Appointments & Referrals

(302) 651-5913

Select option 2

Our expert nurse navigator can help you schedule appointments with all the specialists your child needs.


Insurance We Accept »

Melissa's Story

Thanks to high-quality Cerebral Palsy Center care, having CP meant using a walker with only occasional balance problems and stiffness in her legs.

Read Her Story »

mother and daughter at the Cerebral Palsy Center

Health Information

Browse articles related to pediatric cerebral palsy.

Go to Patient Education »

Conditions We Treat

Cerebral Palsy Center at Nemours/Alfred I. duPont Hospital for Children

1600 Rockland Road, Wilmington, DE, USA 19803 | Get Map & Directions »


What Is Cerebral Palsy?

Cerebral palsy (CP) is actually a collective term for a number of neuromuscular disorders that affect a child’s ability to move and maintain balance and posture. “Cerebral” means having to do with the brain, and “palsy” means weakness or problems with using the muscles. CP is the most common motor disability in childhood. The Centers for Disease Control and Prevention (CDC) estimates that about 1 in every 323 children living in the United States has cerebral palsy. At the Cerebral Palsy Center we also treat children with CP-like conditions that have another specific diagnosis like Rett Syndrome.

Causes

CP is caused by abnormal brain development or damage to the developing brain, particularly in areas which control muscles and movement. CP is neither genetic nor an infectious disease. Approximately 90 percent of kids with CP are born with it, although it may not be detected until months or years later. The earliest signs usually appear before a child reaches 3 years of age. Less than 10 percent of children have cerebral palsy as the result of brain damage in the first few months or years of life, from a brain infection such as bacterial meningitis or viral encephalitis, or from a head injury such as a car accident, fall or child abuse.

Cerebral palsy-like conditions may have many different specifically identified causes including genetic problems. It's important to make the specific diagnosis whenever possible to determine treatment, to understand prognosis and for genetic counseling.

 
Common Symptoms

A child’s symptoms depend upon the exact areas of the brain that are affected. Children with milder symptoms might walk a little awkwardly, but might not need any special help. Those with more severe cases, however, might need special equipment to walk, or might not be able to walk at all. Children with CP also frequently have spasticity (muscle spasms or uncontrolled movements), seizures, urinary incontinence (inability to control the muscles holding the bladder closed), behavioral disorders, developmental delay, intellectual disability, and speech/language problems. Children with more severe CP may need lifelong care and assistance.

In order for bones to attain their normal shape and size, they require the stresses from normal musculature (the force on the bones from normally developed muscles). So, a child with cerebral palsy may have a variety of bone and joint deformities. Some kids with CP may be shorter in height than the average person because their bones are not allowed to grow to their full potential. Sometimes, bones also grow to different lengths, so a child may have one leg longer than the other.

CP disorders don’t worsen over time, but kids’ symptoms may change as they grow.

 
How We Diagnose Kids at the Cerebral Palsy Center

To help diagnose children with cerebral palsy (CP), we’ll first seek to carefully understand any past medical history and how kids have developed since birth. Some diagnostic imaging scans or blood tests may be used to rule out other diagnoses, but it’s important to note that there’s currently no scan or blood test that can be used to confirm a CP diagnosis. In fact, many children have normal scans and blood tests and still have cerebral palsy. In these kids, the current understanding is that the cerebral palsy condition is caused by microscopic changes in the brain that we can’t see with current images or blood tests.

A child may fall into one of these common scenarios:
  • born very premature and spent time in a neonatal intensive care unit (NICU). If a child also had a brain bleed, there’s an increased risk of having CP. There may also be problems with leg movement and control, or delayed motor development. In this case, we make a CP diagnosis by observing and monitoring children over time.
  • had a normal birth and delivery, but doesn’t reach the normal developmental milestones such as sitting up, standing or walking. In this situation, kids may need further testing such as a magnetic resonance imaging (MRI) scan or blood testing to rule metabolic problems (with how food is absorbed and used to make energy) or congenital malformations (defects that occur while in the womb).
  • had a normal birth, but walked late and seems to have problems with one particular side of the body. Children might otherwise appear normal, and to be developing normally. In this case, we might consider a diagnosis of hemiplegic CP (hemiplegia means one side of the body is affected). We may order an MRI scan to make sure there’s no treatable brain lesion, although this is extremely rare.
 
How We Treat Kids With CP at the Cerebral Palsy Center

Although there's no cure for CP, a variety of treatments and therapies can help improve your child’s quality of life. At the Cerebral Palsy Center, we focus on treatments with documented outcomes, favoring the least invasive treatment possible. Our specific areas of focus include treatment of spinal deformities, and dislocation of the hips and other bones. Our Cerebral Palsy Center experts offer surgical treatment of these areas if necessary, as well as pain management techniques for those children who need it. We may also recommend a body brace (a brace around the torso to help patients remain upright), which can provide some comfort while sitting.

