Children with cerebral palsy (CP) have problems with muscle tone, balance and motor skills. CP is caused by brain damage during development. CP is actually an umbrella term that describes several disorders. Depending on the area of the brain that is damaged and the extent of the injury, different symptoms can result. According to the Merck Medical Manual, CP affects 2 to 4 out of every 1,000 children born in the United States.
Muscle and Tendon Stiffness
CP is strongly associated with muscle and tendon stiffness, either on one side of the body or both. This is true for all three major types of CP: spastic hemiplegia (SH), spastic diplegia (SD) and spastic quadriplegia (SQ). The tightness can interfere with the smoothness of all movements, especially walking.
Trouble Crawling and Walking
Children with the SH and SD forms of CP will crawl and walk later than unaffected children. When children with SH do start to crawl, they often favor one side, tending to avoid using the arm and leg with which they have problems. When they eventually walk, CP children often exhibit a tip-toe gait to compensate for muscle stiffness and short tendons. The use of walkers and leg braces are often useful for addressing these symptoms. Children with SQ, however, will typically never be able to walk.
General Delay in Reaching Developmental Milestones
The earliest indicator that a child has CP is a delay in achieving standard developmental milestones. Most children roll over by 4 months, sit independently by 5 months and crawl by 7 months of age. Parents may wish to consult a pediatrician if their child misses these milestones by more than several months.
Poor Manual Coordination
In addition to problems with gross motor function, children with CP tend to have difficulty controlling their arms and hands. Performing actions that require precise control such as pouring liquid from one container to another is very difficult. Children with SH have trouble with the arm on one side; children with DH have trouble with both.
CP interferes with controlling muscles, including those of the face and tongue. As a result, speech problems are strongly associated with CP. Children with SH and SD both start talking later and have difficulty with pronunciation and being understood. Children with the severe SQ form of CP are typically never able to speak. It should be noted that, in many cases, children with CP have normal intelligence. The inability to speak may be completely due to problems with muscle coordination. Assistive technologies that enable children with CP to communicate via other means have been very useful in overcoming this particular set of problems.
Lack of Muscle Tone
While some muscles of children with CP may be too tight and inflexible, other muscles may be too loose, exhibiting too little tone and activation when needed. For instance, children with the SQ form of CP typically have a loose and poorly controlled neck, resulting in floppy head movements.
Lack of Facial Control
A child with CP will often exhibit uncontrollable spastic contractions of the facial muscles, producing a grimace expression. The control of the lips and tongue can also be problematic, resulting in drooling.
For children with the severe SQ form of CP, seizures are common. The severity and duration are highly variable. Seizures during early infancy are an early indicator that a child may have CP.
Curvature of the Spine (Scoliosis)
As children with the SH form of CP favor one side of the body to walk and balance, a curvature of the spine can develop. This is referred to as scoliosis.
Writhing Movements of the Hands and Feet
A less common form of CP is dyskinetic cerebral palsy (DCP). In addition to other CP symptoms, children with DCP tend to make uncontrollable writhing movements of the hands and feet.
Object Grasping Tremor
Ataxic cerebral palsy (ACP) is a rare form of CP associated with many of its typical symptoms. ACP is different, however, in that some of the symptoms, such as muscle tremors, greatly increase in severity when reaching to grasp a target object.