What is Cerebral Palsy (CP)?

A New HOPE: Stem CELLS

Cerebral palsy is caused by abnormal development or damage to parts of the brain that control movement, balance, and posture. Among all children diagnosed with cerebral palsy, 40-50% are born prematurely. Cerebral palsy is a physical disability resulting from damage to the underdeveloped brain, either before birth, during birth, or shortly after. Although it affects muscle movements, it does not stem from an issue with the muscles or nerves. While symptoms become more noticeable in early childhood, the underlying condition does not worsen over time.

Abnormalities in the brain areas that control muscle movements lead to cerebral palsy. It is not a progressive disease. Significant improvements can be achieved through early intervention in the damaged brain, alongside lifelong rehabilitation practices and treatments.

The History of CP

The earliest possible physical evidence of the condition comes from the mummy of Siptah, an Egyptian Pharaoh who ruled between 1196 and 1190 BCE and died around the age of 20. Due to his deformed foot and hands, it is suspected he may have had cerebral palsy. Ancient Greek medical literature discusses paralysis and weakness of the arms and legs; the modern word "paralysis" derives from the Ancient Greek words παράλυση (parálysis) or πάρεση (páresis), meaning paralysis or paresis, respectively. The works of the Hippocratic school (460-370 BCE), especially the manuscript On the Sacred Disease, describe a group of problems closely aligning with the modern understanding of cerebral palsy.

It is also speculated that Roman Emperor Claudius (10 BCE – 54 CE) had CP.

The modern understanding of CP as stemming from brain-related problems began in the early 19th century with a series of publications on brain abnormalities by Johann Christian Reil, Claude François Lallemand, and Philippe Pinel.

English surgeon William John Little (1810-1894) was the first to study CP extensively. In his doctoral thesis, he stated that CP resulted from complications during birth. He later identified difficult labor, premature birth, and especially perinatal asphyxia as risk factors. The spastic diplegia form of CP became known as Little’s disease.

Around this time, a German surgeon also worked on distinguishing CP from polio. In the 1880s, English neurologist William Gowers advanced Little's research, linking paralysis in newborns to difficult births. He coined the term "birth paralysis" and categorized it into peripheral and cerebral types.

In the United States during the 1880s, Canadian-born doctor William Osler (1849-1919) reviewed dozens of CP cases to classify disorders by their location in the body and underlying causes.

Sigmund Freud (1856-1939) identified causes of the disorder as issues arising during birth, developing during birth, and appearing after birth.

By the early 20th century, attention in the medical community had largely shifted away from CP until orthopedic surgeon Winthrop Phelps became the first physician to treat the condition. He studied CP from a musculoskeletal perspective rather than a neurological one.

Hungarian physical rehabilitation practitioner András Pető developed a system to teach children with CP how to walk and perform basic movements.

What Are the Symptoms of Cerebral Palsy?

Most children with cerebral palsy are born with the disorder, though it may go undetected for months or even years. The symptoms can affect either the entire body or just one side.

In children aged 0-12 months, signs such as weakness or differences in motor movements, muscle weakness, joint and posture abnormalities, difficulties adapting to social life, or inability to perform independent activities may indicate cerebral palsy.

While movement problems are the primary hallmark of CP, challenges related to thinking, learning, sensory perception, communication, and behavior are also common. Statistics reveal that 30% of these children experience epilepsy, 60% have communication difficulties, at least 40% face vision problems, and 25-55% struggle with learning disabilities. Additionally, they may retain reflexes that typically disappear during early infancy.

Summary of CP Symptoms:

• Delays in motor skill development: Difficulty rolling over, sitting up unaided, or crawling.
• Sensory impairments: Vision, hearing, and speech disorders.
• Neurological issues: Seizures, intellectual disability, and blindness.
• Muscle stiffness (spasticity): Tight muscles and exaggerated reflexes.
• Poor muscle coordination (ataxia): Difficulty with controlled movements.
• Respiratory disorders.
• Bladder and bowel problems.
• Tremors and involuntary movements.
• Frequent falls.
• Swallowing difficulties.
• Preference for one side of the body: For example, always holding objects with the same hand.

Causes of Cerebral Palsy

In many cases, the cause of cerebral palsy (CP) remains unknown. However, several risk factors have been identified:

• Blood incompatibility between the mother and baby.
• Genetic disorders.
• Infections during pregnancy or exposure to methylmercury.
• Maternal use of alcohol, drugs, or medications during pregnancy.
• Premature birth, difficult delivery, or twin pregnancy.
• Low birth weight.
• Blood clotting disorders.
• Brain hemorrhage or head trauma within the first few years of life.

