Cerebral Palsy and Associated Conditions

Introduction

Children with Cerebral Palsy often have associated conditions, which are health conditions that a person has in addition to Cerebral Palsy that can have an affect on a childs child’s quality of life. Some of these conditions may be related related to Cerebral Palsy, while others are unrelated, but are commonly associated with Cerebral Palsy.

A systemic review in 2012 comiled information on the rates of co-occurring impairments, diseases, and functional limitations in children with cerebral palsy. The results showed

• 3 in 4 were in pain
• 1 in 2 had an intellectual disability
• 1 in 3 could not walk
• 1 in 3 had a hip displacement
• 1 in 4 could not talk
• 1 in 4 had epilepsy
• 1 in 4 had a behaviour disorder
• 1 in 4 had bladder control problems
• 1 in 5 had a sleep disorder
• 1 in 5 dribbled
• 1 in 10 were blind
• 1 in 15 were tube-fed
• 1 in 25 were deaf

Respiratory Difficulties

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
  

Speech Impairment

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

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
  

Digestive Issues 

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

• Constipation
  
• Vomiting
  
• Aspiration

Vision Impairment

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

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.
  

Epilepsy/Seizures

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.

Learning Difficulties

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

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.

Perceptual Difficulties 

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. 

Communication / Language Difficulties

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.