Cerebral Palsy Patient and Family Resources

• The Guide to Cerebral Palsy (PDF) is a family-centred handbook written for parents and caregivers who have received a recent diagnosis of cerebral palsy for their child. We will give a copy to families during their appointment, when appropriate
• The Cerebral Palsy Association of British Columbia is a non-profit organization in BC. Their  vision is to create a Life Without Limits for people with disabilities. Visit their website for information on education, programs, services, and other resources supporting people living with cerebral palsy and their families

Different parts of the brain control the movement of every muscle of the body. In cerebral palsy, there is damage to, or lack of development in part of the brain. This occurs within the first two years of life.

Symptoms of cerebral palsy can be very different in every child. Children with cerebral palsy may have problems with:

• Motor skills
• Muscle weakness
• Muscle tone (stiffness or abnormally loose)
• Balance
• Awkwardness
• Slowness
• Reflexes
• Learning disabilities
• Speech

These problems can range from mild to severe. In mild cerebral palsy, the child may be slightly clumsy in one arm or leg, and the problem may be barely noticeable. In severe cerebral palsy, the child may have a lot of difficulties in performing everyday tasks and movements.

Effects on the body

The parts of the body affected by cerebral palsy vary greatly from one child to another. Certain words are used to describe the parts affected:

Hemiplegia: the leg and arm on one side of the body are affected (also described as hemiparesis).

Diplegia: both legs are predominantly affected. Children with diplegia usually also have some difficulties with their arm and hand movements.

Quadriplegia: both arms, both legs, and the trunk are affected (also described as quadriparesis). The muscles of the face, mouth and throat can also be involved.

The movement problem

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The Gross Motor Function Classification System (GMFCS) describes the range of abilities in gross motor function seen in children with cerebral palsy. It describes five levels of motor function, emphasizing abilities and limitations in sitting, standing and walking.

• Children with GMFCS levels I and II walk independently
• Children with GMFCS level III require a hand-held mobility aid such as crutches or a walker and may use a wheelchair for distances
• Children with GMFCS levels IV and V have more limitations in self-mobility and require a wheelchair

We can assess GMFCS level accurately from the time a child is two years of age. Knowing a child’s GMFCS level can help the orthopedic team predict the likelihood a child will have specific orthopedic problems as they grow.

Will my child's condition worsen?

No, the damage done to the brain does not become worse. However, as your child grows, it may seem that your child’s condition is changing or becoming worse. It may seem this way for a number of reasons.

The bones in children with cerebral palsy grow more quickly than the muscles. Muscles are stimulated to grow in length by moving and being stretched. This normally occurs throughout the day during a child’s activities and play time.

In children with cerebral palsy, decreased control of muscles and increased muscle stiffness prevent muscles from moving through their full range of motion as easily or as often as other children. Because the bones grow faster than the muscles, the muscles become tight. This is especially true during growth spurts. A problem such as toe walking may become more apparent as the muscles in the heel cord become increasingly tight.

As children grow, their bones develop and change as they begin to use their muscles to move, particularly with standing and walking. This is called bone remodelling.

Because children with cerebral palsy have decreased control of their muscles, have stiffness in their muscles, and/or are delayed in their independent mobility, their bones may not development as expected.

In addition, when bones do not develop as expected, the forces going through a child’s bones when they stand and move are different. These abnormal forces can cause the bones to “remodel” in a way that is not typical.

These changes in the bone may become more noticeable as your child grows. To prevent deformities, we may recommend equipment that supports posture and function from an early age, based on your child’s needs. Examples of equipment include orthotics, mobility aids such as a walker or crutches, standing frames, and wheelchairs with special seating.

The muscles of young children are much larger compared to the size of their body than adolescents or adults. As they grow and gain weight, the force produced by the muscles does not increase as much as their size. This means that standing and walking may require more energy and become more difficult as children grow. For this reason, children should maintain a healthy body weight.