Cerebral Palsy 101 in Long Island

Cerebral palsy (CP) is a group of conditions which involve permanent and nonprogressive motor dysfunction. Motor dysfunction is the inability of the brain to process movements in a normal manner, which can lead to difficulties with movement and balance.  Motor dysfunction can affect muscle tone, posture, and/or general movement. Although the disease itself is not progressive, as the central nervous system (CNS) matures, the clinical manifestations may change over time. As we age, and our movements become more complex, it might appear that CP is becoming worse – for example, if the child is confined to a wheelchair, the child will likely not be able to drive as an adult. General motor dysfunction can result in limitations in functional abilities, such as getting dressed, putting shoes on, making a meal, or driving a car, and can range in severity. Some with CP might be able to perform basic activities of daily living, like getting dressed, going to the bathroom, and brushing their teeth. Others might be wheelchair bound and highly dependent on assistance for all activities. Because motor dysfunction affects the way our brain processes signals from the body, CP patients might experience other motor abnormalities, including altered sensation or perception, communication and behavioral difficulties, intellectual disability, and musculoskeletal complications. Those with CP might also experience growth failure, lung and bone problems, urinary disorders, generalized pain, and sleep disturbances.

Risk Factors for Cerebral Palsy

Approximately two per one thousand live births result in CP1. This is a drastic reduction from even the 1990s, where we saw 155 per 1000 live births diagnosed with CP2. This improvement is likely related to the advancements in overall perinatal care that pregnant women receive. We most commonly see CP in preterm (prior to 37 weeks) and very low birth weight (< 3.3lbs) infants. In addition to gestational age and birth weight, there are numerous other prenatal and perinatal factors that must be accounted for. Some of these risk factors are modifiable on the mother’s part. If the mother is a heavy alcohol drinker, smoker, experiences obesity, or untreated vaginal infections during pregnancy, the fetus’ risk of CP can be increased. Though there are some things the pregnant woman can do to prevent CP, there are also factors that we have no control over. These factors include preeclampsia (high blood pressure in pregnancy), placental abruption (where the placenta detaches from the uterine wall), congenital abnormalities, neonatal infection, respiratory distress syndrome, and more.

How and When is Cerebral Palsy Diagnosed?

CP is generally diagnosed between 12 and 24 months as a baby starts missing important milestones in development. This disease can be difficult to diagnose, as there is not one single test that can be done. Thus, many examinations, brain imaging, and a thorough history of the pregnancy and events of delivery are crucial. Babies who exhibit early signs of CP may experience excessive irritability, trouble sleeping, poor feedings, frequent vomiting, and poor visual attention. Additionally, the tone in the baby’s arms and legs might be increased or decreased, and the baby might exhibit poor head and body control from an early age. If you think your baby might have CP, frequent and routine visits to the pediatrician are of utmost importance. The pediatrician will be able to assess milestones (i.e., sitting, walking, hand function, and disappearance of infant reflexes) and determine if further evaluation is needed. There are three different types of CP which are usually diagnosed between 18 and 24 months of age. We will discuss those subtypes at length in the following article.