Understanding Cerebral Palsy: Symptoms and Early Signs

Introduction:

Cerebral palsy (CP) refers to a group of neurological disorders that appear in infancy or early childhood and affect body movement and muscle coordination. CP is caused by damage to or abnormalities inside the developing brain that disrupt the brain’s ability to control movement and maintain posture and balance. The term cerebral refers to the brain; palsy refers to the weakness of motor function.

CP can be accompanied by altered sensation, cognition, communication, and perception.

There is no cure for cerebral palsy, but early detection, early supportive intervention, medications, and surgery can help many individuals improve their motor skills and optimize their functioning.

Early Risk Factors

A child may have a higher chance of having CP because:

• They were born many weeks before their due date 
• They were born small or did not grow as much as expected
• Images of their brain showed areas that we abnormal, or their brain did not receive enough oxygen when they were born
• They received a low score on a neurological exam
• They received a low score on an assessment of their motor skills
• They had abnormal movements on the General Movements Assessment

See page 1 of our handout here to bring to your doctor and learn about risk factors.

Early Signs 

Aside from these early risk factors, other early indications that a child may have Cerebral Palsy is usually a motor delay, in which they are slow in learning to roll over, sit, crawl, or walk. Decreased muscle tone (hypotonia) can make them appear relaxed, even floppy. Increased muscle tone (hypertonia) can make their bodies seem stiff or rigid. Children with CP may also have unusual posture (back and neck arching, crossing legs) or favor one side of the body when they reach, crawl, or move. 

Some examples (non-exhaustive list) of signs of motor delays:

At 2 months, child does not: hold their head up when on their tummy, move both arms and both legs, or open their hands.

At 4 months, child does not: use their arms to swat or bat at toys, bring their hands to their mouth, hold their hands open

At 6 months, child does not: roll from tummy to back, lean on their hands for support when sitting, pick up small objects with either hand

See page 2 of our handout here to bring learn more about milestones and early signs:

Symptoms:

All people with CP have problems with movement and posture. The symptoms of CP differ in type and severity from one person to the next and may even change over time. Symptoms may vary greatly among individuals, depending on which parts of the brain have been injured. 

Children with CP exhibit a wide variety of symptoms, including:

• Lack of muscle coordination when performing voluntary movements (ataxia)
• Stiff or tight muscles and exaggerated reflexes (spasticity)
• Weakness in one or more arm or leg
• Walking on the toes, a crouched gait, or a “scissored” gait
• Variations in muscle tone, either too stiff or too floppy
• Shaking (tremor) or random involuntary movements
• Delays in reaching motor skill milestones
• Difficulty with precise movements such as writing or buttoning a shirt

Classification and Types of Cerebral Palsy:

Cerebral palsy is described based on the number of limbs it affects, the way it impacts movement, and the type of brain injury that caused it. 

Spastic CP: the most common form of CP resulting from damage to the motor cortex.

Dyskinetic (or athetoid) CP: occurs in 6% of people with CP resulting from damage to the basal ganglia.

Ataxic CP: occurs in 6% of people with CP resulting from damage to the cerebellum.

Mixed CP: Mixed cerebral palsy means that someone’s brain is injured in more than one location

Other descriptors:

Quadriplegia: This type affects all four limbs and perhaps torso, facial, and oral muscles

Triplegia: This type affects one arm and both legs and perhaps torso, facial, and oral muscles

Diplegia: This type affects both legs. A person’s arms may be mildly affected

Hemiplegia: Only one side of the body is affected (right or left, legs and arms). 

Monoplegia: Only one limb is affected.

Conclusion:

If a child has a known risk for cerebral palsy, special developmental check-ups are sometimes planned to watch for early concerning signs (see our recommended assessment timeline for providers below). Sometimes, a child’s family or pediatrician might be the first to notice motor delay in a child. If you notice any of these signs, you should talk to your child’s health care provider. If you have any questions or concerns about your child’s development, talk to your pediatrician, and discuss your specific observations. 

For more information on how parents and families can get help now, see our handout here

Suggested assessment timelines for healthcare providers can be found here

References:

1. NIH National Institute of Neurological Disorders and Stroke. Health Information: Cerebral Palsy. Retrieved July 26th 2024 from https://www.ninds.nih.gov/health-information/disorders/cerebral-palsy 
2. American Academy of Pediatrics, Healthy Children (2024). Cerebral palsy. Retrieved July 26th 2024, from https://www.healthychildren.org/English/health-issues/conditions/developmental-disabilities/Pages/Cerebral-Palsy.aspx 
3. CanChild Diagnoses: Cerebral Palsy https://www.canchild.ca/en/diagnoses/cerebral-palsy 
4. Cerebral Palsy Alliance Research Foundations. Types of Cerebral Palsy. Retrieved August 9th 2024 from https://cparf.org/what-is-cerebral-palsy/types-of-cerebral-palsy/?gclid=Cj0KCQjwtsy1BhD7ARIsAHOi4xYZArbSImHeiYRwlOxWKqMMg-2KMtkJ2rb7XQcwz0g32IGNFcwIB4kaAkufEALw_wcB 

Additional Resources:

1. CanChild: CP and the Brain (video): https://canchild.ca/en/resources/264-cp-the-brain-video
2. CanChild: What is Cerebral Palsy? (video): https://canchild.ca/en/resources/265-what-is-cerebral-palsy-video 
3. Steps to Home by EI3 Network. Resources for caregivers and healthcare providers: https://steps2home.org/resources/