Cerebral Palsy and Associated Conditions

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Introduction[edit | edit source]

Cerebral Palsy (CP) is defined as "a group of disorders of the development of movement and posture causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disturbances are often accompanied by disturbances of sensation, cognition, communication, perception and/or behaviour and/or by a seizure disorder.".[1]

While the definition of CP focuses on the aspects of movement and motor control, it also recognises that those diagnosed with CP may also have conditions, disorders or impairments that are related and unrelated (but commonly associated) with CP. [2]When stating that a condition is related, it means that it's manifestation is often the result of primary impairments caused by CP. For example, pain may be a resulting condition caused by muscle spasms. When these conditions occur together with impairments but not because of these impairments, it is said to be 'in association' with the primary impairments of CP.[1] For example, many children diagnosed with CP are also diagnosed with a seizure disorder.

Impairments and resulting conditions can be many and often overlap. For example, an infant diagnosed with CP may have perceptual difficulties linked directly to damage of the brain. However, movement difficulties occurring because of limited movement and exploration capabilities also affect the ability to develop perception.

Conditions which may present:

  • Pain[2]
  • Respiratory problems[3]
  • Intellectual disability/ cognitive dysfunction[2]
  • Problems with perception[1]
  • Seizures[2]
  • Pressure ulcers[2]
  • Osteoporosis[2]
  • Behavioral and/or emotional problems[2]
  • Problems with vision[1]
  • Problems with hearing[2]
  • Problems with feeding or communication[2][1]
  • Changes in the neuromuscular and musculoskeletal systems[1]
  • Incontinence[2]
  • Problems in the gastrointestinal system
Findings of a systematic review by Novak et al. 2012[4]

Pain[edit | edit source]

Pain is reported to be experienced by 32% of children and 74% of adolescents diagnosed with CP in the United States, with the assertion that these reports are modest and likely under-reported.[5]

Pain can be experienced as a direct result of:[5]

  1. Musculoskeletal complications
  2. Increased muscle tone
  3. Spasticity
  4. Hip dislocations
  5. Gastrointestinal dysfunctions

Pain can also be experienced due to interventions such as:[5]

  1. Casting
  2. Botulinum toxin A injections
  3. Physical Therapy

Respiratory Problems[edit | edit source]

Assessment of respiration in a child with CP.jpeg

Respiratory difficulties[3] Difficulties in swallowing, low activity levels, excessive drooling, blocked airways, and the inability to cough are among a few of the various reasons that children with Cerebral Palsy may experience respiratory issues. Respiratory issues have the potential to become serious conditions so monitoring breathing and respiratory function is vital. There are numerous respiratory conditions associated with cerebral palsy, including:

  • Bronchitis
  • Pneumonia
  • Bronchopulmonary Dysplasia
  • Respiratory Distress Syndrome (RDS)
  • Asthma
  • Aspiration

Intellectual disability/ Cognitive dysfunction[edit | edit source]

Learning Difficulties[edit | edit source]

Children with cerebral palsy may experience specific learning difficulties due to a number of factors. Some have learning disabilities, which are neurological processing problems that interfere with basic learning skills, like reading and writing. Learning disabilities can also affect higher level skills, such as organization, sequencing and abstract reasoning. Other learning difficulties may include a short attention span, motor planning difficulties, perceptual difficulties and language difficulties. 

Intellectual Difficulties[edit | edit source]

Children with cerebral palsy vary widely in their intellectual capabilities. Some will show the same abilities as other people, despite their physical difficulties. Others will have some degree of intellectual disability, ranging from mild to significant. A child with an intellectual disability may have limitations in both Cognitive Functioning - the thinking skills that lead to knowledge and Adaptive Behavior - the ability to adapt to the environment and function in daily life. Intellectual disabilities are categorized as mild, moderate or severe.

Problems with Perception [edit | edit source]

Perception is the making sense of information gained from the senses. This enables children to do things such as move around obstacles, judge size and shape of objects and understand how lines are connected to form letters. Children with perceptual difficulties have a hard time making sense of the information they take in through their eyes and/or ears, which can impact many areas of learning. For those who experience these difficulties, their problems often do not become apparent until preschool or school. 

Seizures[edit | edit source]

According to the Centers for Disease Control and Prevention (CDC), around 35% of all children with cerebral palsy will experience seizures. There are different types of seizures, and the symptoms will depend upon what form the child experiences.

  • Absence Seizures: Stare into space and have small and subtle body movements, such as eye blinking and lip smacking.
  • Atonic Seizures:Temporary loss of muscle control and may collapse onto the floor without warning.
  • Clonic Seizures:Marked by jerking muscle movement in the arms, face, and neck.
  • Myoclonic Seizures:Temporary jerking movements in the arms and legs.
  • Tonic-clonic Seizures:Most severe type of seizures, marked by body shakes, loss of consciousness, the body stiffening, and in some instances, loss of bladder control.

