Cerebral palsy is a group of disorders that can affect brain and nervous system functions such as movement, learning, hearing, seeing, and thinking. It is caused by injuries or abnormalities in the brain. Most of these problems occur as the baby grows in the womb, but they can also happen at any time during the first two years of life while the baby's brain is still developing.
In some people, parts of the brain are injured due to low oxygen levels (hypoxia). The etiology is unknown.
Premature infants have a slightly higher risk of developing cerebral palsy. Cerebral palsy may also occur during early infancy because of several conditions, including:
There are several different types of cerebral palsy, including spastic, dyskinetic, ataxic, hypotonic, and mixed.
Varry greatly
Be very mild or very severe
Only involve one side of the body or both sides
Be more pronounced in either the arms or legs or involve both the arms and legs
Symptoms are usually seen before a child is 2 years old and sometimes begin as early as 3 months. Parents may notice that their child is delayed in reaching and in developmental stages such as sitting, rolling, crawling, or walking.
Muscles that are very tight and do not stretch. They may tighten up even more over time.
Abnormal walk (gait): arms tucked in toward the sides, knees crossed or touching, legs making "scissors" movements, walking on the toes
Joints are tight and do not open all the way (called joint contracture)
Muscle weakness or loss of movement in a group of muscles (paralysis)
The symptoms may affect one arm or leg, one side of the body, both legs, or both arms and legs
Abnormal movements (twisting, jerking, or writhing) of the hands, feet, arms, or legs while awake, which gets worse during periods of stress
Tremors
Unsteady gait
Loss of coordination
Floppy muscles, especially at rest, and joints that move around too much
Decreased intelligence or learning disabilities are common, but intelligence can be normal
Speech problems (dysarthria)
Hearing or vision problems
Seizures
Pain, especially in adults (can be challenging to manage)
Eating and digestive symptoms
Difficulty sucking or feeding in infants or chewing and swallowing in older children and adults
Problems swallowing (at all ages)
Vomiting or constipation
Increased drooling
Slower than normal growth
Irregular breathing
Urinary incontinence
There is no cure for cerebral palsy. Treatment aims to help the person be as independent as possible.
Treatment requires a team approach
Treatment is based on the person's symptoms and the need to prevent complications.
Anticonvulsants to prevent or reduce the frequency of seizures
Botulinum toxin to help with spasticity and drooling
Muscle relaxants (baclofen) to reduce tremors and spasticity
Control gastro-esophageal reflux
Cut specific nerves from the spinal cord to help with pain and spasticity
Place feeding tubes
Release joint contractures
Stress and burnout among parents and other caregivers of cerebral palsy patients are common and should be monitored.
Involve parents/caregivers
Establish trust and limit unfamiliar faces as much as possible
Anticipate difficult intubation
Latex allergy
Communication difficulties
Scoliosis = restrictive lung disease
Consider GERD
Increased sensitivity to Succinylcholine
Increased resistance to neuromuscular blockers
MAC decreased
Contractures restrict access to evaluation and positioning
Difficult IV access - use topical LA