Cerebral palsy is a permanent movement and posture disorder that develops due to damage occurring in the brain before, during, or after birth. Differences in muscle tone, delay in motor development, and balance problems are frequently observed in children.

Symptoms of cerebral palsy show themselves in the child’s developmental stages. Findings such as difficulty holding the head up, sitting late, or inability to walk are guiding for diagnosis. In these situations, early specialist consultation is important.

In the diagnostic process, neurological examination, developmental tests, and imaging methods are used. In this way, the degree of the motor disorder and other accompanying problems can be determined.

Physical therapy, occupational therapy, speech therapy, and medication treatments are applied in treatment. A multidisciplinary approach and regular follow-up improve the child’s quality of life by increasing the level of independence.

What Is Cerebral Palsy (Brain Paralysis) in Children?

Cerebral Palsy (Brain Paralysis) in children describes a group of neurological disorders affecting a person’s ability to control muscles, movements, and posture due to abnormal brain development or brain damage in the developing brain during pregnancy, at birth, or within the first 5 years after birth.

Cerebral Palsy should not actually be thought of as a single disease. Rather, it is an umbrella term expressing a condition that occurs as a result of damage or developmental difference in the regions of the brain responsible for movement and posture control. Just as different instruments in an orchestra play in harmony, different regions of our brain also coordinate the movements of our body. In Cerebral Palsy, some of the instruments in this orchestra malfunction. This malfunction may affect how the muscles work, how tense they are, and how coordinated the movements are. This condition can manifest itself in many areas, from the child’s walking to using their hands, from speaking to even swallowing. It should not be forgotten that Cerebral Palsy is not a progressive condition, meaning the initial damage in the brain does not worsen over time. However, as the child grows and develops, the effects of this damage may appear in different ways.

What Causes Cerebral Palsy?

Cerebral Palsy is most commonly associated with premature birth and the baby being deprived of oxygen during birth. The causes of Cerebral Palsy can be quite varied and are generally associated with events occurring in the prenatal, perinatal, or postnatal period. One of the most common causes encountered is premature birth. Since the brains of babies born prematurely have not yet fully developed, they may be more vulnerable to various types of damage. For example, conditions such as brain hemorrhages or lack of oxygen in some parts of the brain may lead to Cerebral Palsy. Some complications occurring during birth may also pose a risk. Situations such as the baby remaining in the birth canal for a long time, umbilical cord entanglement, or the baby not receiving enough oxygen during birth (birth asphyxia) may cause brain damage. Some infections the mother experiences during pregnancy, especially infections such as rubella or toxoplasmosis, may also negatively affect the baby’s brain development. In addition, some medications used by the mother during pregnancy or some toxins she is exposed to may also increase the risk of Cerebral Palsy. In rare cases, genetic factors or a stroke the baby experiences in the womb may also cause Cerebral Palsy. Brain infections such as meningitis and encephalitis or head trauma occurring within the first five years after birth may also lead to damage in the developing brain and cause Cerebral Palsy. However, despite all these risk factors, in some cases the exact cause of Cerebral Palsy may not be determined.

What Are the Symptoms of Cerebral Palsy?

If a baby cries very frequently for no apparent reason, keeps their hands clenched with the thumbs inside the palms and does not open them, or if there is asymmetry in arm and leg movements, it is absolutely necessary to consult a pediatric neurology department. The symptoms of Cerebral Palsy may vary greatly depending on the child’s age, which region of the brain is affected and to what extent, and the severity of the damage. While symptoms may be noticed very early in some babies, in others they may become more evident as motor skills begin to develop. In the newborn period, situations such as the baby having difficulty sucking and swallowing, excessive restlessness and frequent crying spells, the body being excessively floppy (hypotonic) or excessively stiff (hypertonic) may raise suspicion of Cerebral Palsy. In older babies and small children, delays in motor development are an important sign. For example, while peers can sit unsupported or crawl, a baby with Cerebral Palsy may have difficulty showing these skills. Asymmetry in hand and foot movements, that is, moving one side less or differently than the other, may also be a striking symptom. Some babies may keep their hands constantly clenched and may hide their thumbs inside the palms. In children who have started walking, abnormal walking patterns such as balance problems, frequent falls, walking on tiptoes, walking by crossing the legs over each other (scissoring gait), or walking with very wide steps may be seen. In addition, difficulties may also be experienced in fine motor skills; for example, they may have trouble grasping small objects, buttoning clothes, or using a pencil. Speech development may also be affected, and delayed speech or speech that is difficult to understand may be seen. In some children, difficulty swallowing and, accordingly, feeding problems and difficulties may also arise. Cerebral Palsy may affect not only motor skills but sometimes other areas such as vision, hearing, learning, and behavior. Therefore, if you notice any of the symptoms listed above, it is important to contact a pediatric neurologist without delay.

