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Gillette Children’s Specialty Healthcare is one of the world’s top cerebral palsy centers. Our Center for Cerebral Palsy offers comprehensive testing, treatments and services for children, teens and adults. As one of the nation’s Best Children’s Hospitals in pediatric orthopedics, neurology and neurosurgery, we help our patients achieve their highest possible levels of independence, comfort and happiness in a family-centered environment.
Why Choose Gillette?
- Gillette is one of the nation's Best Children's Hospitals in pediatric neurology, neurosurgery and orthopedics.
- Our facilities and technology are designed specifically for people who have cerebral palsy and other complex conditions.
- We offer one of the world’s best and busiest gait and motion analysis centers.
- Our experts conduct clinical research to promote the highest standards of care.
- We believe that children who have cerebral palsy deserve a lifetime of excellent health care—from birth through adulthood.
Cerebral Palsy Definition
Cerebral palsy is a term used to describe a collection of disorders caused by abnormal brain development or damage to the brain that occurs around the time of birth or early in life.
Cerebral palsy causes problems with muscle tone, movement, balance and/or coordination. Symptoms and effects range from mild to severe. In some infants, problems are evident soon after birth. In others, diagnosis comes in later infancy or toddlerhood.
Cerebral Palsy Types
There are many ways to classify cerebral palsy. When describing the type of movement impairment, providers often talk about spastic, dyskinetic and mixed cerebral palsy.
Spastic Cerebral Palsy
Spastic cerebral palsy is characterized by increased muscle tone. Muscles are unusually tight and stiff, which affects movement and growth. Spastic cerebral palsy is often associated with damage to or developmental differences in the part of the brain called the cerebral cortex. Spastic cerebral palsy encompasses approximately 80 percent of all cases of cerebral palsy.
There are three main types of spastic cerebral palsy—each affecting different areas of the body:
- Diplegia affects the legs more than the arms. This type of cerebral palsy is most common in premature babies.
- Hemiplegia affects one side of the body. This type of cerebral palsy is most common in babies who’ve experienced strokes or traumatic brain injuries.
- Quadriplegia affects the entire body—the legs and the arms. This type of cerebral palsy is most common in babies who experience a lack of oxygen.
Dyskinetic Cerebral Palsy
Dyskinetic cerebral palsy is characterized by uncontrolled fluctuations in muscle tone and by involuntary, sustained or sporadic movements. This type of cerebral palsy is often associated with damage to the parts of the brain called the basal ganglia and the cerebellum.
People who have dyskinetic cerebral palsy experience involuntary movements, such as tremors, or have difficulty balancing and making coordinated movements. They might also experience other types of complex movement disorders.
Mixed cerebral palsy describes people who experience features of both spastic and dyskinetic cerebral palsy. This type of cerebral palsy is associated with damage to multiple areas of the brain.
Cerebral Palsy Causes
Any disruption in brain development or damage to the brain that occurs around the time of birth or early in life can lead to cerebral palsy.
Developing fetuses and infants up to age 1 can develop cerebral palsy if they experience brain damage or disruptions in brain development caused by:
- Bleeding in the brain before, during or after birth
- Infections of the brain, including meningitis or encephalitis
- Shock—a state in which organs and tissues don’t receive adequate blood flow
- Traumatic brain injuries
- Seizures at birth or in the first month following birth
- Certain genetic conditions
In some cases, health care providers are unable to determine the precise cause of a child’s cerebral palsy.
Older children can develop symptoms similar to those of cerebral palsy if they sustain traumatic brain injuries, experience a lack of oxygen, or contract an infection such as meningitis. Children whose injuries occur when they are older receive a diagnosis of brain injury rather than cerebral palsy.
Cerebral Palsy Risk Factors
Cerebral palsy occurs in approximately 1.2 to 2.5 of every 1,000 infants born alive. Many factors—such as premature birth and serious illnesses—increase an infant’s risk of developing cerebral palsy. In some cases, infants who are born at normal weights and experience no known brain injuries still develop cerebral palsy.
Premature Birth and Low Birth Weight
A normal pregnancy lasts 40 weeks. Babies born before 37 weeks have a greater risk of developing cerebral palsy. The risk increases the earlier a baby is born. Twins and other multiple birth siblings are at particular risk because they tend to be born earlier and at lower birth weights.
The outlook for infants born prematurely or at low birth weights has improved considerably in recent years. Today, many premature infants survive—and new treatments have lowered the incidence of cerebral palsy among them to between 30 and 40 percent.
