diagram of brainWhat is Cerebral Palsy?

Cerebral Palsy is a condition in which there may be abnormal brain development or injury to the brain as it develops. This can occur before, during, after birth or during early childhood.

It is the brain's control over various sensory, muscle or co-ordination functions that is affected. So, although there is no injury to the hands or legs themselves, a child with Cerebral Palsy may not be able to walk or move his or her hands in a co-ordinated purposeful way.

Depending on which part of the brain is affected, the Cerebral Palsied person may not be able to talk, see, hear or understand normal thought processes.

Children with Cerebral Palsy have difficulties in controlling muscles and movements as they grow and develop. The nature and extent of these difficulties may change as children grow but Cerebral Palsy itself is not progressive: the injury or impairment in the brain does not change. However, the effects of the brain injury on the body may change over time for better or worse.

Physiotherapy and other therapies can often help people with Cerebral Palsy reach their full potential and become more independent. Therefore, children with Cerebral Palsy will often be referred to a therapist or see a multi-disciplinary team. Depending on the precise area of the brain that is affected, there may be associated difficulties which become obvious during development; for example, in vision, hearing, learning and behaviour.

No two cases are the same
Varying degrees of injury to different parts of the brain mean that no two children with Cerebral Palsy are exactly alike. Some are so slightly affected that they have no obvious disability. Others may be severely disabled – to the extent that they have limited movement in both arms and legs, are unable to speak, feed themselves or control bladder and bowel movements. Such children will require lifelong care.

Learning difficulties
If the damage involves certain parts of the brain, it may affect the child's perception – that is the ability to give meaning to what he or she hears, sees or touches. As a result, many of these children have learning difficulties and need special teaching techniques to help them reach their potential.

Normal intellect
On the other hand, children with Cerebral Palsy may have normal, or higher than average intelligence – but their intelligence is masked by their disabilities. Some of those who appear to be severely disabled have normal intellect.

Different types of Cerebral Palsy

diagram of brainIn general we talk about three main types of Cerebral Palsy – spastic, athetoid and ataxic Cerebral Palsy. These describe effects on the body and muscle tone that are dependent upon, which part of the brain has been affected. Many people with Cerebral Palsy will have a mixture of these types.

Spastic Cerebral Palsy
This is present in 75% - 88% of people with Cerebral Palsy. Spasticity refers to the muscle tone being unyielding and tight (hypertonia) with a decreased range of movement. It can affect different and many areas of the body so a person with spastic Cerebral Palsy could, in addition to impaired mobility, have difficulties with speech or continence.

If the person is only affected on one side of their body the term used to describe this is hemiplegia or unilateral Cerebral Palsy. If two limbs are affected (usually legs more than arms), the term is diplegia and if all four limbs are affected the term used is quadriplegia.

Athetoid Cerebral Palsy
Sometimes referred to as dystonic, athetoid or choreoathetoid. Present in about 15% of people with Cerebral Palsy. People with Athetoid Cerebral Palsy experience uncontrolled, involuntary, sustained or intermittent muscle contractions as the tone of the muscle can change from floppy and loose (hypotonia) to tight with slow, rhythmic twisting movements.

The whole body can be affected, resulting in difficulties maintaining an upright position. Speech can be hard to understand as there may be difficulty controlling the tongue, breathing and vocal chords.

Ataxic Cerebral Palsy
This is present in about 4% of people with Cerebral Palsy. Ataxia is defined as an “inability to activate the correct pattern of muscles during movement”. People with ataxic Cerebral Palsy find it very difficult to balance. They may also have poor spatial awareness, which means it is difficult for them to judge their body position relative to things around them. Ataxia affects the whole body. Most people with ataxic Cerebral Palsy can walk but they will probably be unsteady with shaky movements. Speech and language can also be affected.

Mixed presentation
It can be difficult to say what type of Cerebral Palsy a person has as it is common to have a combination of two or more types.

As mentioned, it is important to bear in mind that no two people with Cerebral Palsy are affected in the same way. Some have Cerebral Palsy so mildly that it’s barely noticeable. Others may be profoundly affected and require help with many or all aspects of daily life.

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