Cerebral Palsy

Abstract

Cerebral palsy (CP) includes a large group of childhood movement and posture disorders. Severity, patterns of motor involvement, and associated impairments vary widely. The disorder varies in timing of the brain lesion, clinical presentation, and site and severity of the impairments. Cerebral palsy can be defined by the anatomic site of the brain lesion, clinical symptoms and signs, topographic involvement of extremities, timing of presumed insult; and classification of muscle tone. The prevalence of CP is 2.0 to 3.5 per 1000 live births and is inversely associated with gestational age and birth weight. Multiple pregnancy is a risk factor but is confounded by the effects of birth weight and gestational age. Compared with singletons, the relative risks of CP in twins and triplets are 5.6 and 12.6, respectively. Risk factors significantly associated with CP are placental abnormalities, major and minor birth defects, low birth weight, meconium aspiration, emergency cesarean section, birth asphyxia, neonatal seizures, respiratory distress syndrome, hypoglycemia, and neonatal infections. Most cases of CP result from an interference in brain development in utero. Insults during the first, second, and third trimesters are associated with cerebral maldevelopment, periventricular white matter damage, and cortical and deep gray matter damage, respectively. Asphyxia accounts for 10% to 20% of CP cases, but diagnosis requires evidence of encephalopathy. Other causes involve maternal infections, noncerebral congenital anomalies, and assisted reproductive therapies (increased risk of multiple fetuses and preterm deliveries). Life expectancies of those with CP depend on the severities of mental, manual, ambulatory, and visual impairments. If the impairments are not severe, survival is only slightly less than that of individuals without CP; if impairments are severe, life expectancy is reduced in proportion to the number and severity of impairments. The quality of care is another relevant factor. Body structure and function, activity limitation, and participation are recognized as constructs for assessment along with environmental and personal factors. Each construct can influence the others, and their interactions are influenced by the context in which an individual lives. Although CP is a lifelong disorder, most research regards it as a pediatric illness; yet, adults with CP have disadvantages in social life and employment. Fatigue, pain, and depressive symptoms are common in adults, and physical aging can occur more rapidly than in adults without CP. Pediatric services often fail to prepare young people for adult health care. As children enter adolescence, independence should be encouraged rather than being restricted by parents and clinicians. Compared with the general population, health-related quality of life of individuals with CP is lower, but for those who are able to self-report, subjective well-being is similar. By adulthood, the main criteria for quality of life are communication skills and the ability to manage and control the environment. A better understanding of brain plasticity may lead to new treatments or better applications of current therapies. Management will focus on participation and quality of life, with new technologies directed to the individual and the environment. Individual and societal attitudes should understand that those with CP have a right to inclusion, to full participation in society, and to pursue their own desires.