Cerebral palsy is a neurological disorder that affects muscles and a person’s ability to control and coordinate them. The symptoms of cerebral palsy can vary, but it can impact upon:
- Gross motor skills such as crawling, sitting, walking and running
- Fine motor skills such as gripping, writing and dressing
- Posture and balance
- Ability to sleep, speak and eat.
The condition will affect different people in lots of different ways depending on the type of cerebral palsy and its severity. Symptoms can be uncomfortable and often painful.
People with cerebral palsy may also experience a wide range of associated physical and learning difficulties. These include:
- Hip and spine problems (hip dislocation, curvature of the spine)
- Fits or seizures (epilepsy)
- Vision and/or hearing impairment
- Bladder and bowel problems
- Communication difficulties (speaking, comprehending)
- Drooling and swallowing difficulties
- Specific learning difficulties
- Severe learning disabilities
- Behaviour difficulties.
We examine the physical symptoms and associated difficulties experienced by people with cerebral palsy in more detail below.
Diagnosing cerebral palsy
Cerebral palsy is caused by damage to the brain or abnormal development of a baby’s brain during its development, delivery or post natal period.
Despite the condition being present at birth, cerebral palsy can be difficult to diagnose early. In fact, doctors may wait until a child is 24 to 36 months old to make an official diagnosis. This is because early symptoms of cerebral palsy can be confused with other conditions that grow worse over time or are temporary.
When a baby is born, doctors will check a baby’s voluntary movements and muscle tone. They will carry out clinical observations, such as a general movements assessment in a child under four months old. This provides one of the most accurate ways of identifying motor function problems early on. But this assessment cannot predict the severity of the condition.
Health visitors and doctors will also look for signs that a baby is meeting all of its developmental milestones, such as grasping, turning its head, rolling over and sitting up etc., but it is often the parents who first notice significant delays. If doctors are concerned, this will prompt further investigations. See the list of developmental milestones below.
If cerebral palsy is suspected, further diagnostic tests such as neuroimaging with CT (computerised tomography) or MRI (magnetic resonance imaging) will help to confirm it and identify the damage to the brain. The area of damage will indicate what type of cerebral palsy a child has, but it may be difficult to assess the full impact of the condition until the child is 24 to 36 months old.
In babies, signs of possible cerebral palsy visible from birth include:
- Tight or floppy muscle tone
- Unusual postures
- A preference for using one side of its body
- Feeding or swallowing difficulties
- Developmental delays
In toddlers, investigations will start if your child is not walking by 12-18 months and not speaking simple sentences by 24 months.
What muscle-related disabilities are caused by cerebral palsy?
The muscle-related disabilities caused by cerebral palsy will vary according to the type of cerebral palsy a person has, the number of limbs/muscles affected, and the condition’s severity.
General disabilities can include:
- Impaired movement and ability to control the affected area of the body, such as arms, legs, hands, feet, trunk, face, fingers, tongue
- Impaired gross motor skills such as walking, running, jumping and transferring positions
- Impaired fine motor skills such as eating, writing, grasping
- Painful muscle spasms and contractions.
In people with spastic cerebral palsy, and depending on the limbs affected, disabilities can include:
- Extremely stiff muscles (hypertonia) making movement jerky, shaky or impossible
- Difficulty standing, sitting, moving to another position, walking and running
- Bent elbows, wrists and fingers
- Flexion at the hip and knee (bending or a bent condition)
- Scissoring of the thighs (also referred to as adduction)
- Equinovarus foot, where tight calf muscles raise the heel and cause the foot to point down and inwards
- Impaired speech, eating and drinking
- Loose or floppy muscles caused by decreased muscle tone (hypotonia)
- Tremors caused by contracting muscles.
The effects of spasticity on the muscles can cause associated problems such as:
- Muscle pain
- Atrophy of muscles (deterioration/wasting)
- Contracture of the joints
- Bone deformities.
