Living with Cerebral Palsy: The Importance of Early Interventions

Cerebral palsy (CP) is the most commonly diagnosed motor disability of those diagnosed in childhood. CP occurs due to brain trauma either during pregnancy or soon after birth. No one can predict the developmental challenges a person with cerebral palsy will experience as they grow and develop.

Early diagnosis and interventions are essential to maximizing a child's developmental potential. Some adults with CP move and live independently; others are wheelchair dependent and require round-the-clock care.

What causes cerebral palsy?

The overwhelming majority of cerebral palsy cases result from brain damage that occurs before, during, or after birth, known as the perinatal period. CP is called a non-progressive disorder because the brain damage is permanent but does not worsen over time.

Several known risk factors increase a baby's chance of CP development:

Maternal risk factors

Some CP risk factors are related to the mother:

• Multiple gestation. Pregnancies with more than one baby (such as twin gestation) carry a higher risk of CP.
• Infertility treatments. Babies conceived after in vitro fertilization or artificial insemination are more likely to have CP.
• Infections during pregnancy. Certain infections, such as rubella and cytomegalovirus, increase the risk of CP.
• Blood protein mismatch. A protein called the Rh factor can cause several problems when the baby and mother's proteins don't match.
• Exposure to toxins. Exposure to toxic chemicals, drugs, alcohol, and some medications during pregnancy increases risk.

Labor and delivery risk factors

Some risk factors are related to the labor and delivery:

• Preterm birth;
• Low birth weight;
• Prolonged labor;
• Use of tools (forceps, vacuum, c-section) during delivery;
• Decreased oxygen levels during or after delivery;
• Kernicterus (a severe, untreated form of jaundice).

About 8% of CP cases occur after the perinatal period, usually within the first year or so of life. The most common causes for late development include infections that affect the brain, such as meningitis, or head injuries that cause brain damage.

Does cerebral palsy affect walking?

Most people with CP can move their legs, and almost two-thirds can walk. However, about 33% of children with CP cannot walk, even with assistive devices.

Cerebral palsy affects your muscle tone and your ability to move and maintain balance and posture. Muscles can either be too tight (hypertonicity) or too relaxed (hypotonicity), leading to difficulty maintaining appropriate posture and balance for walking.

Many factors influence the effects of CP on a person's ability to move and walk:

• Location and extent of brain damage. Different brain areas are responsible for different functions. The location of the damage can help predict the developmental areas your child may struggle with.
• Age at diagnosis. Earlier diagnosis is associated with better overall outcomes and development.
• Multidisciplinary interventions. CP treatment includes medical, therapeutic, and educational teams to maximize development potential.
• Neuroplasticity. Neuroplasticity refers to the ability of our brains to change and develop connections in response to stimuli. Young brains more readily adapt to changes and can 'take over' some roles the damaged area was supposed to develop. Earlier interventions result in better adaptations by the growing brain.
• Assistive devices. Many children and adults with CP can walk with the help of assistive devices such as braces, canes, or walkers.

Can someone with cerebral palsy talk?

About 1 in 4 people with CP cannot speak, and up to 75% have some form of speech disorder.

Dysarthria, a motor speech disorder, is common because speech requires a great deal of muscle coordination in your head, neck, and face. Developmental delays may also affect a person's ability to hear, understand others, and express themselves. Speech-language therapists are specially trained to help with both cognitive language development and the physical components of speech.

Living independently with cerebral palsy

Some people with mild forms of cerebral palsy work and live independently as adults, but this depends on many factors. For example, one study found people with mild CP were more likely to live independent lives when they continued to have access to support services and systems.

Therapy and treatment goals are unique for each individual with CP.

Federal laws prohibit discrimination and require schools and workplaces to provide reasonable accommodations, so people with disabilities can work and learn to the best of their abilities.

Does cerebral palsy worsen with age?

The brain damage that causes CP does not change over time, and you may hear CP referred to as a non-progressive neurologic disorder. However, symptoms will change over time because babies with CP continue to develop to the best of their ability. During the first several years of life, our brains develop, make connections, and adapt to insults more easily than at any other point in life.

Early interventions maximize neuroplasticity, the brain's ability to adapt or “train” other areas of the brain to take over what the damaged part was intended to do. In the long term, children with early interventions tend to achieve more than those with fewer or later interventions.

Is cerebral palsy a disability?

Yes, cerebral palsy is considered a disability. CP is the most commonly diagnosed motor disability of those diagnosed in childhood. Schools must identify, evaluate, and provide accommodations for students with learning disabilities and physical challenges, including Individualized Education Plans (IEPs). In addition, workplaces are required to provide reasonable accommodations and may not discriminate against workers with disabilities.

Additionally, it is expensive to care for children with CP and maximize their developmental capabilities. Children with CP often qualify for Supplemental Security Income benefits and Medicaid health insurance. Adults with significant disabilities may be eligible for disability-related financial benefits through the Social Security Administration.

Cerebral palsy affects every aspect of a child's health and development. Most people with CP learn to walk and communicate effectively with high-quality therapeutic interventions. Some adults with mild forms of CP live independently, while others require varying types of support and care throughout their life.