The abbreviation CP stands for cerebral palsy. A breakdown of those words provides us with a very general definition of what CP is – “cerebral” means pertaining to the brain, and a “palsy” is a weakness of muscles. This tells us that CP is basically a weakness or difficulty with the use of muscles caused by something in the brain.
But what is it, really? What causes it? What kind of long-term effects does it have? What does it look like to live with CP? As we develop this blog, we’d like to provide a rundown on some of the most common diagnoses for children with special needs in Middle Tennessee. Knowledge is power, and the more we can learn about these diagnoses, the more effective we can be in dispelling stereotypes, providing support, and encouraging the success of the children affected by them. Since cerebral palsy is the leading cause of disability in children worldwide, it seemed as good a place as any to start. Not long ago, a teacher in the preschool was babysitting for a family whose children are enrolled at High Hopes. One of the children in this family is diagnosed with cerebral palsy. Their grandmother was over for a bit to help with the children’s bedtime routine, and as the teacher changed his sister’s diaper, Grandma played with the little boy who has CP. She was pushing the buttons on an alphabet toy, telling him the sounds each letter makes. Because the teacher often spends the day at school with this child, she knew that he knows most, if not all, of his letters and sounds. Being super socially-aware and tactful, she piped up, “Oh, he already knows his alphabet. Buddy, why don’t you show Grandma where the ‘R’ is?” It was only a moment of processing for him before his little pointer finger made a direct journey to the ‘R’ button. And it was only a moment of processing for Grandma before she started crying tears of joy. The teacher realized that his grandmother had no idea prior to that moment that he could recognize his alphabet. It occurred to her then that she has a unique advantage through her work at High Hopes in understanding the nature of several diagnoses, of understanding how they affect a child, and knowing what a child could one day be capable of despite a diagnosis. Hopefully in the post below, we can pass a little of that advantage along to you. So What Is CP? In reality, cerebral palsy is a term that refers to a whole group of disorders. These are all disorders that share common factors – they affect a person’s ability to control movements, muscle tone, and strength, and sometimes posture and balance are also affected. The brain’s signals to the muscles have been interrupted. There are several main kinds of CP, which are typified by how an individual’s condition affects their movement. Spastic CP, the most common type, is characterized by overly stiff muscles, sometimes so stiff that a child’s joints are pulled into painful positions called contractures. This is the type most people think of when they hear the term “cerebral palsy.” Athetoid CP, or dyskinesia is another type. In this type, a child may experience uncontrollable movements such as flexing, twitching, flailing, or muscle spasms. Sometimes children with this type also experience uncontrolled slow writhing movements. The final broad category of CP is ataxia, which means their CP primarily affects their balance and coordination. More than one type can be present in one child. The most common mixed type of CP is spastic-dyskinetic. All types can affect one or more limbs, from hemiplegia (affecting one side of the body), to diplegia (affecting the legs only), to quadriplegia (affecting the entire body). It can also affect three limbs (triplegia), or even just one extremity (monoplegia). A child's muscle tone contributes to the way their CP may present. Typically-developing muscle tone maintains a certain amount of tension or resistance to stretching, even when at rest. Hypotonia is the term used to describe low muscle tone, which can mean that muscles are too relaxed and overall muscle strength is reduced. Hypertonia is on the other side of the scale, describing high muscle tone where muscles can be stiff and rigid much of or all the time. What Causes It? The short answer of what causes CP is abnormal development of the brain. That abnormal development can be caused by many things, such as damage or trauma to the brain, and/or genetic mutations and anomalies. In most children, the exact cause of their CP is hard to pin down, and in many children, CP may actually go undetected for several months or even years after their birth. The vast majority of children with CP are born with the condition. Most develop it due to trauma during birth. However, CP can develop during pregnancy, during birth, or even after birth during infancy. It is a very small percentage of children who acquire CP after birth, and it is usually because of some kind of serious trauma such as a car accident or head injury, or infections such as meningitis. Some of the most common risk factors linked to children born with cerebral palsy include low birthweight and premature birth, an infection affecting the mother, multiple births such as twins or triplets, breech births, a lack of O2 in utero or at birth, lack of growth factors, a lack of nutrients in utero, jaundice in utero or as a newborn, and fetal seizure during pregnancy. Several types of brain conditions are thought to be involved with CP in children. The names are fun to say but impossible to decipher, so here’s a quick glossary of a few of the most common:
What Does It Do? Every child affected by cerebral palsy will present with different and varying degrees of symptoms. CP is very much a condition that can look vastly different from child to child, encompassing many levels of severity, with individualized effects and treatment plans. Some of the most common signs and symptoms of cerebral palsy are a lack of muscle coordination in voluntary movements, stiff or tight muscles and exaggerated reflexes, and weakness in one or more limbs. It also commonly affects a child’s gait, causing them to walk on their toes or walk with a crouched gait. It can also cause scissoring, which is a gait impairment where a child’s legs might pull together, turn inward, and cross at the knees. Many children with CP, especially quadriparetic varieties where all limbs are affected, experience difficulty controlling their oral functions. This means they can have trouble with swallowing and chewing. Many children also experience speech delays and impairments, and many may remain physically nonverbal for the length of their lifetime. Cerebral palsy is a permanent condition, but it is not progressive. This means that, although symptoms may appear to worsen as they grow and develop, in reality a child’s severity of symptoms due to CP is likely to remain virtually the same, or to improve from the time of their birth and throughout their life, rather than worsening as with some other conditions. Most children with CP are expected to live well into a healthy adulthood. Unfortunately, CP is related to a series of other conditions, some of which can be progressive. These co-occurring conditions include epilepsy (or other seizure disorders), autism, spinal deformities such as scoliosis, osteoarthritis, impaired vision and/or hearing, and susceptibility to respiratory illnesses due to aspirating (inhaling solids, such as bits of food, into the lungs). CP has also been known to cause intellectual impairment on many levels. However, on average, more than half the children with this diagnosis show typical cognitive development in all areas except motor function. In fact, a common problem among older people with CP is to sink into depression when communication issues cause frustrations. Many able-bodied people make the mistake of assuming that an impairment in speech is equivalent to an impairment in intellect, and this simply isn’t true. Nevertheless, with a solid support system, early intervention, and good treatment and symptom management, many people with CP go on to lead remarkably typical adult lives. So Is There a Cure?
