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Author: John Morgan

Cerebral Palsy:

Diagnosis, Complications, Prevention and Treatment

Special Care in Dentistry
John Morgan, DDS
Tufts University School of Dental Medicine, 2008


Study Questions
 

  1. How are observations of movement and imaging tests used in diagnosis of cerebral palsy?

  2. List six complications of cerebral palsy.

  3. Describe the six ways in which cerebral palsy can be prevented.

  4. Similarly, describe the six types of treatment that may be used.

Click here to revisit the March of Dimes web site on cerebral palsy: . Note that all quotations in the following sections are from this site.  

How is cerebral palsy diagnosed?

“Parents may become concerned about their baby’s or toddler’s development if the child is having problems learning to roll over, sit, crawl or walk. Parents always should discuss these concerns with their baby’s pediatrician.”

“Cerebral palsy is diagnosed mainly by evaluating how a baby or young child moves. The doctor will evaluate the child’s muscle tone, which can make them appear floppy. Others have increased muscle tone, which makes them appear stiff, or variable muscle tone (increased at times and low at other times). The doctor will check the child’s reflexes and look to see if the baby has developed a preference for using his right or left hand. While most babies do not develop a hand preference (become right- or left-handed) until at least 12 months of age, some babies with cerebral palsy do so before six months of age. Another important sign of cerebral palsy is the persistence of certain reflexes, called primitive reflexes, that are normal in younger infants, but generally disappear by 6 to 12 months of age. The doctor also will take a careful medical history, and attempt to rule out any other disorders that could be causing the symptoms.

"The doctor also may suggest brain imaging tests such as magnetic resonance imaging (MRI), computed tomography (CT scan) or ultrasound. These tests sometimes can help identify the cause of cerebral palsy. Ultrasound often is recommended in preterm babies who are considered at risk of cerebral palsy to help diagnose brain abnormalities that are frequently associated with cerebral palsy (allowing therapy to begin early). In some children with cerebral palsy, especially those who are mildly affected, brain imaging tests show no abnormalities, suggesting that microscopically small areas of brain damage can cause symptoms. About half of babies who are diagnosed with mild cerebral palsy appear to outgrow their symptoms.”

Complications

Besides difficulty with movement and posture, cerebral palsy may result in these health problems: 

  • Joint deformities or dislocation if there is considerable spasticity

  • Nutrition problems if there are swallowing or feeding difficulties

In addition, some children with cerebral palsy will have multiple handicaps that may require long-term care.  Some of the associated problems may include:

  • Difficulty with vision, hearing and speech

  • Intellectual disability

  • Dental problems

  • Seizures

Can cerebral palsy be prevented? 

Despite improvements in prenatal care, the incidence of cerebral palsy appears to be on the rise. This is thought to be because the more premature babies are surviving, and prematurity remains a risk factor for cerebral palsy. Some cerebral palsy of known causes can be prevented. Here are some examples: 

  • “Rh disease usually can be prevented when an Rh-negative pregnant woman receives appropriate care.

  • Women can be tested for immunity to rubella before pregnancy and be vaccinated if they are not immune.

  • Babies with severe jaundice can be treated with special lights (phototherapy).

  • Head injuries in babies, a significant cause of cerebral palsy in the early months of life, often can be prevented when babies ride in car seats properly positioned in the back seat of the car.

  • Routine vaccination of babies with the Hemophilus influenzae type b (Hib) vaccine prevents many cases of meningitis, another cause of brain damage in the early months.

  • A woman can help reduce her risk of preterm delivery when she seeks early (ideally starting with a pre-pregnancy visit) and regular prenatal care and avoids cigarettes, alcohol and illicit drugs.”

How is cerebral palsy treated?

Here is a summary, adapted from the March of Dimes web site:

  • The health care team. A team of professionals works with the child and family to develop a needs-based individualized treatment plan. “The team is generally coordinated by one health care professional and may include pediatricians, physical medicine and rehabilitation physicians, orthopedic surgeons, physical and occupational therapists, ophthalmologists, speech/language pathologists, social workers and psychologists.” Dentists also play an important role.

  • Physical therapy. Physical therapy is usually begun immediately after diagnosis. Physical therapy “enhances motor skills (such as sitting and walking), improves muscle strength and helps prevent contractures (shortening of muscles that limits joint movement).” Braces, splints or casts may also be used “to help prevent contractures and to improve function of the hands or legs. If contractures are severe, surgery may be recommended to lengthen affected muscles.”

  • Drugs. They are sometimes used to dampen spasticity and decrease abnormal movement. While oral drug treatment is often “not very helpful,” intramuscular injection with Botox (botulinum toxin) may prove helpful for a period of several months, making physical therapy more effective. Finally, “a new type of drug treatment is showing promise in children with moderate to severe spasticity. During a surgical procedure, a pump is implanted under the skin that continuously delivers the anti-spasmodic drug baclofen.”

  • Surgery.  Selective dorsal rhizotomy is a surgical technique used with some children with severe spasticity that affects both legs and has not responded to alternative treatments. This technique “may permanently reduce spasticity and improve the ability to sit, stand and walk. In this procedure, doctors identify and cut some of the nerve fibers that are contributing most to spasticity. This procedure usually is done when a child is between 2 and 7 years of age.”

  • Therapies and technology. Occupational therapists assist the child to learn basic skills such as feeding, dressing, hygiene, etc. Speech therapists assist children with speech problems. Increasingly, in severe cases, children may be taught to use a computerized voice synthesizer to generate speech.

  • Mechanical aids. These include “walkers, positioning devices (to allow a child with abnormal posture to stand correctly), customized wheelchairs, specially adapted scooters and tricycles.”

Cerebral palsy may require long-term care. As seen above, the type and amount of treatment depends on how many of the symptoms the child has, and how severe they are. Additional treatments may include hearing aids, eyeglasses or eye surgery and joint surgery.

Click here to visit the National Institute of Neurological Disorders and Stroke web site, which provides more information on cerebral palsy.