Cerebral palsy (CP) is a lifelong neurological condition that disrupts the development of movement and posture, causing limitations in normal function. CP affects approximately 17 million people across the globe, a prevalence of approximately 2 in every 100 births.
Unlike other conditions, CP is diagnosed within the first two years of life. The condition occurs in either fetal or infancy stages of development when there is an event that causes either a lack of oxygen supplied to the brain, an infection, trauma, or premature birth. Those with CP experience impairments in movement, as well as sensations, perception, cognition, communication, and behavioural deficits.
CP can be categorized into four different motor types: spastic (70-80%), ataxic (6%), dyskinetic (6%), and mixed types. Spastic presents with the person’s muscles appearing stiff and rigid, this form is a result of damage to the Motor Cortex of the brain. Dyskinetic arises from damage in the Basal Ganaglia (located in the brain), and is characterized by involuntary movement. Those with an ataxic form of CP present with shaky movements and is often accompanied by poor balance and proprioception. This form of cerebral palsy comes from damage in the Cerebellum of the brain. Each form of CP can either affect all limbs (quadriplegia), both legs (diplegia), or both arms and legs on one side of the body (hemiplegia). Motor function can be assessed in children by using the Gross Motor Function Classification System (GMFCS); categorizing gross motor skills into five different categories that is based on their performance at home, school, or within their community. The GMFCS aids in prognosis, education, treatment, and resource allocation for the individual and their family, making early detection an indicator for better outcomes.
The five categories of the GMFCS are marked as follows:
- Level I – Children can perform gross motor tasks (ex: running and jumping), but their ability to balance, change/control speed, and coordination are impaired. No gait aid is needed.
- Level II – Children may have difficulties with walking far distances, need railings to climb stairs, or have difficulties maintaining balance on uneven surfaces. Gross motor abilities are minimal, often presents in impairments in running or jumping. They likely use a handheld mobility aid or wheeled mobility for longer durations or distances.
- Level III – Typically children in this level will walk using a hand-held mobility aid for short distances, and wheeled mobility for longer. Will often self-propel for shorter distances and use hands to hold onto railings.
- Level IV – Children are dependent on powered and/or wheeled mobility methods, some requiring a person to assist. Around home they walk short distances, but in the community they use a manual or powered wheelchair.
- Level V – Children categorized in this level use a manual wheelchair as their means of transport in all settings. Children are limited in maintaining both upright trunk positioning and control of extremities.
As mentioned, early intervention has been proven most effective. Treatments that are most beneficial are active, functional, and goal directed. Physiotherapists, speech language pathologist, and occupational therapists are three key players in a person’s rehabilitation. By working with a physiotherapist, treadmill work, strength training, and aerobic exercise training have all demonstrated positive outcomes. Often, those with CP have an array of speech deficits – ranging from being unable to talk to troubles with enunciation. A speech language pathologist (SLP) works to enhance one’s speech, language, communication, and swallowing abilities. As well, an occupational therapist is beneficial in aiding families with equipment, programs, and forms of cognitive therapy.
Though cerebral palsy is a lifelong condition, our brains are resilient and adaptable (neuroplastic). Targeted rehabilitation can assist the brain in creating new pathways for better gait, balance, coordination, and overall quality of life.
• Registered Kinesiologist • Surrey Neuroplasticity Clinic, RK
Grecco LA, Zanon N, Sampaio LM, Liviera CS. A comparison of treadmill training and over ground walking in ambulant children with cerebral palsy: randomized controlled clinical trial. Clin Rehab 2013; 27(8):686-96.
Hanna SE, Rosenbaulm PL, Bartleett DJ, Paisano RJ, Walter SD, Avery L, Russell DJ. Stability and decline in gross motor function among children and youth with cerebral palsy aged 2 to 21 years. Dev Med Child Neurol. 2009; 51: 295-302.
Novacheck TF, Trost JP, Sohrweide S. Examination of the child with cerebral palsy. Childs Nerv Syst 2007; 23: 1015-1031.
Novak I, McIntyre S, Morgan C et al. A systematic review of the interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol 2013; 55: 885-910.
Rodda J, Graham KH. Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm. Eur J Neurol 2001, 8: 98-108
Verushurun O, Ketalaar M, Takken T, Helders PJ, Gorter JW. Exercise programs for children with cerebral palsy: A systematic review of the literature. Am K of Phy Med Rehab 2008; 87:404-417