Cerebral Palsy is a term that describes several neurological disorders that appear in infancy or early childhood. Cerebral Palsy is caused by a brain injury or brain abnormality that interferes with the brain cells responsible for controlling muscle tone, strength, and coordination. This disorder permanently affects body movement and muscle coordination, and as the child grows, these changes affect skeletal and joint development, which may lead to impairment and possibly deformities. Cerebral palsy can cause impairment of muscle tone, gross and fine motor functions, balance, control, coordination, reflexes, and posture. Oral motor dysfunction, such as swallowing and feeding difficulties, speech impairment, and poor facial muscle tone. Associative conditions of the disorder include sensory impairment, seizures, and learning disabilities.
Early Signs of Cerebral Palsy
Most children with cerebral palsy are born with the disorder, however, it may not be detected until months or years later. At birth, is the delivery was traumatic, or significant risk factors were encountered during pregnancy or birth, doctors may be able to detect cerebral palsy immediately. The early signs of cerebral palsy typically appear before the child is 3 to 5 years old. The most obvious sign of cerebral palsy is developmental delay, where the child is delayed in reaching key growth milestones, such as rolling, crawling, sitting, and walking. There are also signs such as abnormal muscle tone, unusual posture, persistent infant reflexes, and early development of hand preference. The eight clinical signs of cerebral palsy include muscle tone, movement coordination and control, reflexes, posture, balance, gross motor function, fine motor function and oral motor function.
Muscle tone impairment is the most noticeable sign of cerebral palsy. Muscle tone is the ability of muscles to work together by maintaining proper resistance. Cerebral palsy caused by brain injury or malformation impairs the ability of the central nervous system to coordinate muscle movement. A child with cerebral palsy may demonstrate a combination of the following signs. The two most common signs of abnormal muscle tone are hypotonia and hypertonia. Hypotonia is decreased muscle tone or tension, meaning flaccid, relaxed, or floppy limbs. Hypertonia is increased muscle tone or tension, meaning stiff or rigid limbs. Other signs of abnormal muscle tone include dystonia, mixed, muscle spasms, fixed joints, abnormal neck and truncal tone, and clonus which is muscular spasms with regular contractions typically occurring in the ankles and wrist.
Movement Coordination and Control
The impairment of muscle tone on a child’s body can create effects on muscle control and coordination. Muscle control impairments can include limbs to be constantly extended, contracted, or moving in rhythmic patterns or jerking spastically. These signs become more apparent when the child is under stress. The impairment of coordination and control includes spastic movements, athetoid or dyskinetic movements, ataxic movements, mixed movements, or gait disturbances, such as in-toeing and out-toeing.
Reflex and Posture
Reflexes are involuntary movements the body makes in response to stimulus. Abnormal reflexes, such as hyperreflexia are excessive reflex responses that cause twitching and spasticity. Underdeveloped or lacking postural and protective reflexes are early warning signs of abnormal development and cerebral palsy. Posture and balance is affected by cerebral palsy, and shows signs in infants when they begin to sit up and learn to move around. Posture is usually symmetrical, however, a child with cerebral palsy may have asymmetrical posture, meaning the right and left limbs do not mirror one another. For example, one leg may bend inward at the hip, while the other leg bends outward.
There are three types of motor function delays that appear as a child with cerebral palsy develops. First, is gross motor function delay, which is the ability to make large coordinating movements using multiple limbs and muscle groups. Impaired gross motor functions may include limited capabilities with walking, running, jumping, and maintaining balance. Second, fine motor function which executes precise movements, including grasping small objects, holding objects between thumb and forefinger, setting objects down gently, drawing or turning pages in a book. Third, impaired oral motor function, meaning difficulty in using the lips, tongue, and jaw. Signs of oral motor function impairment may include difficulty speaking, swallowing, chewing, or drooling. Oral motor function impairment can affect a child’s breathing, articulating, voicing, and cause apraxia, or the inability of the brain to effectively transmit proper signals to the muscles used in speaking.