Cerebral Palsy - Symptoms

The symptoms of cerebral palsy are usually not noticeable at birth. Instead, they begin to show up during the first eighteen months of a child's life.

Normal children pass through a series of developmental stages. At each stage, they learn how to perform one or more common tasks. Infants with CP have difficulty performing these tasks. Such difficulties may indicate that an infant has CP. The tasks considered to be milestones in normal development include the following:

• Babbles (6 to 8 months)
• Sits well with support (8 to 10 months)
• Crawls (9 to 12 months)
• Walks alone (12 to 15 months)
• Uses one or two words other than dada and mama (12 to 15 months)
• Eats with fingers; holds bottle (12 to 18 months)
• Turns pages in books; removes shoes and socks (24 to 30 months)
• Walks up and down steps (24 to 36 months)

Because children develop at different rates, using these milestones to diagnose cerebral palsy (or any other disorder) must be used with great caution. The fact that an otherwise healthy child does not reach one of these milestones at the suggested age is not necessarily a sign that the child has CP. He or she may just be developing at a slower rate. In addition, problems with vision or hearing may cause such delays.

Five forms of cerebral palsy are recognized. They are defined according to the kind of muscle damage and the location of that damage:

• Spastic: Muscles are rigid (tight), posture may be abnormal, and the ability to do delicate work is impaired.
• Athetoid: Muscular movements are slow, twisting, and involuntary (beyond the person's control).
• Hypotonic: Muscles are floppy, without firmness.
• Ataxic: Balance and coordination are impaired.
• Dystonic: Any combination of the above symptoms.

Cerebral palsy is also described according to the parts of the body affected:

• Hemiplegia: One arm and one leg on the same side of the body are involved.
• Diplegia: Both legs are involved; in addition, one or both arms may also be involved.
• Quadriplegia: Both arms and both legs are involved.

A diagnosis of CP usually involves combining terms. For example, someone with spastic diplegia shows symptoms of rigid muscles in both legs. In addition, the terms mild, moderate, and severe are sometimes used to describe the seriousness of the disorder.

Loss of muscle control as a result of CP can cause other problems with bones and muscles. Examples of these problems include scoliosis (curving of the spine; see scoliosis entry), hip dislocation, and contractures. A contracture is a permanent shortening of a muscle. It can cause muscles to become fixed in awkward positions, resulting in clenched fists or equinus (pronounced eh-KWI-nuss). Equinus is a foot deformity that prevents one's heel from touching the ground when walking. Contractures can be painful and can interfere with the normal activities of daily living.

Brain damage that causes cerebral palsy may also cause a variety of other disorders. These include:

• Mental retardation
• Learning disabilities.
• Attention deficit disorder
• Seizure disorder (tendency toward convulsions)
• Visual problems, especially strabismus ("cross-eye")
• Loss of hearing (see hearing loss entry)
• Speech problems

About one-third of children with CP have some moderate-to-severe mental retardation, one-third have mild mental retardation, and one-third have normal to above average intelligence. For some children, disorders related to CP can have an even greater impact on a child's life than the physical handicaps caused by CP.