Cerebral palsy (CP) is the most common physical disability, affecting 35,000 Australians, or one in 500 people. It is estimated that one Australian child is born with cerebral palsy every 15 hours.
We know CP is caused by injury to the developing brain, which affects the part of the organ responsible for movement. This injury usually occurs before birth, but we often don’t know the cause.
CP is a life-long condition and can vary in severity from very mild, where people can walk and climb stairs, through to extremely severe, which leaves no independent mobility. People with cerebral palsy usually have a normal lifespan but experience the effects of ageing earlier.
How does CP affect movement?
Cerebral palsy can affect the body in different ways:
- one in four people CP with are unable to walk
- three in four experience chronic pain
- half have an intellectual disability
- one in three have epilepsy.
In most cases, there is involuntary muscle tightness, known as spasticity. Quadriplegia involves all four limbs, while diplegia affects the movement of the legs.
Another common form of CP is hemiplegia, the inability to move either the right or left side of the body, which can also be caused by strokes.
What are the causes of CP?
In the past, it was assumed that most cerebral palsy resulted from a lack of oxygen during birth. But we now know that this is the case for only a small minority.
Most cerebral palsy occurs during pregnancy, with extremely premature birth a major risk factor for the condition.
Thankfully, the rate of cerebral palsy has been declining in preterm babies in developing countries such as Australia and Holland, probably as a result of expert neonatal intensive care.
Mothers are now administered steroids prior to the preterm birth and the premature infants are given caffeine after birth to remind them to breathe during the first few weeks of life.
Half the children diagnosed later with cerebral palsy, however, were born on time and were well at birth. There often isn’t an obvious cause in such cases, but there are many known risk factors.
Statistical risk factors include the failure of the baby to thrive during pregnancy, having an abnormal placenta, a family history of cerebral palsy or other neurological conditions.
Other known associations include birth defects, maternal thyroid disease and infections. In the past, severe neonatal jaundice due to problems with the rhesus blood group caused cerebral palsy.
But this has been virtually eradicated, due to anti D therapy – although other causes of jaundice can still be damaging.
Another 10% of cerebral palsy results from a damaging event following birth such as meningitis, road accidents, near drownings and non-accidental injury.
How is CP treated?
There are many effective therapies including casting (holding a muscle in a stretched position with a plaster cast, which helps lengthen the shortened muscles associated with cerebral palsy), muscle strengthening and Botox (which is injecting into over-active or spastic muscles to provide a window for therapy to work on strengthening under-active muscles).
A new type of activity-based physical therapy called goal-directed training is also delivering results. We know from research among elite athletes and musicians that the brain forms efficient nerve connections and dedicates more space to tasks that are carried out repetitively and successfully. This appears to be the case in cerebral palsy as well.
Another therapy that appears to help is called constraint-induced movement, which can also be used in infants who have had a stroke. It involves constraining the unaffected arm in a mitt and challenging the weaker arm with appropriate tasks.
Next steps in CP research
Recent research has focused on early diagnosis of CP to help decrease the rate of complications such as hip dislocation or scoliosis of the spine.
In premature babies, a drug called magnesium sulphate has been shown to decrease the rate of cerebral palsy by 30% in babies of less than 30 weeks gestation. And scientists have just started testing whether magnesium sulphate can also help babies born between 30 and 34 weeks of gestation.
Another exciting recent finding shows that cooling full-term infants who are clearly unwell at birth, and showing signs of neurological abnormality, may decrease the risk of cerebral palsy.
Other protective therapies which are about to be trialled in humans include melatonin and erythropoietin, which have shown promising results in animal trials.
But while hundreds of Australians have sought expensive risky and unproven stem cell therapy in developing countries, research is still at an early stage in reputable laboratories.
Research in cerebral palsy has historically lagged behind other medical areas. But recently growth in the number and quality of studies offers hope for prevention, better interventions to improve the quality of life of people living with this condition and, hopefully, one day a cure.
See more Explainer articles on The Conversation.