Pressure Ulcers[edit | edit source]

Osteoporosis[edit | edit source]

Behavioural and/or emotional problems[edit | edit source]

Vision Impairment[edit | edit source]

Up to one in ten children with Cerebral Palsy have severe visual impairment. Up to half of all children with Spastic Cerebral Palsy have Strabismus, better known as cross-eye. Overall as many as 75 to 90 percent of children with CP have a vision impairment, including:

  • Cortical (Cerebral) Visual Impairment
  • Amblyopia (Lazy Eye)
  • Optic Atrophy (Deterioration of the Optic Nerve due to damage)
  • Nystagmus (repetitive, uncontrollable eye movements in a vertical or horizontal direction)
  • Visual Field Defects (loss of one side of the visual field)
  • Refractive Errors (near and farsightedness and astigmatism or blurred vision)
  • Strabismus or 'Squint' where one or both eyes are turned in or out and are prevented from working together, which may lead to double vision or focusing with one eye at a time.
  • Hyperopia (long-sightedness). 

Hearing Impairment[edit | edit source]

Some children with Cerebral Palsy may have hearing impairment. Hearing impairment refers to any degree of impairment of the ability to hear sound. The degree of one’s hearing loss is measured on a scale and can be slight, mild, moderate, severe or profound. There are three main types of hearing loss, including:

  • Conductive which occurs when there is a problem in the outer or middle ear resulting in hearing only faint sounds.
  • Sensorineural which occurs when the inner ear (cochlea) or the auditory nerve are damaged. This type of hearing impairment reduces the ability to hear faint sounds and speech often sounds muffled.
  • Central which occurs as a result of damage in the central nervous system, not the ear, affecting the ability to interpret or understand language. The individual may be able to hear perfectly, but they cannot interpret or understand the language.

Communication / Language Difficulties[edit | edit source]

Children with cerebral palsy may have difficulties with understanding and expressing ideas. They may require support to follow instructions, construct sentences, give specific information or tell stories that make sense. If a child is having any of these difficulties, it may have an effect on learning.

Speech Impairment[edit | edit source]

Many children with cerebral palsy have dysarthria, a motor speech disorder where the muscles of the mouth may be affected, which makes speech difficult. People with dysarthria have difficulty controlling the muscles used for speech, such as as the:

  • Lips
  • Tongue
  • Vocal Folds
  • Diaphragm

Apraxia is another common motor speech disorder that affects children with Cerebral Palsy. Childhood apraxia of speech, as it’s referred to in children, is when a child has difficulty saying words, sounds and syllables. The child knows what they want to say, but their brain is unable to plan and coordinate the muscle movements needed to do so. Children with cerebral palsy may also struggle with speech sound disorders. These include problems with articulation and phonological processes, or speech patterns used by children to simplify adult speech. For children or aduts with restricted speech, an alternative communication system may assist them (for example communication board, book or electronic device). 

Oral Motor Impairment[edit | edit source]

Children with Cerebral Palsy often have impaired oral motor control, which means they have difficulty controlling the muscles in their mouth and throat. This can lead to problems with feeding (sucking, chewing, etc.) and dysphagia, or difficulty swallowing. Oral motor impairment also causes drooling in about 30 percent of individuals with Cerebral Palsy. Problems with feeding and swallowing, as well as drooling, can be improved through Speech and Occupational Therapy.

Dysphagia

Children with cerebral palsy are at risk of dysphagia due to poor muscle and motor function control. Symptoms may include:

  • Inability to swallow and/or pain when trying to swallow
  • Regurgitation
  • Heartburn
  • Feeling stomach acid in the throat
  • Unusual weight loss
  • Hoarse Voice
  • Food stuck in the chest area and/or throat
  • Gagging and coughing when attempting to swallow
  • Drooling
  • Delayed (or sometimes absent) swallowing reflex
  • Back pain
  • Sore throat

Changes in the neuromuscular and musculoskeletal system[edit | edit source]

Incontinence[edit | edit source]

Digestive Issues [edit | edit source]

Structural changes in the system of a child with Cerebral Palsy may lead to long term digestive issues including:

  • Constipation
  • Vomiting
  • Aspiration

References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, Jacobsson B, Damiano D. Proposed definition and classification of cerebral palsy, April 2005. Developmental medicine and child neurology. 2005 Aug;47(8):571-6.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Vitrikas K, Dalton H, Breish D. Cerebral palsy: an overview. American family physician. 2020 Feb 15;101(4):213-20.
  3. 3.0 3.1 Proesmans M. Respiratory illness in children with disability: a serious problem?. Breathe. 2016 Dec 1;12(4):e97-103.
  4. Iona Novak, Monique Hines, Shona Goldsmith and Richard Barclay. Clinical Prognostic Messages From a Systematic Review on Cerebral Palsy. Pediatrics , October 8, 2012.
  5. 5.0 5.1 5.2 Peck J, Urits I, Kassem H, Lee C, Robinson W, Cornett EM, Berger AA, Herman J, Jung JW, Kaye AD, Viswanath O. Interventional approaches to pain and spasticity related to cerebral palsy. Psychopharmacology bulletin. 2020 Oct 10;50(4 Suppl 1):108.