What are the effects and signs?
There are two main groups of problems in children with Cerebral Palsy (CP) -:
Medical problems
- Musculo-skeletal problems (further impairing mobility and posture)
- Oromotor difficulties (leading to feeding and nutritional problems and speech problems)
- Epilepsy
Functional problems as a result of the medical impairments
- Mobility problems
- Speech problems
- Vision and hearing problems
- Impaired cognitive functions
- Incontinence
Musculoskeletal Problems
Children with CP may have a number of musculo-skeletal abnormalities that are often quite debilitating and cause further deterioration to their gross motor functioning -:
• Difficulty walking and maintaining balance resulting from spasticity and contractures.
• Difficulty with fine motor tasks such as writing or doing up buttons.
• Arm/leg weakness or both.
• Scoliosis (abnormal curvature of the spine) is more common in patients with CP.
• Various abnormalities of the foot and ankle such as flat feet or equinus (deformity of the ankle which results in child toe-walking).
• Degenerative hip disease and hip dislocation are common complications during the adolescent growth spurt, particularly in children with athetoid Cerebral Palsy. This may result in pain when sitting and standing.
Note - Children that are able to walk by age 2 years are likely to continue to be able to walk. Children who do not sit by age 4 years don’t usually ever walk.
Oromotor difficulties
When the muscles of the face and throat are affected by CP there are multiple effects. Even in the absence of a learning difficulty, the child may have a significant communication problem due to problems pronouncing words clearly. They often also have difficulty with controlling secretions resulting in excessive drooling as well as problems swallowing. This may cause significant feeding difficulties for children with CP (feeding can take a long time) and has implications for nutrition.
Poor nutrition and dental problems may result from feeding and swallowing difficulties. Furthermore, trouble with swallowing makes these children prone to choking on secretions from the mouth and stomach (aspiration). Aspiration may injure the lungs causing difficulty breathing and if it occurs repeatedly can permanently damage the lungs. In the most extreme situation, aspiration can cause sudden death in a young infant with CP.
Epilepsy
Epileptic seizures occur frequently in children with cerebral palsy (CP). The incidence is related to the severity of the brain damage. It is higher in those children with quadriplegia, lower in those with hemiplegia, and much lower in children with diplegia and the athetoid form of CP.
The first epileptic seizures typically are seen during infancy. The seizure disorder is the consequence of the brain abnormalities associated with the CP. Clinical studies indicate that early seizures are associated with more cognitive deficiencies.
Practically every type of epileptic seizure has been described in individuals with CP. Generalized tonic and tonic-clonic seizures and partial complex seizures are most frequent. Some syndromes, such as infantile spasms and Lennox-Gastaut syndrome are particularly frequent in children with CP. See Epilepsy guidance.
Hearing and Vision
Some CP patients have hearing problems, particularly those children who had kernicterus (severe neonatal jaundice). Visual impairment, especially strabismus ("cross-eye") is very common in CP. Other visual problems result from incomplete development of the retina of the eye or from injury to the area of the brain that interprets the signals from the eye, this may result in cataracts and other abnormalities. See Hearing Impairment guidance.
Incontinence
Children with CP may have poor bladder function caused by impaired control of bladder muscles or a small irritable bladder. This often results in repeated infections and incontinence.
Cognitive/Psychological/Behavioural
Learning difficulties occurs more frequently in persons with CP, the overall rate is between 30-50%. One difficulty in assessing cognitive ability is to evaluate verbal skills and may result in the underestimation of cognitive abilities in CP. There is also increased occurrence of depression, ADHD and autistic spectrum disorders.