Comments on this article are now closed.
Tom Hennessy
Retired
Lack of oxygen is called ischemia. The result of ischemia is well known. Hemosiderin. Iron.
"Free iron, total F-isoprostanes and total F-neuroprostanes in a model of neonatal hypoxic-ischemic encephalopathy: neuroprotective effect of melatonin."
http://www.ncbi.nlm.nih.gov/pubmed/19141088
THIS is a 'human model of iron induced neurodegeneration' which began right after they began to give her iron.
"Neurodegeneration was coincident with aggressive oral iron replacement. Oral chelation improved many symptoms." http://www.ncbi.nlm.nih.gov/pubmed/17911185
Tom Hennessy
Retired
Epigallocatechin-3-gallate (EGCG)
"Generally indicating that EGCG enhances adult neurogenesis in the hippocampus"
http://www.nutraingredients.com/Research/Researchers-uncover-how-green-tea-compound-boosts-brain-function
"Epigallocatechin-3-gallate, or EGCG.32 EGCG is a well-known antioxidant. In recent years, it was shown to powerfully chelate unbound iron"
Read more"Unlike many drugs and nutrients, EGCG readily crosses the blood-brain barrier. This allows it to capture and isolate iron from the brain…
Sue Ieraci
Public hospital clinician
"Hereditary aceruloplasminaemia is a disorder of iron metabolism that is characterised by iron accumulation in the brain and other visceral organs."
This is not cerebral palsy.
Tom Hennessy
Retired
"This is not cerebral palsy"
It is , a human model of brain iron accumulation. You should maybe read to comprehend.
Tom Hennessy
Retired
"We describe a 42-year-old man with right hemiplegia from cerebral palsy"
"Subsequent investigations diagnosed hemochromatosis"
http://www.ncbi.nlm.nih.gov/pubmed/9415662
Tom Hennessy
Retired
"Plasma non protein bound iron as the best early predictive marker of neurodevelopmental outcome, with 100% sensitivity and 100% specificity for good neurodevelopmental outcome at 0–1.16 µmol/l, and for poor neurodevelopmental outcome at values >15.2 µmol/l."
http://brain.oxfordjournals.org/content/126/5/1224.short
Sue Ieraci
Public hospital clinician
That 1997 report about a man with cerebral palsy AND haemochromatosis showed that people with cerebral palsy can still have other pathological conditions just like all other human beings. No surprise.
Sue Ieraci
Public hospital clinician
"Lack of oxygen is called ischemia."
No - Mr Hennessy. Lack of oxygen is called hypoxia.
Ischaemia is lack of blood supply (similar root to the word anaemia). Ischaemia ultimately causes hypoxia, but the terms are different.
Tom Hennessy
Retired
"No surprise."
That was real contributive.
Tom Hennessy
Retired
I asked you before. You seem to feel you have something to contribute ? Ischemia is lack of oxygen. Next time you read ischemia , remember , it is low oxygen , which leads to gangrene. Gangrene too is lack of oxygen .
Sue Ieraci
Public hospital clinician
ischemia is·che·mi·a (ĭ-skē'mē-ə)
n.
A decrease in the blood supply to a bodily organ, tissue, or part caused by constriction or obstruction of the blood vessels.
Hence "myocardial ischaemia" - lack of blood supply to the myocardium (heart muscle), due to blockage or spasm of a coronary artery.
I feel that I have many things to contribute, Mr Hennessy, including the correction of your errors.
Tom Hennessy
Retired
"Transient ischemic attack TIA (transient cerebral ischaemia) is a brief temporary (transient) interruption of the oxygen (ischemia) to the brain"
Let me point out .. ischemia .. is interruption of the oxygen to the brain.
Write it down and remember it so you won't be attempting to act stupid around me again.
Sue Ieraci
Public hospital clinician
No, TIA is a temporary interruption of BLOOD SUPPLY to the brain, often caused by a small embolus (blood clot).
