Cerebral palsy 

About one in 400 children born alive has cerebral palsy. An expert explains the causes, symptoms and treatment

Learn more about cerebral palsy

Transcript of Cerebral palsy

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

that's caused 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 severity 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 been 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 brain 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 the local child development team, usually.

In this group they will meet a number of professionals

who can help with the difficulties they're encountering.

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 particular 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 working normally they become short,

contractures can develop and sometimes orthopaedic surgery is needed.

So we try and delay this

by doing stretching and strengthening exercises,

using splints and orthotics where necessary.

In some instances we inject the stiff muscles

with botulinum toxin to relax them.

Occasionally more specialised treatments are indicated,

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 palsy 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.

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