Cerebral palsy (CP), a disorder caused by damage to the brain, especially affecting ability to control movement and posture. Palsy is a synonym for paralysis, although a more accurate description of the usual muscular symptoms might be weakness (paresis), and inability to make voluntary movements and suppress involuntary ones.

Depending on the location and extent of the damage, cerebral palsy can be mild, revealing itself as a kind of awkwardness, or severe, largely incapacitating a child from infancy. It is sometimes associated with other problems such as seizures (epilepsy), mental retardation, ear and hearing problems, eye and vision problems, communication problems (see communication skills and disorders), and impairment of other senses. Some of the children most severely affected with cerebral palsy may not survive infancy, but most will have a normal life span.

Cerebral palsy is not contagious. It is not progressive-it does not get worse as time passes, and may instead improve somewhat with therapy (see below). It is not inherited, except in rare cases where it is associated with a genetic disorder, notably Lesch-Nyhan syndrome.

Most cases are caused by brain damage during pregnancy, childbirth, or the neonatal period (just after birth); this is called congenital cerebral palsy, because it is present at or around the time of birth. However, approximately 10 percent of the cases are acquired cerebral palsy, in which CP has been triggered by events after birth, such as a traumatic brain injury, infections such as meningitis, and other types of brain damage, including injury from child abuse and neglect.

Just why CP occurs is far from clear. Approximately 58% of the cases of cerebral palsy occurred in children who were born at full term and full weight, and in whom doctors could discern no cause of brain damage, at the present state of knowledge and technology. However, studies have shown that numerous conditions are risk factors for cerebral palsy, not necessarily leading to it, but increasing the risk that a child will have it. Among the main risk factors are:

Infections in the mother during pregnancy, including rubella (German measles); sexually transmitted diseases such as gonorrhea, chlamydia, and syphilis; and various other bacterial and viral infections, some of which attack the baby's nervous system.

Premature birth.

Low birth weight, though some infants who weighed under 2 pounds at birth and spent months in neonatal intensive care have been unimpaired.

Difficult or abnormal delivery, especially awkward fetal presentation (position at birth), lengthy or too abrupt labor, or obstruction of the umbilical cord.

Hypoxia, or insufficient oxygen, in the brain, for a variety of reasons, such as premature separation of the placenta during delivery or swelling of the brain due to illness.

Incompatability between parents' and fetus's blood types, especially Rh incompatibility.

Jaundice of the newborn or hyperbilirubinemia (see liver and liver problems), sometimes associated with Rh incompatibility.

Medications and drug abuse taken by the mother.

Lead poisoning.

Smoking by the mother.

Alcohol abuse by the mother.


With increased knowledge, developing technology, and enhanced prenatal care, the risks of CP can be much diminished, even if it cannot be completely prevented. Precise figures are hard to come by, because of the wide variation in the disorder and lack of requirement that doctors report it, but the United Cerebral Palsy Association estimates that approximately 3000 infants are born with cerebral palsy each year, and some 500 other preschool-age children later acquire the condition.

Cerebral palsy is generally recognized in the early years, as developmental delay becomes apparent. Though various kinds of medical scans can help doctors identify some brain abnormalities, the disorder is most often seen in its symptoms. These may include:

Retention of primitive reflexes, involuntary reactions to particular stimuli that are normally found only in newborns.

Muscular weakness and "floppiness" (hypotonia).

Assumption of abnormal, awkward positions, which (if uncorrected) can lead to skeletal disorders.

Favoring one side of the body over the other.

Poor muscle control and lack of coordination.

Muscle spasms or seizures.

Problems with sucking, chewing, and swallowing.

Unusual tenseness and irritability in infancy.

Inability to control bladder and bowels (incontinence).

Difficulty in speaking.

Difficulty in concentrating, which has adverse effects on learning.

Trouble in interpreting sense perceptions, such as inability to identify objects by touch.

Other problems with the senses, especially hearing and vision.

