Cerebral Palsy

Cerebral palsy is a permanent disorder of movement and posture caused by non progressive injury or abnormal development of the fetal or infant brain. The brain lesion does not progress, although musculoskeletal manifestations evolve as the child grows.

Motor phenotypes include spastic, dyskinetic, ataxic and mixed cerebral palsy.

• Delayed motor milestones
• Abnormal tone
• Persistent primitive reflexes
• Early hand preference
• Abnormal posture or gait
• Scissoring
• Toe walking
• Dystonia
• Feeding and swallowing dysfunction

Associated problems include epilepsy, visual impairment, hearing loss, intellectual disability, communication disorder, chronic pain, hip displacement and contractures.

Diagnosis is clinical and developmental.

MRI brain is useful for defining the underlying pattern of brain injury and identifying malformations.

Investigate alternative diagnoses when there is loss of previously acquired milestones, progressive weakness or an evolving neurological syndrome, because cerebral palsy itself is non progressive.

• Multidisciplinary rehabilitation is central.

• Physiotherapy and occupational therapy target mobility, posture and functional independence.

• Speech and feeding assessment is required where communication or swallowing is impaired.

• Treat focal spasticity with physiotherapy, splinting and botulinum toxin where appropriate.

• Oral baclofen may be used for generalized troublesome spasticity, with dosing gradually titrated under specialist supervision.

• Orthopaedic surveillance is essential for hip displacement, scoliosis and contractures.

• Treat epilepsy, nutritional problems, constipation, pain and reflux actively rather than regarding them as inevitable consequences.