For those children who need it, we recommend therapy to encourage the functional use of their hands. We may use splinting, but only if needed, to prevent deformity.

If your child has spasticity (muscle spasms or uncontrolled movements), we most often use a team approach to the management of the condition, bringing in specialists from neurology, rehabilitation medicine, physical therapy and any other necessary disciplines. There are a number of treatments available, depending on the location and severity of your child’s spasticity.

physician and patient at the Cerebral Palsy Center

Forms of Cerebral Palsy

CP is classified according to the kind of movement disorder involved, which can be further described by the parts of the body affected.

Spastic Cerebral Palsy

This is the most common type of CP, affecting more than 70 percent of children with CP. Kids with spastic CP have increased muscle tone (this is called “hypertonia”), so their muscles are overly stiff. This is due to a lesion (an injured or abnormal spot) in certain areas of the brain and spinal cord, specifically the upper motor neurons and the corticospinal tract or the motor cortex.

This damage impairs the ability of some nerves in the spine to transmit signals from one neuron (nerve cell) to another — they don’t properly receive a neurotransmitter (the chemical needed to transmit signals) called “gamma-aminobutyric acid” (or “GABA”), leading to hypertonia in the muscles controlled by those damaged nerves.

 
Characteristics of Spastic Cerebral Palsy

Due to the constant state of muscle stiffness, the movements of children with spastic CP can be awkward.

Spastic CP cases are usually described by which parts of the body are affected:
  • Spastic diplegia ― This term refers to muscle stiffness over symmetrical parts of the body, most often in both legs (diplegia means the paralysis of two parts). A child’s arms are usually less affected or completely unaffected. Kids with spastic diplegia might have difficulty walking, as their hip and leg muscles are so tight their legs pull together, turn inward and cross at the knees (this is also known as “scissoring”). If the stiffness is less severe or is better described as weakness, it’s called “diparesis” (two-part weakness).

    There are three levels of severity of spastic diplegia. “Mild diplegia” means a child can usually walk but might walk a little differently, and can usually play and run to a limited extent. “Moderate diplegia” means the child can walk, but with a slight bend in the knees. These children usually can’t run and have to use handrails to go up and down steps. “Severe diplegia” means a child usually need crutches, a walker or a wheelchair to get around.

  • Spastic hemiplegia ― This type of CP affects only one side of a child’s body, and usually the arm is more affected than the leg (hemiplegia means the paralysis of one side of the body). Kids with hemiplegia have limited use of the limbs on one side and normal use of their limbs on the other side. If the stiffness is less severe it may be called “hemiparesis” (one-sided weakness).

  • Spastic quadriplegia ― Spastic quadriplegia (the paralysis of four parts) is the most severe form of spastic CP and affects all four of child’s limbs, trunk and face. Kids with spastic quadriplegia usually can’t walk and may have other developmental disabilities, such as intellectual disability, seizures and vision, hearing or speech problems. If the condition is described more as weakness instead of paralysis, it may be called “quadriparesis” (four-part weakness).
 
How We Treat Spastic Cerebral Palsy

Compared to other types of CP, children with spastic CP usually find it a bit easier to manage. The spasticity can, however, lead to contractures or short muscles and cause joint dislocation leading to arthritis — often as early as a person’s mid-20s. Occupational therapy and physical therapy methods that include assisted stretching and strengthening, as well as targeted physical activity and exercise are usually the main methods to manage spastic CP. Aquatic therapy also can help in many cases.

If the spasticity is severe, we may recommend medications such as antispasmodics (medicines to prevent spasms), Botox (a protein that helps to relax the muscles) and baclofen (a medicine that relaxes the muscles). These may be administered orally or through a pump implanted under the skin. Oral doses go through the digestive system, and not all of the medicine makes it to the spinal fluid where it’s needed. The pumps are designed to deliver the medication directly to the spinal fluid, so much lower doses can be used.

Early Treatment Is Key

Early treatment is important to prevent hip dislocation and arthritis. As your child grows, we’ll carefully monitor his or her hips, especially under the age of 10, when hips typically dislocate. Most often, we’ll perform X-rays of your child’s hips once a year to help stay ahead of any dislocation.

Some children develop knee or feet problems that can make walking difficult. In this case, we may recommend correction so your child can continue to walk. We may also recommend surgical lengthening of your child’s muscles, most often in middle childhood (6-9 years old). As your child gets older, particularly past the age of 10, we’ll pay special attention to your child’s spine, as many children develop scoliosis and need proper wheelchair seating, spinal orthotics or even surgery. This is more commonly required in children who have no ability to walk. We’ll continue to carefully monitor everything until your child is done growing.

