Understanding Cerebral Palsy
Every 14 hours a child is born with CP (cerebral palsy), making it the most common childhood physical disability in Australia. It affects the way the brain controls the body's muscles resulting in speech, movement and posture difficulties.
Having cerebral palsy can be like being inside a body you can't fully control. This condition may be accompanied by other difficulties, such as vision, epilepsy, cognition and learning and other medical complications.
Key facts about cerebral palsy
- One in 400 children born in Australia has cerebral palsy
- About 34,000 Australians (7,000 Queenslanders) have cerebral palsy
- In any year, cerebral palsy is more common than cancer, strokes, eating disorders, appendicitis and road traffic accidents
- Many causes are unknown, although it is believed to be associated with injury or changes to the developing brain. The disorder becomes visible early in life and is a permanent condition
- The severity of cerebral palsy varies from person to person, depending on the area of the body affected and the type of impairment
Classification of cerebral palsy
Although classification is complex, types of CP (cerebral palsy) are based on which part of the body is affected and the type of impairment.
- Diplegia - Both legs and both arms are affected, but the legs are significantly more affected than the arms. Children with diplegia usually have some clumsiness with their hand movements.
- Hemiplegia - The leg and arm on one side of the body are affected.
- Quadriplegia - Both arms and legs are affected. The muscles of the trunk, face and mouth can also be affected.
Types of cerebral palsy
CP (cerebral palsy) can be grouped into three main types: spasticity, dyskinesia (often referred to as athetosis or dystonia) and ataxia. There are also a small number of cases hypotonia.
Spasticity is the most common type of cerebral palsy, making up around 80% of all people with cerebral palsy. Spasticity occurs when muscles are high in tone (tension), but weak in strength. A person experiencing spasticity may have difficulty moving their limbs and adopting stable posture.
Hypotonia is characterised by poor muscle tone without other signs of motor impairment that cannot be explained by cognitive impairment. Hypotonia, particularly truncal hypotonia, is often found in people with cerebral palsy, but isolated hypotonia may only affect around 1-2% of people with cerebral palsy.
Ataxia and hypotonia occur quite often in people with other types of motor impairment. But when considered as the primary motor impairment, they are the least common forms of cerebral palsy. Classification for some people is difficult since any combination of these motor impairments may occur. The predominant type may also change over time for a particular person.
Dyskinesia, often referred to as athetosis or dystonia, is reported in around 10-12% of people with cerebral palsy. It refers to uncontrolled movements, which are usually most visible when a person starts moving. People with this type of cerebral palsy often have very weak muscles, or feel floppy when they are carried.
Dyskinesia is often found alongside spasticity. It can result in a rigid posture (sometimes referred to as dystonia), or in abnormally slow, writhing movements (sometimes referred to as athetosis). These intensify during times of stress and when a person is concentrating, but are absent while a person sleeps. Many people with dyskinesia also have communication difficulties.
What impacts can cerebral palsy have?
Fine motor skills and coordination
Difficulty with hand control, affecting an individual’s ability to handwrite, cut with scissors or cook. When handwriting, a person with cerebral palsy may be unable to keep the paper steady, set out work or complete work within a specific time. Difficulty with hand control also impacts on the ability to perform many self-care and daily living tasks.
Some people may not need support but others may require support such as Ankle Foot Orthoses (AFOs), walking frames or sticks, a mixture of walking aids or a wheelchair. Individuals may tire more easily, be slower and clumsier, especially at the end of the day or week when they are more tired.
A person’s ability to look after themselves. Those with severe difficulties will always depend upon a lot of assistance from others. People with cerebral palsy, just like any other person, vary with their motivation to be independent. Some want to do everything themselves, while others are happy to have things done for them. It is important that children have the opportunity to learn independence with daily living skills and participate in them as much as possible.
Difficulties in the areas of attention, motor planning and perception. These may impact on developing literacy and numeracy skills.
- A short attention span: Individuals may be more easily distracted and/or unable to concentrate for as long as their peers.
- Motor planning difficulties: Individuals know what they want to do, but have difficulty understanding how to do it. Learning tasks can take more effort, concentration and energy. They might have difficulty with transferring skills between environments. They may do some tasks automatically, but when requested to do something or under pressure to perform, may have difficulty completing the task. They often seem to rush into activities without planning the stages required in order to complete them.
- Perceptual difficulties: Perception is the ability to make sense of information gained from the senses. This enables individuals to do things such as move around obstacles, find their way, judge size and shape of objects and understand how lines are connected to form letters. Perceptual difficulties impact on learning in all areas of development and have a major impact on learning literacy and numeracy.
Difficulties understanding spoken and written language, for example difficulties following instructions, understanding concepts and reading. Individuals with cerebral palsy may also have difficulty expressing themselves through language, even though they can speak. For example, people with cerebral palsy may struggle making a choice or request, naming objects or finding the words they need.
Some individuals with cerebral palsy have unclear speech or an inability to speak due to difficulties with the movement of the muscles required for speech. Volume control may also be affected as a result of the impact on the muscles involved in respiration.
CP (cerebral palsy) is a physical disability and is not strongly associated with behaviour problems. However, there are individual differences in how people behave and cope with the day-to-day demands in their lives. Some show frustration, as they become aware they cannot do the same as their peers or communicate their needs to others. These emotions may be affected by their ability to understand their difficulties and cope with the differences between their abilities. Sometimes these challenges can be emotionally overwhelming.
Eating and drinking
Individuals with cerebral palsy can also experience difficulty eating, drinking and swallowing due to problems with controlling and coordinating the muscles of the mouth and pharynx (throat). Saliva control can also be an issue, with loss of saliva often becoming more noticeable when person is concentrating on a motor task.