Cerebral palsy involves permanent neurological problems resulting from damage to the brain occurring in the antenatal, perinatal and early postnatal periods.
Although it is not a progressive condition, the nature of the symptoms and problems may change as the child grows and develops. There is a massive variation in the severity and type of symptoms, ranging from subtle symptoms to requiring a wheelchair and entirely dependent on others.
Risk Factors
Antenatal
- Maternal infection
- Preeclampsia
- Multiple pregnancy
Perinatal
- Birth asphyxia
- Preterm birth
- Low birth weight
Postnatal
- Meningitis
- Severe neonatal jaundice
- Head injury
Type of Cerebral Palsy
- Spastic: Hypertonia (increased muscle tone) and loss of inhibitory upper motor neurone control (UMN damage)
- Dyskinetic: Problems with dystonia, athetoid movements and oral motor control (damage to the basal ganglia)
- Ataxic: Problems with coordinated movement (damage to the cerebellum)
- Mixed: Mixed problems
Patterns of Spastic Cerebral Palsy
- Monoplegia: One limb affected
- Hemiplegia: One side of the body is affected
- Diplegia: Both legs are affected (arms may also be less severely affected)
- Quadriplegia: Four limbs are affected more severely
Patients with quadriplegia often have associated severe deficits, including speech disturbance and seizures.
Presentation
It is difficult to predict the extent of cerebral palsy or even whether it will occur based on the events in the perinatal period. Children at risk of developing cerebral palsy, such as those with hypoxic-ischaemic encephalopathy, need to be followed up to identify any signs and symptoms that develop.
Signs and symptoms become more evident during development:
- Failure to meet milestones
- Increased or decreased tone, generally or in specific limbs
- Hand preference below 18 months
- Problems with coordination, speech or walking
- Feeding or swallowing problems
- Learning difficulties
Neurological Examination
You can gain a lot of information about a child from their gait:
- Hemiplegic / diplegic gait: Upper motor neurone dysfunction
- Broad-based gait / ataxic gait: Cerebellar dysfunction
- High-stepping gait: Foot drop or a lower motor neurone dysfunction
- Waddling gait: Pelvic muscle weakness due to myopathy
- Antalgic gait (limp): Localised pain
| Finding | Upper Motor Neurone | Lower Motor Neurone |
| Inspection | Muscle bulk preserved | Reduced muscle bulk with fasciculations |
| Tone | Hypertonia | Hypotonia |
| Power | Normal or slightly reduced | Dramatically reduced |
| Reflexes | Brisk | Reduced |
Patients with cerebral palsy may have a hemiplegic or diplegic gait. This gait is caused by increased muscle tone and spasticity in the legs. The leg will be extended with plantar flexion of the feet and toes. They have to swing the leg around in a large semicircle when moving it from behind to in front. There is not enough space to swing the extended leg in a straight line below them.
Patients with cerebral palsy will have upper motor neurone signs, with good muscle bulk, increased tone, brisk reflexes and slightly reduced power. Power may be normal. Look for athetoid movements that indicate extrapyramidal (basal ganglia) involvement. Test for coordination to look for cerebellar involvement.
TOM TIP: Practise recognising the patterns of upper and lower motor neurone lesions. Cerebral palsy is a good condition for examiners to include in OSCEs, as signs are reliable and patients are stable. Key differentials of an upper motor neurone lesion in a child are acquired brain injury, stroke and tumour.
Complications and Associated Conditions
- Learning disability
- Epilepsy
- Kyphoscoliosis (abnormal forward and sideways curvature of the spine)
- Muscle contractures (shortening of muscles, tendons and connective tissue, restricting joint movement)
- Hearing and visual impairment
- Gastro-oesophageal reflux
Management
Cerebral palsy is a permanent condition with lifelong problems. It cannot be cured, but there are many ways to manage the symptoms and maximise function. The focus is on supporting the patient in achieving a fulfilling and independent life wherever possible. Management will involve a multi-disciplinary team approach.
Physiotherapy is used to stretch and strengthen muscles, maximise function and prevent muscle contractures.
Occupational therapy helps patients manage everyday activities, such as getting dressed and using the bathroom. That can involve teaching techniques for performing tasks, making home adaptations, and supplying equipment, such as rails for assistance, or fitting a hoist.
Speech and language therapy can help with speech and swallowing. When swallowing difficulties prevent them meeting their nutritional requirements, an NG tube (short term) or PEG tube (long term) may be required. A PEG tube involves a port to the stomach on the abdominal wall.
Dieticians can help ensure they meet nutritional requirements.
Paediatricians will regularly see the child to optimise their medications. This may involve:
- Muscle relaxants (e.g., baclofen) for muscle spasticity and contractures
- Anti-epileptic drugs for seizures
- Glycopyrronium bromide for excessive drooling
Orthopaedic surgeons can perform procedures to release contractures or lengthen tendons (tenotomy).
Social workers can help with benefits and support.
Charities and support groups provide opportunities to connect with others affected by cerebral palsy and learn and share information on the condition.
Last updated January 2026
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