The blood carries glucose and oxygen, and carries away waste products, so lack of oxygen is one of the consequences of the blockage - but the meaning of the word relates to the lack of BLOOD - not oxygen.
ISCHAEMIA is one of many terms using the Greek root for blood. Other examples are anaemia, thalassaemia. The Latin root for blood is Sanguis, as in sanguine.
Low oxygen is termed hypoxia, absence of oxygen - anoxia.
Is it clear now, Mr Hennessy, or would you like me to go through this again?
Tom Hennessy
Retired
"Transient ischemic attack TIA (transient cerebral ischaemia) is a brief temporary (transient) interruption of the oxygen (ischemia) to the brain"
Tell it to them. They need some elucidation from you.
"Ischemia is the lack of oxygen supply to tissues and is common in myocardial infarction, stroke and trauma as well as surgical procedures"
Tell it to them too. They also need some elucidation from you.
Tom Hennessy
Retired
Tell the Texans.
"Sometimes the lack of oxygen to the heart (called ischemia) does not cause any pain."
http://www.texasheartinstitute.org/HIC/Topics/Cond/CoronaryArteryDisease.cfm
Tom Hennessy
Retired
Dr. Peter Gott should be elucidated too , by you.
"Ischemia Refers To Lack Of Oxygen In Tissues"
http://news.google.com/newspapers?nid=1906&dat=19860916&id=4AAgAAAAIBAJ&sjid=ZQUFAAAAIBAJ&pg=4511,726028
Tom Hennessy
Retired
I'm surprised an article by a Dr. Giuseppe Buonocore , with three books under his belt , is being given so many thumbs down without any counter arguments. One would like to see the evidence for the thumbs down.
"Books by Giuseppe Buonocore
Neonatology: A Practical Approach to Neonatal Diseases
by Giuseppe Buonocore (Editor), Rodolfo Bracci (Editor), Michael Weindling (Editor)
Neonatal Pain: Suffering, Pain, and Risk of Brain Damage in the Fetus and Newborn
by Giuseppe Buonocore (Editor), Carlo V. Bellieni (Editor), I. Carrasco de Paula (Foreword)
Pain and Brain Damage in the Fetus and Newborn"
william mcinnes
investigator into medical negligence
Dear Authors, your comment "In the past, it was assumed that most cerebral palsy resulted from a lack of oxygen during birth. But we now know that this is the case for only a small minority" is interesting from the point of view that within that small minority are cases where clearly the cerebral palsy was caused by obstetric negligence and that fact seems to be buried in denial particularly by medical negligence insurers.
You have provided a link to the study "Intrapartum asphyxia: a rare cause…
Read moreSue Ieraci
Public hospital clinician
The reality is the opposite of what you suspect, William McInnes. IN the past, many obstetricians were held culpable for causing CP, contributing massively to malpractice insurance and risk-aversion. We now know that a large number of obstetricians paid out for no fault of their own practice.
The authors have not said that there are NO intra-partum causes - you quoted this yourself: "But we now know that this is the case for only a small minority" A small minority does not equal none.
There is a large body of research in this area - it should be easy to find for an investigator.
william mcinnes
investigator into medical negligence
I think Sue you are trying to justify that because many obstetricians were held culpable for causing CP in the past and had to pay out for no fault of their own practice means that any research into present day obstetric negligence should not be discussed. Obstetric negligence still happens, only now the Consensus Statement criteria now make it easier to hide from the truth of it. Have a read of it and tell me for instance if a "sentinel event" includes an asphyxial event which arose out of a lack of care by an obstetrician which led to hypoxic ischemic encephalopathy and cerebral palsy. If it does not please tell me why not. I look forward to your response.
Sue Ieraci
Public hospital clinician
William McInnes - I'm not trying to justify anything.
All registered clinicians are held accountable for their outcomes. Obstetricians, like all other hospital specialists, have to audit their outcomes. You must have heard of the recent high-profile cases of doctors being held accountable for their outcomes. Why the conspiracy theory?