In people with ataxic cerebral palsy, where balance and depth perception is affection, muscle-related disabilities include:
- Uncoordinated, shaky movements
- Lack of balance and clumsiness
- Tremors in the arms and hands particularly when performing precise movements
- Inaccurate movements / overshooting targets
- Instability when walking (falling over)
- Speech and swallowing difficulties
- Slow eye movements.
In people with dyskinetic cerebral palsy, which includes athetoid, choreoathetoid and dystonic cerebral palsy, muscle-related disabilities include:
- Involuntary movement outside of a person’s control, triggered by an attempt to move
- Drooling and grimacing if the tongue and facial muscles are affected
- Impaired speech, eating and drinking.
Symptoms and pain are often made worse by physical and emotional stress.
In athetoid cerebral palsy, muscle-related disabilities include:
- Difficulty maintaining a position such as sitting or standing due to fluctuations in muscle tone (a person experiences both hypertonia and hypotonia)
- Slow, continuous writhing movements
- Random or repetitive movements outside of a person’s control
- Difficulty holding objects
In dystonic cerebral palsy, muscle-related disabilities include:
- Slow, twisting repetitive movements
- Limbs forced into awkward/uncomfortable and sustained positions.
In choreoathetoid cerebral palsy, muscle related disabilities include:
- Unpredictable and irregular involuntary movement combined with the muscle-related disabilities associated with athetoid cerebral palsy
- Movements that range from clumsy to violent, depending on the condition’s severity.
See also Types of cerebral palsy .
What developmental delays indicate cerebral palsy?
A baby’s normal development is charted by its ability to do certain things within a certain age bracket, such as sit up, grab toys, smile, roll over and walk. These abilities are referred to as developmental milestones.
If your baby is slow to meet these development milestones it may be that nothing is wrong. But it could mean that they have cerebral palsy (or another condition). If your doctor or health visitor is concerned, it could trigger a series of investigations to establish the cause of the delay.
Examples of milestones that indicate normal development and gross motor skills include:
At the end of two months (eight weeks) old:
- Beginning to hold head up
- Attempts to push up when lying on tummy
- Smoother arm and leg movements.
At the end of four months (16 weeks) old:
- Attempts or can roll over from tummy to back
- Holds a toy or attempts to grab hanging toys
- Pushes up when lying on tummy
- Can bring hand to mouth.
At the end of six months old:
- Begins to sit without support
- Can roll over
- Can support weight on legs when standing
- Rocks back and forth in an attempt to crawl.
In toddlers, investigations will start if your child is not walking by 12-18 months and not speaking simple sentences by 24 months.
If you are concerned that your baby is not meeting its developmental milestones, contact your health visitor or doctor. You can find out more about developmental milestones at the NHS website (Birth-to-Five Development Timeline).
Is epilepsy common in people with cerebral palsy?
Around a third of children with cerebral palsy will also suffer from epilepsy, a condition associated with damage to the brain that causes seizures or fits. Fits can be severe, causing someone to lose consciousness, shake or enter into a trance-like state where no loss of consciousness is felt.
Cells (neurons) in the brain conduct electrical signals and communicate with each other using chemical messengers. Seizures are caused by abnormal bursts of neurons (cells) firing off electrical impulses.
Epilepsy cannot be cured but controlled with effective anti-epileptic drugs. Surgery may be recommended in severe cases.
People with epilepsy may need to adapt their lifestyle to manage their condition. They should seek advice before getting pregnant and about driving and contraception.
How does cerebral palsy affect IQ and cognitive ability?
As well as affecting people’s manual ability, balance and posture, cerebral palsy can affect a person’s cognitive ability, which is their ability to understand and process information and the world around them.
That’s not to say that everyone with cerebral palsy will experience learning difficulties. Some people who are severely physically impaired will have average and above average intelligence and understanding.
Impaired cognitive ability in people with cerebral palsy is usually a result of their brain injury, and the extent of impairment will depend on where in the brain the injury occurred and the level of damage.
Damage to the brain could result in specific learning difficulties, such as difficulty spelling. In these cases overall intelligence is not impaired. When damage to the brain affects overall intellectual functioning and language development, it is referred to as a learning disability or a severe learning disability.
