March is Cerebral Palsy month. Cerebral Palsy (CP) is a common childhood condition, occurring in 1.8–2.3 cases per 1000 children in high income countries, and 2.7 case per 1000 children in low income countries (1). Yet, I am often surprised at how few people know what CP is.
A Google search reveals confusing and sometimes contradictory information. My heart goes out to those parents with children who have just been diagnosed with CP… the information is overwhelming and scary and bewildering… how to make sense of it all?
And the bottle line is; CP is pretty simple… but the brain.. Ah! The incredible miracle and mystery that is the human brain… that is what makes CP so complex!
What is CP?
CP is a collective term for a large variety and spectrum of movement difficulties as a result of damage to the developing brain. What is the developing brain? A child’s brain begins to develop in utero within the first week after the eager little sperm found its target. The brain continues to develop at a rapid pace until the child is about one year. So, CP is a result of any brain damage caused in utero, during birth or within the first year of life. After one year, any brain damage is often referred to as something else.
Good’ol Wikipedia defines CP as a “group of movement disorders…” Which I must say, I don’t wholly agree with. CP is damage to the brain… that is what the child experiences… as an observer, as an outsider, what we see is the result of that damage, which is the atypical development and atypical movement.
How can this brain damage occur?
As I have said before, the brain is really incredible, and what is even more incredible is the speed at which this complex organ develops. Different parts of the brain develop at different times during the course of development and therefore different parts of the brain are more susceptible that others, to changes in its environment at different times.
A child born preterm, may exhibit one type of brain changes, while a full term baby who didn’t get enough air at birth will present with a different pattern of brain injury. These will be different to a child who experienced a stroke at 1 day old, or a child whose mother lost a lot of blood while she was pregnant or a child that suffered a near drowning at 8 months old or a child who is HIV positive.
Sometimes, a child has CP and doctors can’t say how the brain damaged happened… maybe it was a genetic mutation? Maybe the mother has a virus while she was pregnant that no-one knew about?
The problem is, as the medical profession, we don’t always have all the answers… especially when it comes to the brain.
If one child has the same mechanism of brain injury and at the same time in development as another child, will they have the “same” CP.
No. The brain of one person is never the same as the brain of another person. Remember, development depends on genetics as well as environment. Two children with CP may look similar in the way they move but they are never the same.
It also depends on the extent of the injury, the scenario may be the same, but one child may have less damage than another child.
How does this brain injury affect a child?
What we have to remember is that up until the point of injury, the brain was developing normally… therefore, we have an area that doesn’t work so good, in a normal brain. It’s like having a broken toe that’s really sore… the rest of your body works perfectly, but you look weird the way you walk and stand, because of one part that doesn’t work so well.
Different parts of the brain, have different functions therefore, depending on the location of the brain injury, it will have different effects on the brain’s function.
In short, this brain damage results in some children moving too much and some children moving too little. In some children it appears that their legs are affected and others it appears that their arms are more affected, or their neck or their back. Some can talk and others can’t even swallow. Some children will walk and others will never. Some child will have sensory difficulties and other won’t, some will have behaviour difficulties and others not so much… and all of this is on a spectrum… from mild to severe.
The brain has to coordinate the child’s movement in space… the child has to solve problems posed to it by gravity and the function they need to do (whether that function is looking at mom, or swallowing or breathing or walking or sitting or balancing). Therefore what we see as “atypical” and “a movement disorder” is just the child’s strategy of solving a problem with the way their brain works.
BUT REMEMBER… the child may look like they move differently and that their “hamstrings are too tight” or they have a “spastic bicep” or their hips are dislocated… but these are secondary problems as a result of living in a world with gravity. The primary difficulty is in the BRAIN. At the beginning… there is nothing wrong with the child’s muscles or bones.
Does CP get better or get worse?
CP is a static condition. Meaning that once the brain injury has occurred and the child is medically well, the damage in the brain cannot get worse. However what we see in a child with CP changes. Depending on the brain injury, the child develops, they learn to coordinate their body in a certain way, and they can do more things, however as they grow and get heavier and secondary changes take place, or they get therapy and other interventions… it can appear that people with CP that they are getting better or getting worse. The injury is not changing, it is just how they choose to use their brain that changes.
So what is an official definition?
There are plenty of super wordy, academic definitions about CP that change on a regular basis. The one, I like the best is by Jean-Pierre Maes, which says;
“Cerebral Palsy is a persistent condition where atypical postural tone reflects the use of atypical patterns of coordination. These atypical patterns of coordination are determined by the original impairment of the central nervous system (the brain), the ways the person has learnt to develop postural stability and to interact with the environment and subsequent musculoskeletal changes. In CP, atypical coordination of movement develops and changes over time even though the original cause of the disorder in non-progressive.” (2)
CP is complex because the brain is complex, and I definitely could not do it justice in a short(ish) blog post. Please feel free to contact me should you want some more information.
- Kakooza-Mwesige A, Andrews C, Peterson S, Wabwire Mangen F, Eliasson AC, Forssberg H. Prevalence of cerebral palsy in Uganda: a population-based study. Lancet Glob Health. 2017 Dec 1;5(12):e1275–82.
- Maes J-P. Movement Analysis and Education Strategies for the treatment of children with Cerebral Palsy and similar neurological conditions, Specialist Course Hand-outs. 2017.