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Understanding Cerebral Palsy (CP)

If you have been told your child has Cerebral Palsy (CP) you may be very concerned, many people have no idea what this means for their child. You may already know that she isn’t doing as much as you would expect her to do for her age, or she may be more difficult to dress or change her diaper because of stiffness in her legs as you handle her. Some babies just don’t move as much as you expect when you lay them down on a mat.

The way Cerebral Palsy affects each child can be very different. The diagnosis is described as an ‘umbrella term’. There are different causes and no two children will have exactly the same issues. However, we do understand that there are criteria that we can use to determine the diagnosis.

  • It is an umbrella term, i.e. a group of disorders
  • It is due to a non-progressive interference in the brain. There are a large number of causes for the injury. Most occur before birth, with only 10% due to injury during birth. After birth infections or head injuries may result in Cerebral Palsy.
  • It is permanent but not unchanging. Once the brain is injured, it doesn’t get worse but the effects on how the baby can grow and develop skills will change with time. For example, if the areas of the brain that helps us have smooth controlled movements is injured and the legs are stiff it will be hard for the baby to learn to sit up and balance at the same age we expect other children to be able to sit. The injury is permanent as we cannot cure damage to the brain.
  • It affects the immature brain. The babies brain develops from the first few weeks of pregnancy and continues to develop rapidly in the first two years of life. If at any stage in that time development is disturbed it can cause Cerebral Palsy.
  • It affects movement and /or posture and disturbs or delays how children can master the necessary skills of life.
  • By definition it is any disruption of the normal development of the brain by whatever cause before it is fully developed, and in any part of the brain. All the causes and all the different types are covered by this umbrella called Cerebral Palsy. It affects the ability to learn to control movement. So, if your child drools, then the muscles in and around the mouth that let us swallow are affected. If your child can’t sit up then it is the muscles in the trunk that are not working properly. Everything we do relies on muscles allowing us to move. If the brain isn’t controlling these muscles in a coordinated way we can’t function well

    SThis umbrella term means that your child might be mildly affected or more extensively affected. So, one side of the body is affected more, or maybe the lower half is more affected than the upper half or all the body may be affected. Medially we classify the areas affected by the following terms.

    • Hemiplegia is one side affected.
    • Diplegia is the lower half more than the upper half (legs more than arms)
    • Quadriplegia is all the body affected.
    • This umbrella term also covers the different types of movement problem and medically we have terms to describe these different types of CP.

      • Some children are too stiff and can’t move much at all. This is termed Spastic or Hypertonic CP.
      • Some children with CP cannot stay still and have spasms of movement. This is termed Dystonic Athetoid CP.
      • Some can’t stay still and have wriggly movements. This is termed Choreoathetoid CP.
      • Some are unsteady and can’t balance or do not have smooth movements, they have poor control over how they pick things up or they walk clumsily. This is termed Ataxic CP.
      • Sometimes a mixture of these signs can be seen in one child. For example, a child with ataxia may have also spasticity.

        The last way to classify is to determine how much the child with CP is affected by his or her CP signs. It is tempting to simply classify as being mildly, moderately or severely affected but we need to be more precise to know how much the impairment of having CP affects how the child can function.

        In other words, how much does it hinder the child from interacting fully with their family and in their community?

        How does it prevent them having all the experiences that children without CP can have with their family, in their schools and in their relationships as they grow?

        There are classifications which indicate how much a child can do and not just how they are when examined in a doctor’s room. They may be scared or shy when examined in a doctor’s room. Assessing them in a fun and child friendly place helps us see how much they can do.

        Physiotherapists at AKi use the Gross Motor Function Classification (GMFC) and Manual Abilities Classification (MACs) to record the level of involvement.

        However, the really useful assessment is done by learning as much about the child’s abilities as possible, working close with families. We believe the training we do with families is the key to helping the child reach their potential. The information the parents give us and the problems that matter to the parent and child guides us in planning our therapy.

        In summary it is fair to say no two children with CP are ever the same. Think of your own families and see if two siblings are the same? We do know that useful experience of movement and a stimulating environment are essential for all children to develop. With children who come to AKi we help parents give the best quality of these experiences in practical ways that can be practised and become part of everyday life at home.

        Scientists are studying how the brain learns to control movement. What we now understand tells us that it is important to give a child lots of opportunities to experience trying to do things for themselves. We can help so that they can be more effective and successful as they play and explore and interact with everyone, but it is better if they want to try to do things for themselves.

        You will find a lot more information about Cerebral Palsy at:

        https://www.canchild.ca

        First and foremost, all children deserve happy and exciting childhoods with lots of stimulation activities.