One way of measuring a person’s cognitive ability is an IQ test. IQ stands for intelligence quotient, and an IQ assessment is a standardised way of measuring a person’s ability to think and reason compared with other people the same age. A score of 100 is ‘average intelligence’ and usually someone with impaired cognitive ability will score 70 or below.
Many more people with cerebral palsy will experience a range of learning difficulties simply as a result of their reduced physical abilities and the discomfort directly associated with their condition. Symptoms of cerebral palsy can affect sleep, concentration, coordination and wellbeing, and therefore a person’s ability to learn.
Aids and support can help people living with cerebral palsy to overcome their difficulties.
What learning disabilities are associated with cerebral palsy?
Learning difficulties in people with cerebral palsy can be mild, moderate or severe and may only be related to a specific area of learning.
If a child with cerebral palsy has difficulty with a specific skill, such as spelling or arithmetic, but their overall intelligence is not affected, this is called a specific learning difficulty.
Where damage to the brain is extensive and language development and overall intellectual function is affected, this is referred to as a severe learning disability.
It is important to remember that many people with severe physical disabilities will have normal and above normal intelligence.
Learning difficulties/disabilities can include:
- Short attention spans
- Difficulty organising and sequencing information
- Language difficulties
- Difficulty understanding concepts
- Difficulty remembering information
- Impaired decision-making.
Signs that a baby or child has a cognitive impairment can include:
- Delayed language development
- Difficulty in interacting/socialising with others
- Difficulties remembering information
- Angry outbursts
- Hearing and/or visual impairments.
Children with cerebral palsy who have learning disabilities may require special educational provision to be made for them so that they can reach their full potential in skills such as reading, writing, numeracy and comprehension. An assessment, provided by your local authority and your NHS care team, will identify any special educational needs.
What behavioural problems are associated with cerebral palsy?
Challenging behaviour or behavioural problems can be evident in all children and young people with cerebral palsy, regardless of the severity of the condition and their intelligence. It is more common in people with associated learning difficulties, such as impaired reasoning and communication difficulties.
Behavioural problems can include:
- Self injury, including head banging, grinding teeth, scratching and eating inedible items
- Aggression towards others, including hitting, biting, screaming and verbal abuse
- General anti-social behaviour, including damage to belongings or property, stealing, inappropriate sexual behaviour and tantrums.
Less worrying behaviour exhibited by people with cerebral palsy may include rocking, repetitive speech and repetitive movements.
Ensuring a rich, stimulating environment and a means of effective communication is the first step to improving challenging behaviour. Professionals can also assess your child’s behaviour – and the factors influencing it – and advise on appropriate approaches and therapies to help.
What communication difficulties are associated with cerebral palsy?
We communicate with others using gesture and speech and good communication is vital to healthy development. It’s the way that we get to know one another, express thoughts and emotions and develop independence.
Unfortunately, 6 out of 10 children with cerebral palsy will have difficulty with speech, language and communication. Children with athetoid cerebral palsy are more likely to experience these difficulties.
Communication difficulties in people with cerebral palsy can be caused by:
- Reduced ability to control muscles in the face, respiratory system, tongue, vocal chords and eyes
- Reduced ability to control body language/posture
- Hearing impairments
- Visual impairments
- Associated learning difficulties
All of these problems can affect a person’s ability to communicate effectively.
Specific communication difficulties may include:
- Reduced ability to produce sounds or clear speech because a person cannot control or coordinate the muscles surrounding the mouth, tongue and/or vocal chords
- Coordinating breath to support speech
- Controlling body movements to enable clear speech
- An inability to produce sounds
- An inability to speak
- Reduced ability to express thoughts and emotions through speech, hands, eye contact and body language
- Reduced ability to write, type and indicate.
There are a variety of methods, technological aids, learning strategies and therapies available to help children, young people and adults with cerebral palsy to communicate effectively, even if their condition and communication difficulties are severe.
Good communication between you and your child is important, so seek advice as early as possible from a speech and language therapist, occupational therapist or physiotherapist.
You can find out more about these therapies in Treatments for cerebral palsy.