“Spasticity” refers to an increase in tone, or tension, in a muscle. Due to damage or genetic abnormality, the brains of people with spastic cerebral palsy are unable to control how flexible or taut a muscle should be. Instead, the muscle itself controls how tight it should be, meaning the muscle is usually too tense, or spastic.
As a result, the movements of people with spastic cerebral palsy appear stiff, jerky or labored. Difficulty moving limbs is a characteristic symptom, as is a difficulty in grasping objects.
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What Is Athetoid (Dyskinetic) Cerebral Palsy?
Cases of athetoid, or dyskinetic, cerebral palsy are generally thought to be caused by injury to the basal ganglia, a group of brain structures that control coordinated movement. Many children born with the condition have low muscle tone, which means their limbs may appear floppy. Other children will display symptoms associated with both hypotonia (low muscle tension) and hypertonia (high muscle tension) in a condition technically referred to as athetoid dyskinetic cerebral palsy.
Involuntary movements, especially of the trunk and limbs, are a classic sign of athetoid cerebral palsy.
- Athetosis – slow writhing movements (normally affects the hands and / or feet)
- Dystonia – repeated twisting triggered by protracted muscle contractions
Chorea are also common – small and random (not repetitive) uncontrollable movements. Patients often have trouble maintaining their posture and balance while standing, walking or sitting. Movements that require coordination, like reaching out and grasping an object, can also be difficult.
Most people who develop athetoid cerebral palsy do so after suffering a birth injury during or shortly after delivery. Writing in the World Journal of Pediatrics, researchers attributed the majority of cases to kernicterus and hypoxic-ischemic encephalopathy – two frequent results of medical negligence. Kernicterus is a severe form of jaundice, although with proper diagnosis and treatment, the condition can be prevented in most cases. Hypoxic-ischemic encephalopathy is a tragically common form of brain injury caused by oxygen deprivation and decreased blood flow. Many children sustain hypoxic-type brain damage during labor and delivery due to improper medical treatment.
What Is Ataxic Cerebral Palsy?
Around 6% of cases will be classified as ataxic cerebral palsy, a condition caused by damage to the cerebellum, a brain structure at the back of the skull responsible for regulating muscular activity and coordination.
People with ataxic cerebral palsy may appear clumsy or uncoordinated when they move. Tremors in the upper limbs are common, and actions that require precise motor control, like writing or tying shoe laces, can be difficult. Walking may seem unsteady, and balance is usually impaired to a significant degree. Depth perception is frequently affected as well. Children with ataxic cerebral palsy often develop a “wide-base gait” as they walk, spreading their feet apart further than their hips.
In a limited number of children, doctors will diagnose multiple forms of cerebral palsy at once.
Secondary & Associated Conditions
Beyond cerebral palsy’s effect on muscle tone and movement, coordination, posture and balance, these conditions are often accompanied by associated symptoms. Difficulty communicating is fairly common, as are issues with breathing and bladder and bowel control problems. All of these associated effects are gathered together under the heading of “secondary conditions.”
Many children with cerebral palsy also have learning disabilities, and upwards of 50% will experience seizures. Intellectual impairment and sensory disabilities can also be present and, while researchers don’t think that these “associative conditions” are caused by the same brain damage, they are more common in people with cerebral palsy disorders.
Unlike other neurological disorders, cerebral palsy conditions are not progressive, according to the National Institute of Neurological Disorders and Stroke. That means the brain damage, or malformation, causing a child’s symptoms doesn’t get worse over time. But a child’s symptoms can change, getting more or less pronounced as they age.
Does Medical Malpractice Cause Cerebral Palsy?
Researchers once believed that the majority of cerebral palsy cases were caused by birth asphyxia, but that understanding has been shaken by recent medical studies.
In most cases, it appears that cerebral palsy disorders develop as the result of genetic abnormalities and environmental factors while an unborn child is still in the womb. Some maternal infections, like rubella, can impair the development of a fetus’ nervous system. Genetic mutations can lead to poor myelination, in which a child’s nerve fibers are inadequately protected. For many children, there is very little a physician could do to avoid the development of cerebral palsy.
Medical Negligence & Cerebral Palsy
That isn’t always the case, however. For 10% to 20% of children diagnosed with cerebral palsy, the condition is ultimately explained as the result of brain injuries suffered during childbirth. Medical negligence is often suspected in these cases, especially those involving brain damage caused by birth asphyxia. Infants are routinely deprived of oxygen – at the most sensitive time – due to medical mistakes, errors that could have been avoided by a competent healthcare professional.
Traumatic brain injuries are another possibility. During difficult deliveries, doctors must strive to protect an infant’s head from harm – but the improper use of forceps often makes this impossible. Abnormal fetal presentations, like a breech birth, have been linked to an increased risk for cerebral palsy disorders.
As we mentioned earlier, children who survive kernicterus may also be more likely to develop certain forms of cerebral palsy. Left untreated, the common infant condition jaundice, in which a child’s skin appears yellow due to increased levels of the bile pigment bilirubin, can rapidly progress to kernicterus. Many families are told that they have nothing to worry about – and dismissed without a proper diagnosis – only to learn later that their child’s very life was placed directly in harm’s way.
Diagnosing Cerebral Palsy
Diagnosing cerebral palsy can be difficult, and the condition is often impossible to diagnose immediately after a child’s birth. While doctors can run several tests to monitor a child’s brain function, which might turn up clues to a brain injury, there isn’t a specific test for cerebral palsy.
Many families only begin to suspect the possibility after their son or daughter has failed to meet a developmental milestone, like holding the head up without assistance or taking a first step. Beside signs of functional delay, physical growth delays are often an early sign of cerebral palsy. You can find a complete guide to developmental milestones, from two months to five years, at the US Centers for Disease Control & Prevention.
Most children receive an accurate diagnosis by their second birthday, after the brain has had time to develop, although kids with milder forms of cerebral palsy are often diagnosed between three and five. This process can be discouraging for parents, and detrimental to the health of children, many of whom would benefit from early interventions and proactive treatment strategies.
Can We Treat Cerebral Palsy?
Cerebral palsy disorders can’t be cured, but there are many treatments to help people with cerebral palsy improve their quality of life, leverage their strengths and manage their weaknesses. Of course, each treatment plan will be unique to a child’s condition, but most kids benefit from some measure of physical therapy, helping them become as mobile as possible. Many people with disabilities use assistive technologies, like braces and splints, to improve their functional abilities.
Medicines are available to control some of cerebral palsy’s symptoms. Muscle relaxants, for example, can help loosen taut muscles and decrease muscle spasms. Anticonvulsants are commonly used to prevent or manage seizures, which up to half of all children with cerebral palsy disorders will experience. Some doctors have raised concerns that the side effects of these medications, especially muscle relaxants, pose more risks than benefits for growing children, so make sure to discuss any questions or concerns you have with your child’s healthcare team.
In severe cases of cerebral palsy, some children benefit from surgical intervention, according to WebMD.