Cerebral Palsy

Specialists at UT Southwestern Medical Center have experience and expertise in diagnosing and treating cerebral palsy, a group of movement disorders caused by problems in the part of the brain that governs muscle movement and coordination.

We offer the latest medical, surgical, and rehabilitative therapies to relieve symptoms and help people with cerebral palsy reach their full potential, from childhood through adulthood.

What Is Cerebral Palsy?

Cerebral palsy is a group of neurological disorders caused by injury or abnormal development of the brain, most often occurring before birth. It appears in infancy or early childhood and permanently affects a person’s ability to move and to maintain balance and posture.

Cerebral palsy is the leading cause of childhood disabilities, but those disabilities can range from very mild to severe. All people with cerebral palsy have problems with movement and posture. Some can walk, and others need assistance or may not walk at all. Some might need lifelong care to manage their symptoms, while others may not need any assistance.

There is no cure for cerebral palsy, but the disorder does not progress or get worse, though its symptoms can change over a person’s lifetime. Treatment of cerebral palsy can significantly improve a person’s ability to function and participate in daily life.

What Are the Types of Cerebral Palsy?

Cerebral palsy can be classified based on the person’s main movement disorder:

• Stiff muscles (spasticity)
• Uncontrollable movements (dyskinesia)
• Poor balance and coordination (ataxia)

Spastic cerebral palsy affects about 80 percent of people with cerebral palsy. People with spastic cerebral palsy have stiff muscles, which makes their movements limited or difficult. Spastic cerebral palsy can affect different parts of the body:

• Spastic diplegia affects mainly the legs, with the arms less affected or not affected at all.
• Spastic hemiplegia affects only one side of a person’s body, and usually, the arm is more affected than the leg.
• Spastic quadriplegia affects all four limbs, the trunk, and the face.

Dyskinetic cerebral palsy causes muscle tone to fluctuate from too stiff to too loose and leads to problems controlling the movement of hands, arms, feet, and legs. People with dyskinetic cerebral palsy may find it difficult to sit and walk. If the face and tongue are affected, the person may have a hard time sucking, swallowing, and talking.

Ataxic cerebral palsy causes problems with balance and coordination. People with ataxic cerebral palsy can be unsteady when they walk and may have a hard time with quick movements or movements that need a lot of control, such as writing or reaching for something.

Mixed cerebral palsy means that a person has symptoms of more than one type of cerebral palsy. The most common type of mixed cerebral palsy is spastic-dyskinetic cerebral palsy.

What Causes Cerebral Palsy?

Cerebral palsy is caused by abnormal brain development or damage to the developing brain. These problems most often arise before birth, but they can occur during birth or in the first years of life. The cause of the damage varies from person to person, and in many cases, the cause of cerebral palsy is not known.

Many factors can lead to problems with brain development, including:

• Gene mutations that affect brain development
• Maternal infections that affect the developing fetus
• Fetal stroke, which disrupts blood supply to the developing brain
• Premature birth earlier than 37 weeks of pregnancy, especially with low birth weight
• Infant infections that cause inflammation in or around the brain
• Traumatic head injury to an infant, such as from a motor vehicle accident, a fall, or physical abuse

Lack of oxygen to the brain related to difficult labor or delivery can cause cerebral palsy, but it is much less common than historically thought. Some 85 percent to 90 percent of cases of cerebral palsy are caused by problems that occur before birth.

What Are the Symptoms of Cerebral Palsy?

The signs and symptoms of cerebral palsy are different from person to person, depending on the part of the brain that is damaged.

Symptoms of cerebral palsy appear during infancy or preschool years, and can include:

• Delays in reaching motor-skill milestones
• Difficulty with precise movements such as writing or buttoning a shirt
• Excessive drooling or difficulty swallowing
• Lack of muscle coordination
• Shaking (tremor) or involuntary movements
• Stiff or tight muscles and exaggerated reflexes
• Variations in muscle tone, going from too stiff to too floppy
• Weakness in one or more arm or leg
• Walking on the toes, a crouched gait, or a scissored gait

The damage to the brain that causes cerebral palsy can also generate other developmental or neurological problems, such as:

• Abnormal touch or pain sensations
• Bladder and bowel problems
• Changes in the spine, such as scoliosis
• Intellectual disability
• Joint problems, such as contractures
• Mental health conditions, such as emotional disorders and behavioral problems
• Problems with hearing
• Problems with speech
• Problems with vision and abnormal eye movements
• Seizures

While cerebral palsy does not get worse over time, symptoms such as muscle shortening and muscle rigidity can worsen if they are not treated. Prompt diagnosis and continuous care of cerebral palsy can help reduce the severity of its symptoms.