As of yet, there is no cure for cerebral palsy. However, there are many treatment options, including many types of therapy. Early intervention is key! The earlier a diagnosis can be reached and therapy can begin, the more progress a child is able to make. Physical therapy is the cornerstone of treatment for cerebral palsy, most often as part of an overarching therapy regimen, and much research is still ongoing as to the best methods to encourage success. For some, equipment may provide answers to difficulties their CP causes. Orthotics (specialized braces for the leg, foot, and ankle) can help to place the feet and lower extremities in proper alignment for standing and gait. Many children use wheelchairs for increased mobility, including manual and power varieties. Walkers, gait trainers, standers, and specialized stationary chairs can greatly aid a child in daily activities and strengthening exercises, especially in combination with physical and occupational therapies. And for children with difficulties in speech, assistive devices using both touch and eye-gaze are life-changing technologies. On the pharmaceutical side, the most common medications are oral. Prescriptions of diazepam, baclofen, dantrolene sodium, and tizanidine can help to ease stiff, contracted, or overactive muscles. In some cases, a baclofen pump may be the best option, as it allows for adjustable doses of medication to be directly supplied to a child's spinal fluid whenever it is most needed, and allows for smaller doses leading to less lethargy and stomach involvement than the traditional oral delivery. A child with a milder form of CP may also receive injections of botulinum toxin (commonly known as botox, but in the CP world more often referred to as BT-A). These injections reduce contractures by keeping nerve cells from over-activating muscles. Some children with CP may even benefit from surgeries. Most common are orthopedic surgeries to lengthen muscles and tendons that are proportionately too short. This can help to improve mobility and gait, and lessen pain. Many children with accompanying spinal conditions such as scoliosis also have surgeries to correct those malformations. In some cases, a surgery called selective dorsal rhizotomy may be helpful. In this procedure, a surgeon locates and selectively cuts the sensory nerve fibers that come from muscles and enter the spinal cord. Any surgery comes with risks, and families will consult extensively with physicians to determine the best treatment plan for their child. Some promising treatment work is being done in constraint-induced therapy. This is where a therapist will encourage use of a weaker or non-dominant upper limb by restraining its stronger counterpart. Functional electrical stimulation, where low-level electrical currents stimulate muscle movement, and low-intensity vibration treatments, which can improve bone structure in the legs, are also being used as a treatment for CP. Much research is being done in ways to improve the lives of people with cerebral palsy. Most research currently being done has to do with stem cell research, including a major study going on at Duke. The future may bring even higher quality of life to those with a CP diagnosis. So What Does Success Look Like? For every child, success will look a little different. For one child we know, a huge success arrived when he learned how to use his “talker.” He has an assistive communications device that responds to his eye gaze. When he said his first words to his mother through his talker, it was a moment of joy for both of them. Another child we love was experiencing a significant delay in the motor function of his legs. He could army crawl for miles, but he had a lot of trouble standing up and taking steps. After lots of PT, he now walks everywhere, as fast as any of his friends (when he wants to be), through the assistance of a walker. He may very well be walking independently before too long! With any diagnosis, the key is hitting those little milestones. One at a time. Celebrate every victory, and it won’t be long before you’re looking back amazed at how far you’ve come.
 Centers for Disease Control & Prevention. (2015, July 13). Facts About Cerebral Palsy. Retrieved from CDC.gov: https://www.cdc.gov/ncbddd/cp/facts.html
 Centers for Disease Control & Prevention. (2016, November 8). Tracking and Research on Cerebral Palsy. Retrieved from CDC.gov: https://www.cdc.gov/ncbddd/cp/research.html  Centers for Disease Control & Prevention. (2017, March 13). 11 Things to Know about Cerebral Palsy. Retrieved from CDC.gov: https://www.cdc.gov/features/cerebral-palsy-11-things/index.html  National Institute of Neurological Disorders and Stroke. (2013, August). Cerebral Palsy: Hope Through Research. Retrieved from NINDS.NIH.gov: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Cerebral-Palsy-Hope-Through-Research