What Are the Types of Cerebral Palsy?

Cerebral Palsy can be divided into different types according to the affected body regions and the type of motor disorder. The most common type is spastic Cerebral Palsy. In this type, there is increased muscle tone (tension), and this makes movements stiff and uncoordinated. Spastic Cerebral Palsy is also divided into subtypes according to the affected body regions: spastic diplegia (generally the legs are affected), spastic hemiplegia (one side of the body is affected), and spastic quadriplegia (the whole body is affected). Another type is dyskinetic Cerebral Palsy. In this type, involuntary and uncontrolled movements are seen. These movements may be slow and twisting (athetoid), fast and sudden (choreoathetoid), or accompanied by fluctuations in muscle tone (dystonic). Ataxic Cerebral Palsy is less common and is characterized by balance and coordination problems. In some cases, features of more than one type may be seen together in one child; this is called mixed-type Cerebral Palsy. Classifying Cerebral Palsy is important in understanding in which areas the child has more difficulty and in creating the appropriate treatment plan.

How Is Cerebral Palsy Diagnosed?

The diagnosis of Cerebral Palsy is generally made by a pediatric neurologist using the child’s medical history, physical and neurological examination, and in some cases imaging methods. Early diagnosis is very important in terms of starting treatment early and maximizing the child’s developmental potential. The doctor first obtains detailed information about the pregnancy and birth process. The timing of the baby’s developmental milestones, the course of development in motor skills, and any noticed symptoms are carefully evaluated. In the physical examination, the child’s muscle tone, reflexes, posture, and movements are examined. In the neurological examination, brain and nervous system functions are evaluated. Magnetic resonance imaging (MRI) is frequently used to support the diagnosis and visualize possible damage or developmental differences in the brain. In some cases, tests such as electroencephalography (EEG) may also be performed, especially if there is suspicion of seizures. In addition, some blood tests may be requested to investigate whether there is a genetic or metabolic cause. Diagnosing Cerebral Palsy is a process that may take time and requires careful evaluation.

What Are the Treatment Options for Cerebral Palsy?

Since it is not possible to reverse the occurred brain damage, treatment is given under the leadership of Pediatric Neurology together with the Physical Therapy and Orthopedics Departments in order to increase functions and prevent contractures. Muscle relaxant medications, physical therapy, various orthoses, botulinum toxin (botox) injections, surgical methods, and muscle-movement-speech training programs are selected and applied according to the child’s condition.

With treatment and rehabilitation approaches, it is possible to increase children’s functional abilities, prevent contractures, correct posture disorders, and improve their quality of life. Treatment requires a multidisciplinary approach, that is, it is important for physicians and therapists from different specialties to work in cooperation. This team generally includes professionals such as a pediatric neurologist, orthopedist, physical therapist, occupational therapist, speech and language therapist, special education specialist, and psychologist. Physical therapy is one of the cornerstones in the treatment of children with Cerebral Palsy. Physiotherapists apply special exercise programs aimed at increasing muscle strength, improving flexibility, providing balance, and improving gross motor skills such as walking. Occupational therapy aims to teach fine motor skills, daily living activities (such as dressing, undressing, eating), and the use of adaptive equipment. Speech and language therapy is applied to improve communication skills, correct speech disorders, and help children with swallowing difficulties. In some cases, muscle relaxant medications or botulinum toxin (botox) injections may be used to reduce excessive tension in the muscles. Surgical interventions may also be required to correct orthopedic problems or eliminate muscle shortening. In addition, various orthoses and assistive devices (such as walkers and wheelchairs) may be used to increase the child’s mobility and independence. It should not be forgotten that since every child’s condition is different, the treatment plan is also prepared individually and is regularly reviewed according to the child’s needs. Intensive and continuous rehabilitation programs started at an early age can help children with Cerebral Palsy maximize their potential.

What Is the Long-Term Life of Children with Cerebral Palsy Like?

Cerebral Palsy, which involves physical disability, is a lifelong condition. However, the long-term lives of children with Cerebral Palsy may vary greatly depending on the severity of their condition, other accompanying health problems, and the treatment and support they receive. Children affected at a mild level can generally live independently, go to school, work, and actively participate in social life. Children affected at a more severe level may need more help in daily living activities and may need to participate in special education and support programs. However, many children with Cerebral Palsy can make significant progress with appropriate treatment and support and can live meaningful and fulfilling lives. What is important is early diagnosis, a continuous and comprehensive treatment and rehabilitation program, the support of families and the environment, and believing in the child’s potential. Let us not forget that every individual is valuable, and children with Cerebral Palsy can also achieve many things in line with their own abilities and interests. As a society, it is also an important responsibility for us to support these children and their families, to facilitate their participation in social life, and to offer them opportunities.

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