How Is Cerebral Palsy Diagnosed?

Signs and symptoms of cerebral palsy often become more apparent over time, so a diagnosis of cerebral palsy might not be made until a few months after birth. In cases where the symptoms are mild, diagnosis may take longer.

If a doctor believes a child might have cerebral palsy, they may order a series of tests, including:

• Developmental screening to identify specific developmental delays, such as motor or movement delays
• Brain imaging to reveal areas of damage or abnormal development in the brain, such as magnetic resonance imaging, cranial ultrasound, or electroencephalogram (EEG)
• Laboratory tests of the blood, urine, or skin to screen for genetic or metabolic problems
• Additional tests to identify any problems with vision, hearing, speech, intellect, development, or movement

Doctors often use a rating scale tool, such as the Gross Motor Function Classification System, to determine a child’s function and the severity of any mobility, posture, and balance problems. This information helps specialists select the best treatments for each patient.

How Is Cerebral Palsy Treated?

There is no cure for cerebral palsy, but early intervention can significantly improve the lives of those who have the condition. Treatment for cerebral palsy depends on the specific symptoms and needs of each person, and those needs may change over time.

At UT Southwestern, we bring together a team of specialists trained in treating children and adults with cerebral palsy. Our team includes:

• Physicians, such as pediatric neurologists, physiatrists, orthopedic surgeons, neurosurgeons, and GI specialists
• Child developmental specialists
• Mental health specialists
• Occupational, physical, recreational, and vocational therapists
• Speech-language pathologists
• Adaptive equipment specialists
• Orthotics specialists

These experts work together with patients and their families to develop a personalized treatment plan to improve motor skills and overall function. Each treatment plan is based on the individual’s symptoms and needs.

Medications are often used to lessen muscle tightness, improve functional abilities, treat pain, and manage drooling, complications related to spasticity, or other symptoms. These medications can include:

• Muscle injections with botulinum toxin or nerve injections with phenol to treat the tightening of a specific muscle
• Oral muscle relaxers
• An intrathecal baclofen pump to manage severe spasticity or dystonia
• Medications or botulinum toxin injections to reduce drooling

Rehabilitative therapies often play an important role in treating cerebral palsy, including:

• Physical therapy such as muscle training and exercises to improve strength, flexibility, balance, motor development, and mobility. Physical therapists also guide parents on how to safely care for their child's everyday needs at home and continue muscle training and exercise at home between therapy visits.
• Occupational therapy to develop independence in daily activities and routines at home and school and in the community. Occupational therapists may recommend adaptive equipment such as braces, splints, walkers, wide-based canes, standing and seating systems, or electric wheelchairs.
• Speech and language therapy to improve speech or to learn communication through sign language or devices such as a computer and voice synthesizer. Speech therapists can also address difficulties with eating and swallowing.
• Recreational therapy to improve sensory and motor skills. Both adults and children benefit from regular physical activity.

Surgical procedures may be needed to lessen pain, improve mobility, or make it easier to use a walker, braces, or crutches. These treatments include:

• Orthopaedic surgery to address joint or bone deformities, to lengthen muscles, or to lengthen or reposition tendons
• Neurosurgery to cut nerve fibers to specific spastic muscles (selective dorsal rhizotomy) and intrathecal baclofen (ITB) pump placement, or deep brain stimulation (DBS) surgery

Other treatments may be recommended for other issues such as seizures, osteoporosis, and problems with mental health, sleep, oral health, nutrition, incontinence, vision, or hearing.

What Clinical Trials Are Available for Cerebral Palsy?

As an academic medical center, UT Southwestern is dedicated to improving understanding and treatment of diseases such as cerebral palsy.

Current and planned research includes upper limb paralysis, including pediatric stroke and cerebral palsy, and a pilot study on diplegia cerebral palsy and robot-assisted training.

Find clinical trials.