Cerebral Palsy Treatment in Delhi, India

Based on the affected part of the brain, cerebral palsy is of four types:

1. Spastic cerebral palsy
2. Dyskinetic cerebral palsy
3. Ataxic cerebral palsy
4. Hypotonic cerebral palsy

Most people experience a combination of the above types. Also, the effects of different types become apparent as the child grows and begins to perform basic functions such as walking.

The symptoms of cerebral palsy are different in different individuals. In some cases, it may affect the whole body, while in others, it may be limited to a limb or two. General symptoms are:

• Problems with movement and coordination
• Stiff muscles and exaggerated reflexes, known as spasticity
• Variations in muscle tone - stiffness or floppiness
• Rigid muscles with normal reflexes
• Lack of balance and muscle coordination, known as ataxia
• Tremors or jerky involuntary movements
• Difficulty walking, such as a scissors-like gait with knees crossing, walking on toes, a crouched gait, a wide gait or an asymmetrical gait.
• Slow, writhing movements
• Favouring one side of the body, for example, only reaching with a single hand or dragging a leg while crawling
• Difficulty with fine motor skills, for example, buttoning clothes or picking up utensils.
• Speech and eating-related issues
• Delays in speech development
• Difficulty speaking
• Difficulty with chewing, eating or sucking
• Excessive drooling or problems with swallowing
• Developmental issues
• Delays in reaching motor skills milestones, like sitting or crawling
• Intellectual disabilities
• Learning difficulties
• Delayed growth, causing smaller size than would be expected
• Other problems
• Seizures (epilepsy)
• Abnormal pain sensations
• Bladder and bowel problems like urinary incontinence
• Constipation
• Abnormal touch sensations
• Difficulty hearing
• Problems with vision and abnormal eye movements
• Mental health problems like emotional and behavioural problems

Cerebral palsy does not improve with age but rather worsens. However, with growing age, some symptoms become less apparent. On the other hand, muscle rigidity and shortening can worsen if not treated on time.

Cerebral palsy develops due to abnormal brain development, injury, or damage to a developing brain. The damage usually occurs when the baby is not born but may also occur at the time of birth or early infancy. The main cause of the disorder is not known. However, some factors that may contribute include:

• Gene mutations: These result in genetic anomalies or differences in brain development.
• Maternal infections: Many infections the pregnant mother suffers may be transmitted to the developing foetus and cause damage to the brain. This damage may develop cerebral palsy.
• Foetal stroke: This condition causes an obstruction of blood supply to the developing brain that damages it.
• Bleeding into the brain: Sometimes, an internal haemorrhage in the womb or in a newborn baby damages the brain and leads to cerebral palsy.
• Infant infections: Some infections occurring in infants may cause inflammation in or around the brain, thereby damaging it.
• A traumatic head injury: Traumatic injuries to an infant, such as from a fall or physical abuse, or a motor vehicle accident, may lead to the development of cerebral palsy.
• Lack of oxygen to the brain may occur during difficult labour or delivery. However, this is a lot less common nowadays.

The symptoms of cerebral palsy take time to develop and may not be apparent until a few months to a year after birth. Hence, it takes time for the condition to be diagnosed. Diagnosis may be delayed due to mild signs and symptoms in some cases.

If the paediatrician suspects cerebral palsy, they may evaluate the child's symptoms and monitor their growth and development. Further, they review the child's medical history and conduct a physical examination. Finally, they may refer to a specialist, such as paediatric physical medicine and rehabilitation specialist, paediatric neurologist, and child developmental specialist if indicated.

They may also advise some tests to confirm the diagnosis and to rule out other causes of the symptoms. Some scans include:

• Imaging of the brain such as MRI, cranial ultrasound, and EEG.
• Laboratory tests such as genetic and metabolism testing
• Additional tests to assess issues with vision, hearing, speech, intellect, development, growth and movement.

Patients with cerebral palsy require lifelong care with a medical care team. The medical team comprises a paediatrician, neurologist, physical medicine and rehabilitation specialist, and mental health specialist.

It is imperative to understand that there is no cure for cerebral palsy. However, treatment can help improve the quality of life. Different treatment modalities help children perform daily activities with ease and include therapies, medications, surgical procedures, and other necessary treatments.

Cerebral palsy can contribute to numerous muscle and coordination complications during childhood and adulthood, which include:

• Contracture: Contracture is the shortening of muscle tissue due to severe muscle tightening. This occurs due to spasticity. This may lead to the inhibition of bone growth, bone bending, joint deformities, and complete or partial dislocation of bones.
• Malnutrition: Malnutrition may occur due to swallowing difficulties, especially in infants. People with cerebral palsy often fail to receive adequate nutrition, which further impairs muscle and bone growth. A feeding tube may be needed in some severe cases to facilitate feeding.
• Mental health conditions: Individuals with cerebral palsy may experience anxiety and depression. In addition, social isolation and difficulty in coping with disabilities can also contribute to depression and cause behavioural issues.
•  Heart and lung disease: Individuals with cerebral palsy may develop breathing, heart, and lung disorders, in addition to problems with swallowing that may lead to respiratory problems, like aspiration pneumonia.
• Osteoarthritis: Increased pressure on the joints or abnormal alignment of joints with an increase in age and weight may lead to the early onset of osteoarthritis.
• Osteoporosis: Bone fractures are common due to reduced bone density. Other contributing factors include inadequate nutrition, mobility, and anti-epileptic drug use.
• Other complications: Some other associated complications include sleep disorders, skin and intestinal problems, chronic pain, and issues with oral health.

