra help and encouragement to prepare for added expectations and responsibilities.
- Talk to your teen about intimate relationships. Teens and young adults with CP may need more guidance than other people their age in developing these relationships.
Learn to change your routines as your child with CP grows and develops. For example, you may not be able to continue caring for a severely affected child who is growing tall and heavy. Try to plan ahead for the time when your grown child with CP is not under your care.
Planning for adulthood
Preparing your child for adulthood takes careful planning. It also requires patience and resourcefulness on your part.
- Encourage independent living skills. A time may come when you or other family members can no longer assist your child in all areas.
- Plan for an adult's current and future health care needs. Complications of cerebral palsy may develop and affect quality of life. Also, some forms of CP are more severe and require special assistance.
- Use occupational therapy and similar programs that may be helpful. Most adults with CP are employed, despite moderate to severe physical disability. Laws protect the rights of disabled people to find and hold employment (among other rights). Learn about disability laws and policies. See the Human Resources and Skills Development Canada webpage at www.hrsdc.gc.ca/eng/home.shtml.
Older adults with CP may need extra help preparing for retirement.
Medicines can help control some of the symptoms of cerebral palsy (CP), prevent or minimize complications, and treat other medical conditions related to CP.
Muscle relaxants (antispasmodics) are the most common medicines used for people who have CP. They can help relax tight muscles and reduce muscle spasms. Most antispasmodics are taken by mouth. Some are injected directly into stiff or spastic muscles. Examples include:
- Botulinum toxin (such as Botox).
- Diazepam (such as Valium).
Anticonvulsants help prevent or control seizures. These include:
- Lamotrigine (Lamictal).
- Oxcarbazepine (Trileptal).
Anticholinergics help some people who have CP who have uncontrollable body movements (dystonic cerebral palsy) or who drool often. These include:
Stool softeners and mild laxatives may help treat constipation, which is a common complaint of people who have CP.
What to think about
Some doctors believe that oral antispasmodic medicines should not be given to growing children. They are concerned that side effects from these medicines can cause problems for children that are worse than the tight muscles and muscle spasms related to CP. For example, drowsiness is a side effect that may interfere with a child's ability to concentrate and learn in school. Other doctors believe that the benefits of these medicines outweigh the risk of side effects.
Ask your doctor the following questions about any medicine prescribed for your child:
- How successful is it in treating my child's problem?
- What are the short-term and long-term side effects?
- What are the chances that the medicine will stop working? What options are available if this happens?
- How might it affect my child's growth and development?
Surgery for people who have cerebral palsy (CP) may help reduce muscle stiffness or spasms and allow more flexibility and control of the affected limbs and joints.
The main surgery choices are:
- Orthopedic surgery (for muscles, tendons, and joints). It's done to increase range of motion. For example, the surgeon may lengthen a tendon, cut through muscles or tendons, or attach a tendon to a different part of the bone.footnote 2 Surgery to treat spinal curves (scoliosis) or to prevent or treat hip dislocation is also done.
- Selective dorsal rhizotomy (cutting nerves of affected limbs) for contracture or other mobility problems. This procedure is usually considered only for children who have severe muscle tightness in the legs.
Other surgeries related to cerebral palsy
- Surgery for various orthopedic problems. Surgery for other problems is sometimes needed for children with CP. These surgeries vary depending on the specific problems involved. For example, some children may need surgery to correct uneven leg length.
- Medicine-related surgery. A small pump is surgically implanted under the skin in the belly for some people who have CP. This pump can deliver medicines, such as baclofen, directly into the fluid surrounding the spinal cord.
When surgery may be used
A thorough checkup is needed to help the doctor find out which muscles and nerves are affected and what type of surgery would best treat the condition. A gait analysis may be part of the examination.
Doctors don't agree about the best age for children to have surgery for cerebral palsy. Some may suggest surgery at a young age, while others may suggest other treatments before surgery. Use this surgery information form ( What is a PDF document? ) to help you decide what's right for your child.