Classification of Cerebral Palsy

Cerebral palsy is classified into four main types based on motor impairment:

1. Spastic CP

The most common form, affecting approximately 80% of cases. Characterized by spasticity (high muscle tone), leading to stiff and jerky movements.

2. Ataxic CP

Occurs in about 5-10% of cases. Damage to the cerebellum results in coordination and balance issues, particularly affecting the arms, legs, and torso.

3. Dyskinetic CP

Associated with damage to the basal ganglia and substantia nigra, often due to bilirubin encephalopathy or hypoxic-ischemic brain injury during development. Symptoms include both hypertonia (high muscle tone) and hypotonia (low muscle tone). It is an extrapyramidal form of CP, featuring involuntary movements and slow, strong contractions that spread through the body.

4. Mixed CP

This type combines symptoms from spastic, ataxic, and dyskinetic CP.

Diagnosis of Cerebral Palsy

Diagnosing CP primarily involves a detailed medical history and physical examination.

• Observing children under 4 months old and evaluating their movements is the most effective method.
• Key early signs include abnormal muscle tone, delayed motor development, and persistence of primitive reflexes.
• Mild CP cases are often only identified after the age of 5.
• Neuroimaging techniques, such as CT scans or MRIs, play a crucial role in confirming the diagnosis. They can reveal the timing of the initial brain damage and associated conditions like epilepsy or intellectual disabilities.

John McLaughlin, a CP specialist, advises waiting until the child is 36 months old for a more accurate motor capacity assessment before making a definitive diagnosis.

Is My Child Diagnosed with CP? Parents, Pay Attention!

How to Recognize If a Child Has CP?

Children born with cerebral palsy (CP) may not be able to sit or hold their bodies and heads upright, even with support. Their muscle tone may be either too loose or too stiff. They may also have facial bone anomalies or asymmetrical appearances, such as a larger head and smaller jaw. CP symptoms are typically noticeable between 6 to 10 months of age. As the child attempts to walk and move independently, CP symptoms become apparent, leading to a more accurate diagnosis. Families often notice delays in gross motor skills during this period.

Excessive drooling is common and can pose a choking hazard if severe. Children with CP may experience delays in speech development, impacting their ability to express themselves. They may also damage objects, clothing, and toys within their reach.

Approximately half of children with CP experience urinary issues or urinary tract infections. Kidneys in these children are more prone to infections, and there is a higher risk of urinary dysfunction in later years.

Children with CP may also have sensory processing issues. Adults with CP are at an increased risk of respiratory failure.

Skeletal System Issues in Children with CP

People with CP are at risk of low bone mineral density. Joint compression due to muscle imbalances can lead to joint cartilage atrophy. Joint deformities are more common in spastic types of CP. Spasticity and abnormal gait can hinder proper bone and skeletal development, potentially causing one leg to be shorter than the other. Children with CP often suffer from bone fractures in the arms and legs, making physical activities risky.

Hip dislocation and ankle equinus or plantar flexion deformity are the most common deformities among children with CP. Scoliosis can develop in these children before the age of 10. Growth spurts during adolescence can make walking more difficult for individuals with CP and high muscle tone. To maintain balance, they may walk with a swaying gait (scissoring gait).

Eating and Drinking Challenges in CP

Due to sensory and motor impairments, individuals with CP may struggle with food preparation, holding kitchen items, or chewing and swallowing. Infants with CP may be unable to breastfeed, swallow, or chew. Gastroesophageal reflux (GERD) is common among children with CP. These children may have either heightened or diminished sensitivity around and inside the mouth. Weak balance while sitting, poor control of the head, mouth, and torso, inability to extend their arms forward to reach food or objects, and poor hand-eye coordination can make self-feeding difficult. Dental issues can also contribute to eating difficulties.

Aspiration pneumonia is common among those with CP, leading to coughing during meals and respiratory issues. While slow eating is often manageable, improper or difficult chewing and swallowing can create significant challenges.

Stem Cell Therapy for Cerebral Palsy

Stem cell therapy offers potential benefits in improving movement and function. The goal is to help children develop gross motor skills, improve cognitive functions, and aid in muscle and joint control. Stem cells are utilized to enhance brain function, promote repair, and prevent potential complications. New advancements in stem cell treatment have been proven effective for CP, with promising results in motor improvement, social adaptability, and increased mobility.