Serious Illness, Stroke or Infection in Baby
Infants who experience serious illnesses, strokes or seizures around the time of birth are at greater risk of developing cerebral palsy. Such illnesses might include:
- Severe jaundice (kernicterus)
- Seizures during the 48 hours after birth
- Infections of the brain, such as meningitis or encephalitis
- Strokes caused by broken or clogged blood vessels or abnormal blood cells
Serious Illness, Stroke or Infection in Mother
Cerebral palsy is more common in children whose mothers:
- Experience certain viral and bacterial infections and/or high fevers during pregnancy
- Have coagulation (clotting) disorders or experience blood clots during pregnancy
- Receive excessive exposure to harmful substances during pregnancy
- Have thyroid problems, seizure disorders or other serious health concerns
Pregnancy and Birth Complications
Complications of pregnancy and birth—including inadequate nourishment through the placenta or a lack of oxygen during labor and birth—are associated with an increased risk of cerebral palsy. Cerebral palsy also is more common when babies and mothers have incompatible blood types (the mother is Rh positive and the baby is Rh negative, or vice versa).
Genetic and Developmental Problems
Some cases of cerebral palsy are genetic. Genetic conditions can affect development of the brain or other vital organs, such as the heart. Infants with genetic and developmental problems are more likely to develop cerebral palsy.
Related Risk Factors
Infants who are later diagnosed with cerebral palsy often:
- Show abnormal results during a neurological exam in the hours or days after birth
- Have an Apgar score of less than three at five minutes after birth
- Require a mechanical ventilator to breathe
- Have abnormal magnetic resonance imaging (MRI) scans
Cerebral Palsy Symptoms and Effects
The symptoms and effects of cerebral palsy vary, depending on the location and extent of the damage to the brain. Some children have normal intelligence; others have learning disabilities. Some children have mild difficulties with movement; others are unable to control their limbs. Despite the great variation in symptoms, certain effects are common among people who have cerebral palsy.
Cerebral palsy affects the areas of the brain that control muscle tone, movement, balance and coordination. As a result, all people who have cerebral palsy experience some degree of difficulty making smooth, deliberate movements. Typical symptoms include:
- Abnormal muscle tone (muscles with too much or too little tone)
- Muscles that pull unevenly on the joints
- Abnormal reflexes (the persistence of primitive reflexes that people normally outgrow during infancy)
- Balance and movement problems
Primary effects of cerebral palsy may improve with some treatments.
As a child grows and develops, the primary effects of cerebral palsy can lead to secondary effects, including:
- Inadequate muscle growth, which causes contractures (shortening) of muscles and tendons
- Bone deformities
- Misalignment of the joints
- Excessive fatigue with movement and walking
Treatments can often slow or correct secondary effects of cerebral palsy.
The primary and secondary effects of cerebral palsy can lead people to adopt “coping responses”—ways of moving that compensate for challenges. For example, abnormal muscle tone in the legs can result in stiff knees that make walking difficult. People might compensate for this challenge by swinging their legs in a circle rather than a straight line when walking.
Tertiary effects typically improve following treatment of primary and secondary effects, assuming patients undergo rehabilitation therapy as part of their treatment plans.
Possible Associated Effects
Depending on the extent and location of the damage to the brain, some people who have cerebral palsy experience additional health and cognitive (thinking and learning) challenges. Some examples include:
- Breathing difficulties
- Depression, anxiety and mental health disorders
- Feeding and swallowing disorders (dysphagia)
- Hearing loss and vision problems
- Learning disabilities or cognitive impairment
- Seizures and epilepsy
- Sensory issues
- Sleep disorders
- Speech and language difficulties
The brain-related issues that cause cerebral palsy don’t get worse. The effects of cerebral palsy, however, often do progress as people age—especially without adequate treatment. For example, muscles that can support a 40-pound child might be too weak to support a 130-pound adult. In addition, abnormal muscle tone causes abnormal stress on the joints, which can wear out or become painful.
For these reasons, people who have cerebral palsy sometimes lose abilities—such as walking—when they grow older. In fact, people who have cerebral palsy might begin noticing the effects of aging in early adulthood. That’s why cerebral palsy requires a lifetime of expert medical care. Learn about Gillette’s services for teens and adults.
Cerebral Palsy Diagnosis and Tests
Unlike with many other conditions, no single test can diagnose cerebral palsy. Instead, a diagnosis involves understanding a child’s medical history and identifying symptoms consistent with the condition. Diagnosing cerebral palsy as soon as possible ensures early intervention and a lifetime of excellent medical care.
