More About Cerebral Palsy
Cerebral palsy (CP) is the most common cause of motor disability in early childhood. It is described as a lifelong neurological disorder of movement and posture secondary to non-progressive malformations in the developing foetal or infant brain. The brain injury may occur in utero, at birth, during the postnatal period or in early childhood. CP is often accompanied by one or a combination of difficulties that may include intellectual deficits, disturbances of sensation, perception, and coordination, epilepsy, and secondary musculoskeletal problems. Adults with CP can also be at risk of non-communicable diseases due to lack of physical activity and muscle weakness. CP is a very heterogeneous disorder presenting with different clinical types and brain imaging patterns. Consequently, motor impairments can vary widely between affected children and adults; however, the poor quality of life and discrimination faced by those affected by CP are often similar.
What Does It Mean to Have Cerebral Palsy?
Cerebral palsy is caused by a problem with the brain that happens before, during or soon after birth.
The brain can either be damaged or not develop normally. Although the exact cause is not always clear it can leave a challenging legacy. It means that a baby, a child, a teenager, an adult with CP could have a range of disabilities which can prevent them from being able to stand, to walk, to talk, to play, to control their arms and hands, to eat with a spoon, to use a toilet by themselves.
Many of those with CP will develop pulmonary illnesses, epilepsy and musculoskeletal conditions as they grow older. Some will need 24-hour, 7-days-a-week care for their whole lives. Sometimes this is delivered by care professionals. In all too many cases, it is not, with much of the responsibility falling instead on families. It is beyond doubt that many of those affected have to endure discrimination and severe challenges to their quality of life.
It is thought that c.100,000 people in the UK currently have CP, a condition that, with varying degrees, will be with them their whole lives. In addition, those directly affected includes their families and friends, parents who in many cases give up work to care for them and fight to get the care and services they need but which are all too often hard to get. Roughly two-thirds of the UK’s CP population are adults, for whom there is inadequate statutory provision of care and support.
Learn more about what it’s like to be an adult with CP here.
Types of Cerebral Palsy
Cerebral palsy is a heterogeneous disease presenting with different types:
Spastic CP accounts for 70% of cases and affects muscle control and coordination. It is the result of injury to the motor cortex and the pyramidal regions of the brain that link the motor cortex to the spinal cord, resulting in muscle stiffness and tightness. It includes three subtypes depending on the body area affected; hemiplegia, which affects one side of the body, with the upper body usually more influenced; diplegia which affects the lower extremities of the body (the legs); and quadriplegia which affects all four limbs.
Dyskinetic CP is the second type of CP prevailing in 10-20% of cases. It is responsible for slow and uncontrollable movements of hands, feet, arms or legs that can result in severe changes in muscle tone and posture and can be accompanied by learning disabilities and frequent epilepsy.
Exhibiting one or more type of CP is classified under Mixed CP (10%). Rosenbaum et al. in their groundbreaking report that altered the definition of CP advised that classification of CP should be reliable and very specific to the symptoms. Indeed, CP has varying degrees and can range from a minor limp to severe incapability of movement and communication.
Cerebral Palsy Prevalence and Trends
The reported incidence of cerebral palsy can range from 1.5 to more than 4 per 1,000 live births based on studies from around the world. The estimated prevalence from registries has been static over the past three decades with reported incidences ranging between 2-3 per 1,000 live births for the developed world and 2 per 1,000 live births for the UK. It is estimated that there are circa 100,000 with the condition. As for low and middle-income countries (LMIC), the data on CP prevalence appear to be very scarce and systematic reviews seem to include data for high-income countries (HIC) mostly, although the prevalence of CP in LMIC is suspected to be higher than HIC. However, without a National CP Register, our understanding of its prevalence remains an estimate. If we cannot understand properly the scale of the problem, we cannot adequately combat it.
Extremely pre-term birth infants (born before 28 weeks of gestation) are greatly affected by CP, with an estimated prevalence of 40-100 per 1,000 live births. The increase in the survival of very premature infants has resulted in a modestly increased prevalence of cerebral palsy in developed countries from 1975-1999 that has now subsided.
Despite improvements in antenatal, delivery and postnatal care, CP incidence in term infants has not notably changed over the last 30 years. In fact, term infants (>37 weeks of gestation) account for 50 to 65% of CP cases although preterm birth remains a strong risk factor of CP.
Data from European databases in addition to USA, Australia and China shows that more than 50% of CP cases are among normal birthweight babies (>2500g). Research on CP has primarily focused on very pre-term infants due to the strong association between pre-term birth and the risk of CP. However, infants born at or after 35 weeks of gestation contribute to two thirds of CP cases and are considered the most under-researched group with the majority of the literature fixating on birth asphyxia as the major cause of CP among this group.