Surgery isn't used nearly as often for the arms as for the legs. Surgery on arm deformities carries more risks related to sensory damage.
Sometimes medicine or physiotherapy is used to postpone or prevent the need for surgery.
Physiotherapy after surgery
The type of therapy and special equipment needed after surgery (such as braces, casts, and splints) depends on the child's specific needs. Most children need physiotherapy after surgery. In general, post-surgical physiotherapy usually starts as soon as possible and may continue for as long as 6 months.
- Palmer FB, Hoon AH (2011). Cerebral palsy. In M Augustyn et al., eds., The Zuckerman Parker Handbook of Developmental and Behavioral Pediatrics for Primary Care, 3rd ed., pp. 164–171. Philadelphia: Lippincott Williams and Wilkins.
- Hoon AH Jr, Tolley F (2013). Cerebral palsy. In ML Batshaw et al., eds., Children With Disabilities, 7th ed., pp. 423–450. Baltimore: Paul H Brookes Publishing.
Other Works Consulted
- Ade-Hall RA, Moore AP (2000). Botulinum toxin type A in the treatment of lower limb spasticity in cerebral palsy. Cochrane Database of Systematic Reviews (1). Oxford: Update Software.
- Anttila H, et al. (2008). Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review. BMC Pediatrics, 8(14): 1–10.
- Ashwal S, et al. (2004). Practice parameter: Diagnostic assessment of the child with cerebral palsy. Neurology, 62(6): 851–863.
- Committee on Children with Disabilities, American Academy of Pediatrics (1999, reaffirmed 2010). The treatment of neurologically impaired children using patterning. Pediatrics, 104(5): 1149–1151.
- Delgado MR, et al. (2010). Practice parameter: Pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology, 74(4): 336–343.
- Desch LW (2013). Assistive technology. In ML Batshaw et al., eds., Children With Disabilities, 7th ed., pp. 641–656. Baltimore: Paul H Brookes Publishing.
- Diamond M, Armento M (2010). Children with disabilities. In WR Frontera, ed., DeLisa's Physical Medicine and Rehabilitation, vol. 2, pp. 1475–1502. Philadelphia: Lippincott Williams and Wilkins.
- Glader L, Tilton A (2009). Cerebral palsy. In WB Carey et al., eds., Developmental-Behavioral Pediatrics, 4th ed., pp. 653–662. Philadelphia: Saunders Elsevier.
- Hoare BJ, et al. (2010). Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy (Update). Cochrane Database of Systematic Reviews (1).
- Kedia S, et al. (2014). Neurologic and muscular disorders. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 21st ed., pp. 776–861. New York: McGraw-Hill.
- Murphy NA, et al. (2008, reaffirmed 2012). American Academy of Pediatrics clinical report: Promoting the participation of children with disabilities in sports, recreation, and physical activities. Pediatrics, 121(5): 1057–1061.
- Rapin I (2010). Disorders of motor and mental development. In LP Rowland, TA Pedley, eds., Merritt's Neurology, 12th ed., pp. 568–574. Philadelphia: Lippincott Williams and Wilkins.
- Renshaw TS, Deluca PA (2006). Cerebral palsy. In RT Morrissy, SL Weinstein, eds., Lovell and Winter's Pediatric Orthopaedics, 6th ed., vol. 1, pp. 551–603. Philadelphia: Lippincott Williams and Wilkins.
- Simpson DM, et al. (2008). Assessment: Botulinum neurotoxin for the treatment of spasticity (and evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70(19): 1691–1698.
Primary Medical Reviewer Susan C. Kim, MD - Pediatrics
Brian O'Brien, MD, FRCPC - Internal Medicine
John Pope, MD, MPH - Pediatrics
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Louis Pellegrino, MD - Developmental Pediatrics
Current as ofMarch 28, 2018
Current as of: March 28, 2018