Diagnosis Shortly After Birth
In some cases, doctors diagnose cerebral palsy shortly after birth. Babies born prematurely or who have other significant risk factors are most likely to receive an early diagnosis. In such cases, a newborn often will have an MRI that shows damage to the brain. A neurological exam with abnormal results also helps support an early diagnosis.
In cases of early diagnosis, Gillette specialists might provide evaluations or consultations while a baby is still in a neonatal intensive care unit (NICU). Once a baby comes home from the hospital, regular visits with Gillette’s cerebral palsy specialists play an important role in maximizing a child’s health and abilities.
Diagnosis During Toddlerhood
Most often, children receive a cerebral palsy diagnosis between ages 1 and 3. Such children usually have a birth and medical history that increases their risk of cerebral palsy. Symptoms at birth, however, might not be clear enough to warrant an early diagnosis. Instead, parents and care providers watch for developmental concerns.
Parents and care providers might suspect cerebral palsy if a child misses milestones (such as sitting up or crawling) or shows other symptoms consistent with the condition. Sometimes pediatricians and family practitioners diagnose patients with cerebral palsy. In other cases, they send their patients to a specialty center like Gillette for evaluation.
Diagnosis During Childhood
Although the situation is rare, some children receive a cerebral palsy diagnosis after their toddler years. In such cases, providers might have missed very mild symptoms, or a child might have failed to outgrow what was thought to be another condition (such as idiopathic toe walking).
In addition, children older than 1 can develop symptoms similar to those of cerebral palsy if they sustain traumatic brain injuries, experience a lack of oxygen, or contract an infection such as meningitis. Children whose injuries occur when they are older than 1 typically receive a diagnosis of brain injury rather than cerebral palsy.
Tests and Evaluations to Help Diagnose Cerebral Palsy
Although no single test can diagnose cerebral palsy, doctors use various tests and evaluations to help make a diagnosis. Common tests and evaluations include:
Cerebral Palsy Ability Classification
When describing cerebral palsy, health care providers use two main systems to classify how the condition affects a person’s abilities.
The Gross Motor Function Classification System (GMFCS) includes categories that describe a person’s ability to walk, run and perform other large motor skills. The higher the GMFCS level, the more difficulty a person has performing such skills.
The Manual Ability Classification System (MACS) includes categories that describe a person’s ability to manipulate objects with the hands. The higher the MACS level, the more difficulty a person has performing such skills.
Neither the GMFCS or the MACS describe a person’s thinking and learning abilities.
Gross Motor Function Classification System (GMFCS)
The GMFCS uses five classification levels. The criteria for being classified within a particular level depend on a person’s age. In general, a person’s classification level is determined by the primary method of mobility used after age 6.
The information below describes characteristics of people, ages 12 – 18, classified within each GMFCS level. For more information about the GMFCS (including descriptions and illustrations for ages 6 – 12), visit CanChild Centre for Childhood Disability Research.
GMFCS Level I
Youth walk at home, school, outdoors and in the community. Youth are able to climb curbs and stairs without physical assistance or a railing. They perform gross motor skills such as running and jumping but speed, balance and coordination are limited.
GMFCS Level II
Youth walk in most settings but environmental factors and personal choice influence mobility choices. At school or work they may require a hand held mobility device for safety and climb stairs holding onto a railing. Outdoors and in the community youth may use wheeled mobility when traveling long distances.
GMFCS Level III
Youth are capable of walking using a hand-held mobility device. Youth may climb stairs holding onto a railing with supervision or assistance. At school they may self-propel a manual wheelchair or use powered mobility. Outdoors and in the community youth are transported in a wheelchair or use powered mobility.
GMFCS Level IV
Youth use wheeled mobility in most settings. Physical assistance of 1 – 2 people is required for transfers. Indoors, youth may walk short distances with physical assistance, use wheeled mobility or a body support walker when positioned. They may operate a powered chair, otherwise are transported in a manual wheelchair.
GMFCS Level V
Youth are transported in a manual wheelchair in all settings. Youth are limited in their ability to maintain antigravity head and trunk postures and control leg and arm movements. Self-mobility is severely limited, even with the use of assistive technology.
Manual Ability Classification System (MACS)
The MACS includes five levels that describe the ability of a child (ages 4 – 18) to use their hands and handle objects. For more information about the MACS, visit the MACS online resource site.
- Handles objects easily and successfully.
