My name's Dr Lucinda Carr

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.