From the Guidelines
Cerebral palsy begins during the early stages of neural development, typically occurring before birth, during birth, or in early infancy, with most cases developing during prenatal development when the brain is forming, specifically during the first and second trimesters of pregnancy 1.
Key Points to Consider
- The developing brain is particularly vulnerable to disruptions in blood flow, oxygen deprivation, infections, or genetic abnormalities that can damage developing brain tissue, specifically affecting areas of the brain that control movement and posture, such as the motor cortex, basal ganglia, and cerebellum 1.
- The damage that occurs during this critical period is non-progressive, meaning it doesn't worsen over time, though the physical manifestations may change as the child grows 1.
- The timing of the brain injury determines the pattern and severity of motor impairments, with earlier injuries often resulting in more widespread effects, explaining why cerebral palsy presents as a spectrum of disorders with varying degrees of motor dysfunction rather than a single condition with uniform symptoms 1.
Importance of Early Intervention
- Early detection of high risk of cerebral palsy, followed by cerebral palsy-specific early intervention, is recommended and should be the standard of care to optimize infant neuroplasticity, prevent complications, and enhance parent and caregiver well-being 1.
- Cerebral palsy-specific early intervention maximizes neuroplasticity and minimizes deleterious modifications to muscle and bone growth and development, with task-specific, motor training-based early intervention, such as Goals-Activity-Motor Enrichment (GAME) and constraint-induced movement therapy (CIMT), recommended as the new paradigm of care for cerebral palsy 1.
From the Research
Cerebral Palsy and Neural Development
- Cerebral palsy (CP) is a chronic congenital disorder resulting from abnormal brain development 2.
- The initial injury to the brain in most cases of CP occurs during early fetal brain development 3.
- Prematurity and low birthweight are important risk factors for CP, with intracerebral hemorrhage and periventricular leukomalacia being the main pathologic findings found in preterm infants who develop CP 3.
Stages of Neural Development Affected by Cerebral Palsy
- CP is associated with brain injury that affects movement, posture, and balance, with the movement disorders categorized as spasticity, dyskinesia, ataxia, or mixed/other 4.
- The diagnosis of CP is primarily based on clinical findings, with early diagnosis possible based on a combination of clinical history, use of standardized neuromotor assessment, and findings on magnetic resonance imaging (MRI) 3.
- CP can result in secondary problems, including hip pain or dislocation, balance problems, hand dysfunction, and equinus deformity, requiring a multidisciplinary team approach for management 3, 4.
Treatment and Management of Cerebral Palsy
- Treatments for the movement disorders associated with CP include intramuscular onabotulinumtoxinA, systemic and intrathecal muscle relaxants, selective dorsal rhizotomy, and physical and occupational therapies 4, 5, 6.
- Intrathecal baclofen (ITB) administration via an implanted programmable pump and selective dorsal rhizotomy (SDR) are both used for the treatment of CP spasticity, with SDR leading to improved lower limb spasticity and ambulation in some patients 2, 5, 6.