Some of children may show serious symptoms at birth; some may not show any clear signs for a long time. Most children with cerebral palsy are diagnosed by age 5. It is important to diagnose the disorder early so that therapy can minimize handicaps, learning is not hindered, and the child (and parents) can adjust more readily.



Doctors classify cerebral palsy in two ways: by the affected limbs and by the nature of the movement disturbance:

By affected limbs:

Diplegia, where limbs on opposite sides are affected, such as both legs.

Hemiplegia or hemiparesis, where the arm and leg on one side are affected.

Quadriplegia or quadriparesis, where all four limbs are affected


By the nature of the movement disturbance:

Spastic cerebral palsy, where muscles are tense, contracted, and resistant to movement; the most common form of cerebral palsy, especially in low birth weight or premature babies.

Athetoid cerebral palsy, where the affected parts of the body perform involuntary writhing movements, such as turning, twisting, facial grimacing, and drooling, often associated with jerky, abrupt, flailing motions (chorea). This form of cerebral palsy generally involves damage only to the motor centers, not to other parts of the brain, but the unknowing often take such "strange" and "unnatural" movements as signs of mental or emotional disturbance.

Ataxic cerebral palsy, where the main characteristic is lack of balance and coordination and disturbed depth perception, due to damage to the cerebellum. Ataxia involves trouble maintaining balance and swaying when standing.

Rigidity, where muscles are extremely tight and resistant to movement.

Tremor, where muscles uncontrollably shake, interfering with coordination.

Sometimes several areas of the brain are involved, so the description of a particular child's condition may involve several of the above terms and symptoms.

No cure exists for cerebral palsy, but various kinds of therapies are used to help each child do as much as he or she is capable of doing. Among these are:

Physical therapy, the use of therapeutic exercises and activities to extend the child's range of controlled movement, generally focusing on gross motor skills. Some of these use the Bobath technique, in which exercises first focus on countering primitive reflexes and then on extending the range of voluntary movement, sometimes with the help of behavior modification, offering positive reinforcement to help children act against the body's awkward inclinations. Physical therapists also help children learn how to use orthopedic devices, such as wheelchairs and walkers.

Biofeedback, in which children are given information about the functioning of a particular part of the body, often by electrical machines that produce visual or auditory signals, and are taught to concentrate on changing the visual picture or sound. Through such techniques, children with cerebral palsy can gain increased control over movements and are sometimes able to do things like drink from a cup or control their bladder-things previously beyond their range of skills.
Occupational therapy, the use of therapeutic exercises and activities to extend the child's range of controlled movement, generally focusing on fine motor skills, many of them self-help skills. For children that may mean learning how to dress themselves, comb their hair, brush their teeth, drink from a cup, or hold a pen or pencil. For young adults that includes preparation for living as self-sufficiently and independently as possible (see vocational rehabilitation services).

Speech and language therapy, which can help children overcome some speech and hearing impairments, and also learn to use the great variety of mechanical and electronic devices that have been developed to help them, such as voice synthesizers or specially adapted computers (see ear and hearing problems; communication skills and disorders).

Drugs, including muscle relaxants for spastic muscles and anti-seizure drugs, if epilepsy is involved. Drugs are best used sparingly, however, since the long-term side effects on the already-damaged and still-developing nervous system are unknown.

Surgery, which can be helpful in dealing with certain specific problems, such as those involving eyes, ears, and gait; brain surgery may help some, but is still experimental.

Orthopedic devices, such as wheelchairs, walkers, page-turners, specially equipped automobiles, and the like.

Many physical therapists stress that a varied and stimulating environment is in itself a powerful "treatment" for the child. Also important to both child and family are counseling, which can offer emotional support and relief of stress, advice on handling practical problems, and training to prepare for the future, as the child grows into an adult. Many public and private organizations also provide financial assistance, diagnostic and treatment centers, vocational training and guidance, respite care for families of children with cerebral palsy, special recreational facilities, adapted work settings, and adapted living arrangements.