My name's Dr Lucinda Carr.
I'm a paediatric neurologist
at Great Ormond Street Hospital
for children in London.
Cerebral palsy is a definition.
It's an umbrella term
that describes a persistent disorder
of movement or posture
by an abnormality of the brain,
of the immature brain,
which is non-progressive.
Cerebral palsy is surprisingly common
in that its incidence
is about one in 400 live births,
but obviously it can range in
from mild to severe.
It can be due to many different causes.
A number of those occur
before the time of birth,
in fact the majority.
Sometimes this is due
to the development itself
in that the brain
does not develop normally.
Sometimes that's due to genetic causes.
Sometimes it's because there has
some infection or trauma
when the child is developing
in the womb.
A smaller proportion are due
to problems around the time of birth,
although this, in fact,
is quite uncommon.
The highest-risk group
are children who are born prematurely
and in fact around 40 per cent
of children with cerebral palsy
have been born prematurely.
Often we know that a child's
at high risk of cerebral palsy,
for example a child that's been been
on a special care baby unit
and early ultrasound scans of the
have shown that there's some damage,
so we know that they're at high risk
and we would screen them carefully.
Sometimes it's picked up that there
are problems during the pregnancy,
so we know the child's at high risk,
but there can be signs
when the baby is born
that things are not quite right.
Sometimes they have fits
in the early period,
which again are a bit of a warning sign.
Sometimes it can just be noted
as the child begins to develop
that there are problems
with their movement,
for example they're not moving
their hands and legs normally,
or when the time comes
when you'd be expecting them to walk,
so the milestones
that a health visitor screens you for,
they're not acquiring their milestones,
so they're maybe not sitting at the
right time or walking at the right time.
Once the diagnosis
of cerebral palsy is made,
the child will then be involved with
local child development team, usually.
In this group they will meet
a number of professionals
who can help with the difficulties
Particularly this is the doctor and
a physiotherapist in the first instance,
but sometimes we need
other people to help,
such as speech therapists or
occupational therapists, psychologists.
Our aim is to identify what
things the child finds difficult
and try and help them with this.
The common aim is to try and help
the child achieve their full potential,
to help the child in their movements,
to keep the muscles strong
and of good length,
because one of the risks
of cerebral palsy is
that because the muscles aren't
normally they become short,
contractures can develop and
orthopaedic surgery is needed.
So we try and delay this
by doing stretching
and strengthening exercises,
using splints and orthotics
In some instances
we inject the stiff muscles
with botulinum toxin to relax them.
Occasionally more specialised
but these are only
in specialist centres.
A number of children
will go on to need orthopaedic surgery
to lengthen the muscles.
As they grow older
and go into adult services,
we look carefully at what's called
the transition into adult services
and try and look at what
their needs might be as young adults,
again maintaining their independence
as much as possible.
Most young people with cerebral
are fully independent
and have full, active lives.
So in describing cerebral palsy
I think that it's important to be aware
that it can range from very mild
to really very severe.
There's a lot we can do
in helping improve
the problems that occur
with cerebral palsy.
In the most severe cases
there is only a limited amount
one can offer sometimes
in terms of improving the mobility,
but there is quite a lot we can do
in terms of comfort, care of the child
and giving them
the best quality of life possible.