What is Cerebral Palsy?

Cerebral palsy is the most common childhood physical disability in the United States and throughout the world. There is not a single cause for cerebral palsy, and it is not caused by any specific genetic problem. It is a group of disorders affecting posture, strength and movement that occur as a result of an injury that occurs in the developing brain, typically around the time of birth.

Each child with cerebral palsy is unique. Depending on the location and extent of the injury, it can affect movement, balance, speech, vision and coordination. The damage to the brain may also result in intellectual impairment, seizures, and problems with learning, eating and

Types of Cerebral Palsy

Cerebral palsy can be classified into different types by identifying which limbs are involved, the motor dysfunction experienced by the child, and the child’s capacity for independent mobility. The following classification types include:

Limb Involvement

Limb involvement can be broadly classified as bilateral cerebral palsy, meaning both sides of the body are involved or unilateral, meaning only 1 side of the body is involved. Some terms that are commonly used are:

• Quadriplegia: All 4 limbs are affected or have an impaired ability to move.
• Diplegia: The lower limbs (legs) are significantly more affected than the arms.
• Hemiplegia: Only 1 side of the body’s limbs are affected. This may also be referred to as unilateral cerebral palsy. Often, the arm is more affected than the leg.
• Triplegia: 3 limbs are affected. Usually both legs and one arm are affected.
• Monoplegia: 1 limb is affected. This is the least common type of cerebral palsy.
• Total body involvement: This term is used to describe a person who, in addition to the involvement of 4 limbs, has impairments in speech, vision or cognitive function.

Movement Disorder

This classification of cerebral palsy is described by the most prevalent movement disorder. The most common movement disorder in cerebral palsy is spasticity. Kids with spastic cerebral palsy have muscles that tighten or stiffen and prevents normal fluid movement. In many cases, children with cerebral palsy will have more than 1 movement disorder present. Some of the common movement disorders include:

• Abnormal muscle tone: Muscle tone – or how “tight” muscles are – may be higher or lower than normal. This includes spasticity, rigidity and hypotonia. Damage to the movement control centers of the brain will affect muscle tone.
• Spasticity: Spasticity is high muscle tone, which is worse when a patient is trying to move quickly as opposed to slowly. Moderate or severe spasticity may hinder movement and function and can make muscles and joints tight, leading to contractures.
• Rigidity: Muscles that have rigidity feel heavy and like “a lead pipe” when they are moved passively regardless of how quick or slow the muscle is moving. Rigidity is found in cases of prematurity or near drowning.
• Hypotonia: Hypotonia is low muscle tone. These muscles are often described as loose or “floppy.”
• Involuntary movements: Abnormal involuntary movement is caused by damage to the coordination centers of the developing brain and is referred to as dyskinesia.
• Dystonia: Involuntary, sustained or intermittent muscle contractions that cause twisting and repetitive movements, abnormal postures or both.
• Athetosis: Slow, involuntary writhing movement of face and extremities.
• Chorea: Brief, irregular jerking movements that most commonly begin in the shoulders, neck, trunk and face.

Motor Function

One way to classify cerebral palsy is by examining a child’s capacity for independent mobility (e.g., walking and sitting). The most common classification for mobility is the Gross Motor Function Classification System (GMFCS), and it is divided into 5 levels, I-V, of independent ability based on normal motor milestones – walking, jumping, climbing stairs, etc.

The higher the level of GMFCS, the more affected the child and the less independent mobility they have. GMFCS helps doctors and families understand a child’s current and future motor function, their relative risk for associated problems like scoliosis and hip dislocations, and what equipment, therapy or surgery they might need in the future.

LuskinOIC Takes a Comprehensive Approach to Treating Cerebral Palsy

The Center for Cerebral Palsy at UCLA/LuskinOIC is dedicated to improving motor function in children through a program of early diagnosis, comprehensive assessment and individualized treatment. This includes:

• Access to clinical trials and research on early intervention, surgical techniques and novel treatment modalities in conjunction with UCLA Health.
• Biomechanical assessment of motor impairments in our state-of-the-art Kameron Gait and Motion Analysis Center, where we can analyze the following data:
  • Analysis of community ambulation/activity
  • Biodex – robotic – strength and stiffness testing
  • Comprehensive hip and spine surveillance
  • Gait efficiency and energy expenditure
  • Follow-up of treatment interventions
  • Kinematic and kinetic 3D gait analysis
  • Manual muscle strength training
  • Real-time muscle firing analysis
  • Walking pressures
• Consultations with an orthopedic surgeon, orthotist, developmental pediatrician, physiatrist and physical therapist
• In-clinic orthotic fitting and adjustment
• Neurotoxin (Botox and Dysport) in-clinic injections
• Referrals for therapy, medical equipment, medical specialties including neurosurgery, neurology, gastroenterology, pulmonology, developmental pediatrics, ENT, ophthalmology
• Return appointments offer implementation of care plan
• Surgical spasticity control with Baclofen pump implantation and programming

Causes of Cerebral Palsy

Cerebral palsy may be caused by a multitude of events before, during or after birth that lead to abnormal development or injury to a child’s growing brain. In most cases, the exact cause of cerebral palsy is not known. However, any factor that causes low birth weight or premature birth increases the likelihood of a child being diagnosed with cerebral palsy. Brain damage that leads to cerebral palsy may occur prenatally, or before birth. Less than 10% of cases are the result of oxygen loss during the birth process.

