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Cerebral palsy

Cerebral palsy

Cerebral palsy (CP) is a condition affecting muscle tone, movement and motor skills, which is the ability to move in a coordinated and purposeful manner. Cerebral palsy is a common disorder that occurs before, during or immediately after the birth of children, and into childhood up to 5 years of age. Signs of cerebral palsy usually appear before 18 months of age. Shriners Hospitals for Children is considered a leader in treating the orthopaedic effects of cerebral palsy and it is the most commonly treated condition at the Twin Cities Shriners Hospital.

The exact causes of most cases of CP are unknown, but many cases are the result of problems during pregnancy in which the brain is either damaged or does not develop normally. Brain damage in infancy or early childhood has also been linked to the development of CP. CP affects muscle control and coordination, making even simple movements, like standing still, difficult. CP can be associated with other health conditions like brain damage; vision, hearing and speech problems; and learning disabilities, urinary incontinence and seizures. Cerebral palsy does not get worse over time .

There are three main types of CP:

Ataxic – This type causes a disturbance in balance and depth perception.
Athetoid – This type leads to involuntary and uncontrolled movements.
Spastic – The most common type of cerebral palsy, which causes stiffness and movement difficulties.

There are many subtypes of CP within each of the three main types. Within each main type, there are several more specific diagnoses indicating a more specific area of neurological damage, such as spastic hemiplegia, spastic diplegia and spastic quadriplegia.

Treatment for CP, including spasticity or overly tight muscles, and the orthopaedic effects ,varies depending on the severity of the condition. Our pediatric specialists put together customized care plans for children with CP.

Signs of cerebral palsy

Children with CP can exhibit a wide range of symptoms, from mild to severe. Some typical signs to look for in your child may include:

  • Lack of muscle coordination when engaged in voluntary movements – especially prevalent in ataxia types
  • Stiff muscles and exaggerated reflexes – found in spastic types
  • Walking with one foot or leg dragging
  • Variations in muscle tone, ranging from too stiff to too floppy
  • Excessive drooling or difficulties speaking, sucking or swallowing
  • Tremors, a muscle contraction
  • Difficulty engaging in precise motions like writing or buttoning a shirt
  • Early right or left handedness (before age 2)
  • Persisting infant reflexes still present at an age where they should disappear

Cerebral palsy symptoms do not generally worsen as the child ages, however, untreated spasticity and contractures (muscles that are too short or too tight) can result in worsening orthopaedic issues over time. 

Diagnosing cerebral palsy

Diagnosing cerebral palsy at an early age is important to the well-being of children and their families. There is no single test that confirms or rules out CP and is often a collaboration of medical professional evaluations. Developmental screening is a short test to see if the child has specific developmental delays, such as motor or movement delays. These are completed by the pediatrician at the child’s 9-month, 18-month and 24-month well-child exams. Depending on the severity and complexity of symptoms, diagnosis can be made between the ages of infancy and toddler. Diagnosing CP can take several steps and may include:

  • Newborn screening with APGAR score
  • Developmental monitoring
  • Developmental screening
  • Developmental and medical evaluations
  • Imaging of the head and brain
  • Electroencephalography (EEG)

Treatment of cerebral palsy

Since the type and severity of CP greatly vary from case to case, your child’s treatment will be based on their specific issues and conditions. At Shriners Hospitals for Children — Twin Cities, our multidisciplinary team approach includes the physician, nurse, social worker, physical therapist, occupational therapist, dietician and orthotist. It is our goal to meet as many needs of the child as possible when they are here for their appointment.

  • Therapy: The most important part of any therapy program is the daily stretching exercises that the therapists have set up. Therapy is provided after surgery or to meet specific goals.
    • Occupational therapy may improve the development of the small muscles of the body, such as the face, feet, fingers, hands and toes, in order to improve daily living skills and other activities.
    • Physical therapists work with the muscles of the abdomen, arms and legs to improve a variety of skills, including balance, walking, standing, using the stairs and transferring.
  • Orthotics (Braces) – Braces are used to:
    • Help muscle growth keep up with bone growth
    • Prevent foot and knee injury
    • Help support weak muscles
    • Protect the muscles after surgery
    • Provide stability
  • Medications may be prescribed to control or prevent seizures, and/or to reduce spasticity (overly tight muscles), which can impact movement and motor skills.
  • Mobility aids such as crutches, a walker, or a wheelchair may be necessary.
  • Serial casting: Casting can be used to help stretch muscles that have gotten so tight that exercises and bracing do not help. When the muscle is stretched enough, the cast is removed and replaced with an orthotic (brace).
  • Injectable therapy can help with physical therapy, occupational therapy, and bracing by temporarily weakening certain muscles that are overly spastic or tight.
  • Orthopaedic surgery may be required to stabilize joints, relieve contractures, or correct bony malrotations in an attempt to improve function.

Orthopaedic surgery

For the non-ambulatory child who is unable to walk, surgery is focused on the hips, the upper and lower extremities, and the spine.

  • Soft tissue and bony surgeries may be performed on the hips to prevent the development of painful dislocation that can occur due to muscle imbalance.
  • Soft tissue and bony surgeries are frequently utilized to correct foot and ankle alignment for these children in order to facilitate brace and shoe wear.
  • Scoliosis may develop which compromises sitting balance, and in severe cases, may be life threatening due to inhibition of heart and lung function. In these cases, surgery will be required to correct the spinal deformity.
  • Soft tissue and bony surgeries may be performed on the arms to promote hygiene and in some cases, to improve function.

For children who can walk, surgery is primarily focused on the upper and lower extremities.

  • Soft tissue and bony surgeries may be performed about the hip, knee and ankle to relieve contractures and improve positioning of these joints.
  • Soft tissue and bony surgeries may be performed to correct foot and ankle alignment in order to facilitate brace and shoe wear, as well as improve the loading pattern of the foot.
  • Bony surgery on the lower extremity may be necessary to correct common walking problems such as in-toeing or out-toeing.
  • Soft tissue and bony surgeries for the upper extremities are utilized to promote hygiene and in some cases, to improve function.

Selective dorsal rhizotomy

Who your child may see for this condition:

Cary Mielke, M.D.
Michael Priola, D.O.
Christopher Vara, M.D.
A. Noelle Larson, M.D.
Steven Moran, M.D.
Todd Milbrandt, M.D.
Anthony Stans, M.D.
Albert Tu, M.D.
Ann Van Heest, M.D.

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