- Experiences limitation in performing manual tasks requiring speed and accuracy. (These limitations don’t interfere with independence in daily activities.)
- Handles most objects, but with a reduced quality and/or speed in achieving tasks and activities.
- Struggles with some activities; might need alternative ways of doing tasks. (These limitations usually don’t interfere with independence in daily activities.)
- Handles objects with difficulty.
- Needs help to prepare or adapt activities.
- Does tasks slowly.
- Experiences limited success regarding quality and quantity of tasks and activities.
- Performs activities independently only if they have ben set up or adapted.
- Handles a limited selection of easily managed objects in adapted situations.
- Performs only parts of activities with effort and limited success.
- Requires continuous assistance and/or adapted equipment to attempt an activity.
- Cannot handle objects.
- Experiences severely limited ability to perform even simple actions.
- Requires total assistance.
Cerebral Palsy Treatments
The brain-related issues that that cause cerebral palsy are irreversible. But treatments can improve symptoms and effects—leading to greater independence, endurance and comfort.
At Gillette, we follow patients from birth through adulthood to provide appropriate care and treatments throughout their lives. Each patient’s care path is unique. Below are some of the most common evaluations and treatments associated with cerebral palsy care across the lifespan.
Treatment-Related Evaluations and Tests
Because cerebral palsy is a complex condition that can affect many parts of the body, patients should undergo multidisciplinary evaluations. At Gillette, a patient who has cerebral palsy often sees specialists in neurology, neurosurgery, orthopedics, rehabilitation medicine, sleep medicine, rehabilitation therapies and assistive technology.
Working in teams, our specialists offer a wide range of collaborative evaluations and expert testing to support care and treatment. Evaluations and tests might include:
- Evaluation for spasticity or complex movement disorders
- Gait and motion analysis
- Neurodiagnostic testing, including sleep studies (polysomnography) and electroencephalograms (EEGs)
- Neuropsychological evaluations to understand the cognitive effect of the neurological condition in areas such as attention, memory, learning, and problem solving
- Nutrition and feeding evaluations, which might include swallowing studies
- Radiology and imaging tests
For patients who have spasticity, we provide multidisciplinary spasticity evaluations to determine the best course of treatment. Treatment can involve medications and procedures that reduce muscle spasticity. Treatments might include:
- Oral medications
- Botulinum toxin and phenol (injected spasticity medicines)
- Baclofen pump
- Selective dorsal rhizotomy (SDR) surgery
Over time, cerebral palsy can cause problems with muscles, bones and joints. For example, some patients develop hip problems, leg or arm deformities, or scoliosis. Surgical procedures to correct such problems might include:
- Single event multilevel surgery (SEMLS) and individual orthopedic surgery procedures (typically performed on the legs)
- Arm or hand surgery
- Spine fusion
Rehabilitation medicine specialists and rehabilitation therapists help patients maximize their abilities and learn new patterns of movement following various treatments. Rehabilitative care might include:
- Aquatic (pool) therapy
- Comprehensive inpatient rehabilitation (following procedures such as orthopedic SEMLS or SDR surgery)
- Constraint-induced movement therapy
- Equipment evaluations (see assistive technology treatments below)
- Functional electrical stimulation (FES)
- Neuromuscular electrical stimulation (NES) for feeding and swallowing disorders
- Nutrition and feeding therapy
- Occupational therapy
- Physical therapy
- Robotic-assisted locomotor training for the arms and legs
- Speech and language therapy
Assistive Technology Treatments
Assistive technology options range from orthoses (braces) that support the legs to custom seating systems for children who use wheelchairs. Gillette provides team evaluations and follow-up care for patients who need a wide range of equipment. Assistive technology options might include:
Our Cerebral Palsy Services
Living well with cerebral palsy requires a lifetime of expert medical care. As one of the world’s top cerebral palsy centers, Gillette provides a full range of services for children, teens and adults who have cerebral palsy. We guide patients and their families through the services they need from birth through adulthood.
The Gillette specialties and services most often associated with cerebral palsy care include:
- Assistive technology
- Gait and motion analysis
- Neurodevelopmental pediatrics
- Nutrition and feeding
- Rehabilitation medicine
- Rehabilitation therapies
In addition, Gillette provides services specifically for older teens and adults through Gillette Lifetime Specialty Healthcare. We also support families in making the transition to adulthood and adult-focused healthcare by providing transition services for teens, young adults and their families.
For more information about the services we provide at Gillette, search Conditions and Care.