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| |    Cerebral Palsy by Robert Needlman, M.D., F.A.A.P. reviewed by Laura Jana, M.D., F.A.A.P. When a child does not roll, crawl, or walk at the expected times, one possible explanation is cerebral palsy. Cerebral palsy (also called "CP") is really a group of problems that share two of the features contained in the name: The problem arises in the brain (hence, cerebral) and results in abnormal movement or a lack of movement (hence, palsy, an old term for paralysis). For many people, the words "cerebral palsy" call up fearful images of crippled children. While that picture fits some children with CP, in other cases the only outward sign of CP may be a slight limp. Sometimes CP occurs together with seizures, learning disabilities, or mental retardation. But many children who have CP without those complications are bright--even intellectually gifted. CP is a chronic, often disabling condition, but it is not a disease and it's not contagious. Causes of cerebral palsy While experts once believed that CP was the result of trauma or the cutoff of air during birth, it rarely is. More often, the problem begins before birth with abnormal brain development or damage sustained from infection or a lack of oxygen. Occasionally the brain injury takes place after birth, usually in very ill newborns. The damaged area of the brain does not heal completely, but neither does it get worse over time (unlike Alzheimer's, where brain damage is ongoing). In some children, healthy areas of the brain are able to take over for the damaged areas, and the CP gets better or goes away. In severe cases, however, this rarely happens. Diagnosing CP The first sign of cerebral palsy might be a newborn who does not move one side of the body normally, or a 6-month old who pulls herself along without using her feet, or an 18-month-old who cannot stand steadily. Infants born very premature at extremely low birth weights have a greater risk of CP, and newborn developmental assessments can often pick up the problem early. Any child suspected of having CP needs a thorough neurological assessment, best done by a child neurologist or developmental pediatrician, to make certain there is no other cause for the problem that might be treatable. Often, the evaluation includes some sort of brain scan, either CT (x-ray computed tomography), MRI (magnetic resonance imagery), or ultrasound. Treatments At present, no one knows how to repair the damage to the brain. But a well-coordinated team of therapists can help a child with CP tremendously. Physical therapy can teach her how to use her working muscles to best advantage and avoid crippling muscle contractions in the limbs affected by the CP. Occupational therapy, with the help of devices and training, can allow a child to take care of herself as much as possible and--what is so terribly important for all children--to play. Speech and language therapists can facilitate better communication. Developmental physicians often coordinate the teams and handle medical problems. For additional information, check out these two Internet sites:
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