Numerous risk factors are associated with cerebral palsy. These include:

• Maternal health: If pregnant women are infected, they may transmit the disease or medicines to the foetus that may damage the brain.
• Viral infections
• Cytomegalovirus
• German measles (rubella)
• Herpes
• Syphilis
• Toxoplasmosis
• Zika virus infection
• Intrauterine infections
• Exposure to toxins such as methylmercury.
• Other conditions: Other conditions such as thyroid, seizures, and preeclampsia may lead to cerebral palsy.
• Infant illness
• Bacterial meningitis
• Viral encephalitis
• Severe or untreated jaundice
• Bleeding into the brain
• Factors of pregnancy and birth
• Low birth weight
• Multiple babies: Having multiple children at once can increase the risk of cerebral palsy. It also adds to the risk of premature birth and preterm low birth weight. In addition, if one of the babies dies, the survivor's risk of cerebral palsy increases.
• Premature birth in babies carries a higher risk of developing cerebral palsy.
• Delivery complications increase the risk of the foetus developing cerebral palsy.

Reviewed by Dr. Mukesh Kumar, Associate Director and Head (Parkinson's Disease Unit), Neurosciences, Neurology on 23-Jan-2023.

What is cerebral palsy (CP)?

Cerebral palsy is a group of disorders which may affect a person's movement, posture, and balance. It is caused by damage to the developing brain.

What causes cerebral palsy?

Cerebral palsy can be caused by brain damage that occurs before, during, and shortly after birth. Some causes include infections, genetic factors, and complications during labour and delivery.

Is cerebral palsy a progressive condition?

No, cerebral palsy is not progressive. The brain damage that causes CP doesn't worsen with time, but the symptoms and functional abilities may change.

How is cerebral palsy diagnosed?

Diagnosis involves medical history, physical examinations, and neurological assessments. Brain imaging studies like MRI may also be used.

Are there different types of cerebral palsy?

Yes, there are different types of cerebral palsy, including spastic, dyskinetic, ataxic, and mixed types. The classification is based on the predominant motor symptoms.

Can cerebral palsy be prevented?

In some cases, cerebral palsy may be prevented by addressing risk factors such as maternal infections, proper prenatal care, and preventing complications during childbirth.

What are the early signs of cerebral palsy?

Early signs may include delays in reaching developmental milestones, difficulty with motor skills, and abnormal muscle tone.

Is there a cure for cerebral palsy?

There is no cure for cerebral palsy, but various therapies and interventions can help manage symptoms and improve quality of life.

What are the treatment options for cerebral palsy?

Treatment options are physical, occupational and speech therapy, medications, orthopaedic interventions, and assistive devices.

How does physical therapy benefit individuals with cerebral palsy?

Physical therapy helps improve muscle strength, coordination, and mobility in individuals with cerebral palsy.

Can children with cerebral palsy attend regular schools?

Yes, many children with cerebral palsy attend regular schools with appropriate support and accommodations.

Are there medications to manage symptoms of cerebral palsy?

Medications like muscle relaxants and anti-spasticity drugs may be prescribed to manage symptoms like muscle stiffness.

Can cerebral palsy affect cognitive function?

While cerebral palsy primarily affects motor function, some individuals may also have associated cognitive impairments.

What role does assistive technology play in cerebral palsy management?

Assistive technology like communication devices and mobility aids, can significantly improve independence and function for individuals with cerebral palsy.

Can adults develop cerebral palsy?

While cerebral palsy is typically diagnosed in early childhood, it can result from brain injuries at any age.

Is surgery ever recommended for individuals with cerebral palsy?

In some cases, orthopaedic surgeries may be recommended to address issues like contractures and skeletal deformities.

How does speech therapy help individuals with cerebral palsy?

Speech therapy helps improve communication skills, including speech, language, and swallowing, for individuals with cerebral palsy.

Do all individuals with cerebral palsy have intellectual disabilities?

No, cerebral palsy can vary in severity, and not all individuals with CP have intellectual disabilities.

What is the life expectancy like for someone with cerebral palsy?

The life expectancy of those with cerebral palsy varies based on factors like severity and associated conditions. Many individuals lead normal life spans due to appropriate care and support. However, each case is unique and requires personalized attention from healthcare professionals to enhance the quality of life and its longevity.

Can adults with cerebral palsy live independently?

With appropriate support and accommodations, many adults with cerebral palsy can live independently.

Are there support groups for individuals with cerebral palsy and their families?

Yes, various support groups and organizations can provide resources and assistance for individuals with cerebral palsy and their families.

What challenges do parents of children with cerebral palsy often face?

Parents may face challenges related to caregiving, accessing appropriate services, and advocating for their child's needs.

Can cerebral palsy be associated with other health conditions?

Yes, individuals with cerebral palsy may have associated conditions such as epilepsy, vision or hearing impairments, and intellectual disabilities.

What is the role of early intervention in cerebral palsy management?

The goal of early intervention services is identifying and addressing developmental delays as early as possible, improving outcomes for children with cerebral palsy.

Review