Cerebral Palsy

Cerebral palsy (CP) is a non-progressive, permanent neurological disorder as a result of brain damage before, during or after birth. A key risk factor for it is Hypoxic-Ischaemic Encephalopathy (HIE). Causes include:

• Antenatal – HIE, Maternal infections, Trauma during pregnancy, Placental abruption

• Perinatal – Birth asphyxia, Premature birth

• Postnatal – Meningitis, Kernicterus (severe neonatal jaundice), Trauma, Haemorrhage, Medication toxicity

Types

The most common type of it is Spastic. This is where there's damage to the pyramidal pathways in the brain. It can present with:

• Pyramidal weakness (weak arm extensors and leg flexors)

• UMN signs - Hypertonia, Hyper-reflexia

• Scissor gait

• Can be monoplegic, hemiplegic, diplegic, quadriplegic

Other types include:

• Dyskinetic – This is where there's damage to the Basal Ganglia (extrapyramidal) pathways. It can present with:

  • Difficulty controlling tone (Hypertonia and Hypotonia), causing athetoid (writhing movements of fingers, hands, toes) and oro-motor problems (e.g. speech difficulties)

  • Signs of Parkinsonism

• Ataxic – This is where there's damage to the Cerebellar pathways. It can present with:

  • Uncoordinated movements

  • Signs of a cerebellar lesion (i.e. DANISH)

Presentation

• Usually more evident during development

• Developmental delay

• Signs depend on the type

• Hand preference before 18 months – Usually, children don’t have a preference at this age, but CP children will due to the difference in tone between limbs

• Learning disability (LD)

Types of gait it can present with:

• Hemiplegic – Indicates spastic type

  • Leg extension and plantarflexion, so patient has to swing leg around to walk. Arm will also be flexed.

• Broad-based/Ataxic – indicates ataxic type

• High-stepping – indicates foot drop or LMN lesion

• Waddling – weakness of hip abductors (e.g. gluteus medius)

• Antalgic (limp) – indicates localised pain

Complications

• Learning disability (LD)

• Epilepsy

• Aspiration pneumonia

• Muscle contractures (permanent shortening of a muscle, tendon, or joint)

• Hearing and visual impairment