Depending upon your child’s needs, other treatments may include:
  • speech therapy
  • braces and orthotic devices
  • rolling walkers
  • augmentative communication (communication methods used to help or replace speech or writing) aids such as computers with attached voice synthesizers

Learn More About Our Treatment »

Athetoid Cerebral Palsy

Children with athetoid dystonic (also called “dyskinetic” meaning a disorder of movement) cerebral palsy may have mixed muscle tone. The term “dystonia” that’s often used in the name refers to sustained muscle contractions that cause twisting and repetitive movements or abnormal postures. That means they have both increased muscle tone or stiffness (hypertonia) and floppy, low muscle tone (hypotonia) — not only from day to day, but even during a single day.

This type of CP is due to damage in a specific part of the spinal cord (the extrapyramidal motor system and/or pyramidal tract and basal ganglia). One cause in newborn infants is high bilirubin (the brownish yellow substance from digestive acid that may cause a baby to appear jaundiced) levels in the blood, if left untreated.

 
Characteristics of Athetoid Cerebral Palsy

Children with this type of CP may have problems controlling the movements of their hands, arms, feet and legs. In some children the arms are more affected than the legs, so they may be able to walk but have difficulty using their arms, although athetoid CP usually affects the whole body. This makes it difficult for children to walk, sit or even to hold themselves in an upright, steady position. Movements can be slow and writhing, or rapid and jerky. Sometimes the condition also affects the face and tongue, making it difficult for a child to swallow, suck, eat and talk.

It may take a lot of concentration and hard work for kids with this type of CP to get their hands to a certain spot, such as reaching for a glass or touching their nose. They may not be able to hold onto objects, especially small ones that require fine motor control, such as toothbrushes, pencils, etc.

 
How We Treat Athetoid Cerebral Palsy

At the Cerebral Palsy Center, we may recommend treatment that includes physical, occupational, speech and aquatic therapy. Medications may be used to control seizures, alleviate pain and relax muscle spasms.

Depending upon your child’s needs, other treatments may include:
  • surgery to release tight muscles (although the need for surgery for short muscles is less than with spasticity)
  • braces and orthotic devices
  • rolling walkers
  • augmentative communication (communication methods used to help or replace speech or writing) aids such as computers with attached voice synthesizers
  • the intrathecal baclofen (a medicine that relaxes the muscles) pump can provide excellent control of muscle movements

Learn More About Our Treatment »

Ataxic Cerebral Palsy

Ataxic CP is a somewhat uncommon type of cerebral palsy, occurring in only 5 to 10 percent of all cases. Ataxic CP can be caused by damage to the cerebellum (the region of the brain that controls movement and, to a lesser extent, attention and language).

 
Characteristics of Ataxic Palsy

Kids with ataxic CP have problems with balance and coordination. Children with ataxic CP might have problems reaching for things. Some may have hypotonia (floppy, low muscle tone) and tremors (twitching). Often, vision and auditory problems are present.

Ataxic CP cases usually involve the whole body. However, in rare cases ataxic CP may affect one area of the body more than the other.

 
How We Treat Ataxic Palsy

At the Cerebral Palsy Center, treatment of children with ataxic CP may include physical, occupational, speech and aquatic therapy. Our cerebral palsy experts may use medications to control seizures, alleviate pain and relax muscle spasms.

Depending upon your child’s needs, other treatments may include:
  • braces and orthotic devices
  • rolling walkers
  • augmentative communication (communication methods used to help or replace speech or writing) aids such as computers with attached voice synthesizers
  • the intrathecal baclofen (a medicine that relaxes the muscles) pump can provide excellent control of muscle movements

Learn More About Our Treatment »

Mixed Forms

Mixed cerebral palsy is when symptoms of two or three types of CP are present simultaneously, each to varying degrees. The most common type of mixed CP is spastic-athetoid CP, but there are other combinations.

 
Characteristics of Mixed Cerebral Palsy

Kids with mixed forms of CP may exhibit some or all of the symptoms associated with each type of CP. Mixed CP is the most difficult to treat because its symptoms and development are diverse and sometimes unpredictable.

 
How We Treat Mixed Cerebral Palsy

At the Cerebral Palsy Center, we may recommend treatment that includes physical, occupational, speech and aquatic therapy. Medications may be used to control seizures, alleviate pain and relax muscle spasms.

Depending upon your child’s needs, other treatments may include:
  • surgery to release tight muscles
  • braces and orthotic devices
  • rolling walkers
  • augmentative communication (communication methods used to help or replace speech or writing) aids such as computers with attached voice synthesizers