The factors associated with a cerebral palsy diagnosis are:

• Brain malformation
• Brain injury
• Infection or damage to the placenta or fetus
• Infection such as meningitis
• Lack of oxygen to the brain
• Low birth weight
• Maternal dehydration
• Metabolic disorder
• Poor nutrition
• Premature birth
• Prolonged seizures
• Stroke

Though more rare, cerebral palsy can occur to an otherwise healthy child if there is an injury to the brain during early development. Examples of this include:

• Any event which causes lack of oxygen to the brain
• Brain hemorrhage or stroke
• Brain injury following a fall, car accident or non-accidental trauma
• Infection such as meningitis
• Near-drowning accident
• Poisoning
• Prolonged seizures

Common Symptoms of Cerebral Palsy

Signs and symptoms vary greatly. Not all signs are noticeable at birth in every child with cerebral palsy. Symptoms may become more obvious throughout development. Common signs of cerebral palsy include:

• Abnormal muscle tone (too much or too little)
• Exaggerated reflexes
• Gastrointestinal and nutritional problems
• Impaired motor control
• Muscle spasms
• Poor balance
• Seizures
• Stiff muscles
• Vision and perception problems
• Weakness

An Advanced Approach to Diagnosis

Experienced Specialists and State-of-the-Art Technology

At the Center for Cerebral Palsy at UCLA/LuskinOIC, we take the proper steps to identify, diagnose, and treat your child’s cerebral palsy. We perform a comprehensive evaluation by an expert team of doctors and diagnosis is made by the clinical team.

There is no specific test for cerebral palsy. While some centers and specialists use MRI as an aid to diagnosis, there is very poor overlap between current MRI capabilities and CP diagnosis. However, in uncertain cases, we will use MRI infrequently to rule out other causes for motor problems – brain malformations, etc.

Given the lack of specificity in current diagnostic tools, the CCP at UCLA/LuskinOIC is leading two ongoing research studies to improve our diagnostic abilities. One study is evaluating the usefulness of EEG (a non-invasive study that can measure brain activity) in early diagnosis. If you are interested in participating, please contact the CCP. The other study is evaluating newer MRI techniques for diagnosis in mice.

Based on the diagnosis, your doctor might perform additional tests or procedures such as neurotoxin (Botox or Dysport) injections to improve muscle tone and movement. Your child may also be referred to our Kameron Gait and Motion Analysis Laboratory to obtain an in-depth understanding of their movement patterns. The gait analysis provides information to our team to assist in treatment decisions such as orthopedic surgery, physical therapy, bracing or medication.

Individualized Cerebral Palsy Treatment

The goal of treatment for children with cerebral palsy is to improve limitation and prevent complications. This requires a coordinated multidisciplinary team of specialists during your child’s growing years. This team of clinicians at the Center for Cerebral Palsy at UCLA/LuskinOIC will develop an individually designed treatment program tailored to your child’s condition using a combination of strategies aimed at improving quality of life, function and independence. A treatment plan may include:

Therapy

Physical and occupational therapy are important parts of early intervention for children with cerebral palsy and may be a part of your child’s ongoing treatment for many years. Our goal is to help your child grow up to be independent and able to take care of their daily needs.

Surgical Preparedness Program

LuskinOIC/UCLA Center for Cerebral Palsy developed a surgical preparedness program to reduce anxiety in patients and improve outcomes. Learn more about the program & Dr. Rachel Thompson’s special relationship with patient ambassador Scarlett Ferguson.

https://connect.uclahealth.org/2021/08/30/for-kids-with-cerebral-palsy-removing-anxiety-from-trips-to-the-doctor/

Orthopedic Surgery

While we try to limit surgery, many children and adolescents with cerebral palsy require surgery to improve joint mobility, walking efficiency, spinal alignment and hip position. Patients at the Center are seen every 6-12 months, and medical management is optimized to prevent unnecessary surgery. If surgery is necessary, the surgical plan is developed utilizing clinical exam, X-rays and, in some patients, gait analysis. Surgeries are performed at UCLA’s Mattel Children’s Hospital. Appropriate pre-operative assessments are completed at LuskinOIC and UCLA, and post-operative bracing and therapy is offered at UCLA and LuskinOIC.

Spasticity Management

Spasticity is the most common symptom of cerebral palsy. In addition to orthopedic surgery, therapy and bracing, we offer spasticity management treatment options that can increase ease of movement and decrease unwanted muscle activity in children. Those treatments include neurotoxin injections (Botox and Dysport), Intrathecal Baclofen pump (delivers medicine directly into the fluid around the spinal cord) and selective posterior rhizotomy (a neurosurgical procedure to eliminate spastic reflexes) in consultation with our neurosurgery colleagues at UCLA.

Deep Brain Stimulation

A small percentage of children with cerebral palsy have involuntary movement disorders called dystonia or choreoathetosis. Deep brain stimulation, or DBS, has been found effective in treating these disorders. DBS is often described as a “brain pacemaker” which uses strategically placed electrodes to send pulses to the brain to correct the abnormal activity and ease the symptoms of dystonia and choreoathetosis. The orthopedic surgeons at LuskinOIC do not perform this procedure, but they work closely with the pediatric neurosurgeons at UCLA, who have the expertise to perform these treatments, which can result in a better quality of life for your child and your family.