Cerebral palsy

Seek urgent medical help for a first seizure, a seizure lasting about five minutes or longer, repeated seizures without recovery, serious breathing difficulty, choking, or a sudden unexplained loss of movement or alertness. Loss of previously acquired skills or a new progressive neurological change also needs prompt specialist assessment because it is not the expected pattern of cerebral palsy.

What is cerebral palsy?

Cerebral palsy (CP) is a group of lifelong conditions that affect movement, balance and posture. It results from abnormal development of, or damage to, the developing brain. The underlying brain disturbance is non-progressive: it does not continue spreading through the brain. However, muscle tone, pain, mobility, communication and other effects can change as a person grows and ages.

CP varies widely. Some people walk independently and need little assistance; others use mobility or communication equipment and need ongoing support. Movement may be mainly spastic (stiff), dyskinetic (involuntary), ataxic (affecting balance and coordination), or mixed. A label alone cannot predict a person's abilities, learning, relationships or quality of life.

Causes and risk factors

Most CP is congenital, meaning that the relevant brain development or injury occurred before or around birth. A smaller proportion is acquired after birth during early brain development, for example after meningitis, encephalitis, stroke or a serious head injury. In many people there is no single identifiable cause, and several pathways may interact. Lack of oxygen during birth accounts for only a minority of cases; parents should not be blamed.

Factors associated with a higher chance of CP include very premature birth, low birthweight, multiple pregnancy, some infections during pregnancy, problems affecting placental or fetal blood flow, neonatal encephalopathy, sepsis, stroke, and severe untreated newborn jaundice. Genetic or developmental differences may also contribute. A risk factor is not a cause: most children with one of these factors do not develop CP, while CP can occur without a recognized risk factor.

Good maternity and newborn care may prevent some developmental brain injuries, but not every case is preventable. Vaccination, infection care, appropriate management of threatened very preterm birth, newborn jaundice checks and child-injury prevention should follow local clinical guidance.

Signs and associated health needs

Early features can include delayed movement milestones, unusual stiffness or floppiness, persistent asymmetry, difficulty controlling the head, unusual posture, involuntary movements, or problems with balance and coordination. These signs are not specific to CP, and mild features may become clear only as more complex skills develop.

Depending on the person, associated needs may involve feeding or swallowing, speech and communication, vision, hearing, seizures, pain, sleep, bladder or bowel function, learning, behaviour or mental health. Contractures, hip displacement, scoliosis and reduced bone strength can develop. None of these affects everyone. Assessment should identify the person's strengths, participation goals and individual health needs rather than assume limitations.

How cerebral palsy is diagnosed

There is no single blood test or scan that confirms CP. Diagnosis is clinical and usually develops through repeated observation of movement and development, a detailed pregnancy, birth and medical history, neurological examination and standardized developmental assessment. Families' observations matter. When a baby or child has concerning movement or developmental signs, referral for evaluation and early support should not wait for a final diagnostic label.

Brain MRI may help investigate the cause, particularly when it is unclear or the pattern is unexpected, but imaging does not determine a person's future abilities. The timing and need for sedation or anaesthesia are decided individually. EEG is used when seizures are suspected. Genetic, metabolic, hearing, vision or other tests are selected from the history and examination rather than ordered routinely for everyone.

Loss of acquired skills, a family history of progressive neurological disease, unexpected focal findings, or examination and imaging that do not fit CP are reasons to reconsider the diagnosis and seek specialist review.

Individualized care and support

There is no cure that reverses the brain disturbance, but timely, goal-directed support can improve comfort, communication, function and participation. A care plan should be developed with the person and family and reviewed as priorities change. It may involve primary care, rehabilitation medicine, paediatrics or neurology, physiotherapy, occupational therapy, speech and language therapy, dietetics, psychology, social services, education and orthopaedic or other specialists.

Movement, daily activity and participation

Physiotherapy and occupational therapy may support mobility, strength, positioning, daily tasks and access to home, school, work and community life. Orthoses, seating, walkers, wheelchairs and environmental adaptations should be fitted to individual goals and reviewed as the body and circumstances change. Adaptive sport and recreation can support enjoyment, fitness and participation when chosen by the person and made safe and accessible.

Communication, eating and swallowing

Speech and language assessment can address speech, language, communication and swallowing. Augmentative and alternative communication may include signing, symbols, communication boards, eye-gaze systems or electronic devices. Feeding and swallowing problems need timely assessment because of nutrition, dehydration, choking and respiratory risks; recommendations should preserve safety, comfort and choice.

Managing muscle tone, pain and other conditions

Spasticity or dystonia is treated only when it causes pain, interferes with care or function, or threatens musculoskeletal health. Options may include physical strategies, orthoses, oral or pump-delivered medicines, or botulinum toxin A for selected focal problems. Benefits, sedation, weakness, swallowing or breathing effects and withdrawal risks differ, so treatment must be prescribed and monitored; do not stop medicines abruptly.

Orthopaedic surgery, intrathecal baclofen or selective dorsal rhizotomy is appropriate only for selected people after expert multidisciplinary assessment. Selective dorsal rhizotomy is irreversible and requires discussion of uncertain long-term outcomes, complications and intensive rehabilitation. Seizures, reflux, constipation, sleep problems, pain, mental-health concerns and other conditions also need their own evidence-based care.

Lifelong monitoring

Regular review can identify pain, contractures, hip or spine changes, bone-health concerns, nutrition and swallowing problems, respiratory illness, seizures, sleep difficulty and emotional wellbeing. A new decline should not automatically be attributed to CP. Adults may experience changing mobility, fatigue or musculoskeletal pain and should have access to reassessment, rehabilitation, accessible preventive care and support for independent living, employment and relationships.

Transition from children's to adult services should be planned rather than ending abruptly. Decisions should include the person as fully as possible and respect communication preferences, privacy and autonomy.

Outlook

Abilities and support needs differ greatly and cannot be predicted from one test or diagnosis. Individual assessment of movement, communication, associated conditions, environment and personal goals is more useful than population percentages. Early support, accessible education and healthcare, appropriate equipment and attention to pain and participation can help people with CP pursue meaningful lives across childhood and adulthood.