Cerebral PAlsy
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M.D L. Fleming Fallon, Jr., Dr.P.H.
Definition
Cerebral palsy (CP) is the term used for a group of nonprogressive
disorders of movement and posture caused by abnormal development of, or
damage to, motor control centers of the brain or, in some cases,
hypoxemia (insufficient oxygen in the blood) during the birth process.
CP is caused by events before, during, or after birth. The
abnormalities of muscle control that define CP are often accompanied by
other neurological and physical abnormalities.
Description
Voluntary movement (walking, grasping, chewing, etc.) is primarily
accomplished using muscles that are attached to bones, known as the
skeletal muscles. Control of the skeletal muscles originates in the
cerebral cortex, the largest portion of the brain. Palsy means
paralysis, but may also be used to describe uncontrolled muscle
movement. Therefore, cerebral palsy encompasses any disorder of
abnormal movement and paralysis caused by abnormal function of the
cerebral cortex. However, CP does not include conditions due to
progressive disease or degeneration of the brain. For this reason, CP
is also referred to as static (nonprogressive) encephalopathy (disease
of the brain). Also excluded from the definition of CP are any
disorders of muscle control that arise in the muscles themselves or in
the peripheral nervous system (nerves outside the brain and spinal
cord).
CP is not a specific diagnosis but is more accurately considered a
description of a broad but defined group of neurological and physical
problems.
The symptoms of CP and their severity are quite variable. Persons with
CP may have only minor difficulty with fine motor skills, such as
grasping and manipulating items with their hands. A severe form of CP
could involve significant muscle problems in all four limbs, mental
retardation, seizures, and difficulties with vision, speech, and
hearing.
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Muscles that receive defective messages from the brain may be
constantly contracted and tight (spastic), and the person with CP may
exhibit involuntary writhing movements (athetosis) or have difficulty
with voluntary movement (dyskinesia). There can also be a lack of
balance and coordination with unsteady movements (ataxia). A
combination of any of these problems may also occur. Spastic CP and
mixed CP constitute the majority of cases. Effects on the muscles can
range from mild weakness or partial paralysis (paresis), to complete
loss of voluntary control of a muscle or group of muscles (plegia). CP
is also designated by the number of limbs affected. For instance,
affected muscles in one limb is called monoplegia, affected muscles in
both arms or both legs is called diplegia, affected muscles in both
limbs on one side of the body is called hemiplegia, and affected
muscles in all four limbs is called quadriplegia. Muscles of the trunk,
neck, and head may be affected as well.
Approximately 500,000 children and adults in the United States have CP,
and it is newly diagnosed in about 6,000 infants and young children
each year. The incidence of CP has changed little since the 1960s and
1970s. Ironically, advances in medicine have decreased the incidence
from some causes-Rh disease for example, but have increased its
incidence from other causes-notably, prematurity and multiple
pregnancies. (Medical advances have made it possible for more babies
born prematurely or in multiple but underweight births to survive, thus
allowing more time for CP to be recognized when it does occur.) No
particular ethnic groups seem to be at higher risk for CP. However,
people of disadvantaged background are at higher risk due to poorer
access to adequate prenatal care and advanced medical services.
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