Brain, Nervous System and Mental Conditions
What is cerebral palsy?
Cerebral palsy (CP) is a condition that affects muscle movement. Children with CP may also have difficulties with learning, hearing, seeing and thinking.
The muscles of some children with CP are stiff and rigid. This is called spasticity. Movement is very difficult and often awkward for these children.
Spasticity leads to tight muscles and joints (contractures).
Children with spasticity may also have:
- Dystonia, a movement disorder that causes uncontrollable tightening of the muscles. This may make your child jerk or twist at random times.
- Athetosis, a movement disorder that involves constant twisting and turning of the arms and legs.
Most children who have CP are born with it (congenital cerebral palsy). In a small number of children, CP develops after birth (acquired cerebral palsy).
CP is usually caused by damage to 1 or more areas of the brain. This damage can happen to the developing baby while the mother is pregnant or during birth.
Some causes of CP are:
- Being born early (prematurity)
- Physical injury to the brain, including bleeding into spaces in the brain (ventricles) that make cerebrospinal fluid (CSF)
- Lack of oxygen to the brain (anoxic injury)
Some children have cerebral palsy without any clear cause.
Cerebral palsy is not progressive, meaning the damage to the brain does not get worse over time.
But contractures, twisting and related problems with muscles, joints and bones may worsen. Treatment may help with these effects of CP.
Cerebral palsy affects 1 to 2 children in every 1,000. The condition seems more likely to affect babies that are born early (premature).
Cerebral Palsy at Seattle Children’s
Seattle Children’s offers the most comprehensive care in the Pacific Northwest for children with CP, including nonsurgical treatment options and surgical approaches. We have a dedicated team of doctors, surgeons and therapists with expertise and experience in CP.
- Seattle Children’s brings together pediatric experts from our Neurodevelopmental Clinic, Rehabilitation Medicine, Neurology, Orthopedics, Tone Management Program and Neurosurgery to evaluate your child’s unique needs.
- Doctors and nurse practitioners in the Neurodevelopmental Clinic, Rehabilitation Clinic and Neurology help to diagnose CP and other conditions related to development of the nervous system, including the brain.
- In the Ortho Rehab Clinic, your child sees surgeons who specialize in treating children’s muscles, bones and joints (orthopedic surgeons) and experts who specialize in helping children adapt to conditions that affect their function (rehabilitation doctors and nurse practitioners).
- Our Tone Management Program evaluates and treats babies, children and teens who might benefit from therapy, medicines, surgery or other options to relieve spasticity or dystonia.
- Our neurosurgeons are very experienced in selective dorsal rhizotomy and baclofen pump placement.
- Every child with CP is different. We customize care to help your child and family manage CP and to give your child the best possible function and quality of life now and as they grow.
- Seattle Children’s provides a full range of treatments, from medicines, occupational therapy and braces to surgery – including orthopedic surgery, such as single-event multilevel surgery, and neurosurgery, such as selective dorsal rhizotomy and baclofen pump placement.
- To make sure your child has a full evaluation and receives complete, coordinated care, we will involve experts from across Seattle Children’s.
- Based on your child’s needs, your team may include experts from more specialties and programs, such as our Hand and Upper Extremity Program.
Symptoms of Cerebral Palsy
Cerebral palsy can range from mild to severe. Parents often are the first to notice the early signs, which usually appear before a child is 1 to 2 years old.
You may notice your baby is slow to reach certain developmental milestones, including:
- Rolling over
- Sitting up
Babies with CP may also have trouble feeding.
Some babies with cerebral palsy have more muscle tone than others their age. This makes them seem stiff. Other babies with CP have less muscle tone, which makes them seem floppy.
Diagnosing Cerebral Palsy
Your child’s doctor will most likely schedule a clinic visit to:
- Watch how your child moves (motor skills).
- Ask you about your child’s development and medical history.
- Look for signs of cerebral palsy, including slow development, abnormal muscle tone and stiff or floppy posture.
The doctor may schedule imaging studies to help rule out other disorders and look for brain changes that are typical of CP. These tests include:
- CT (computed tomography) scan to look for areas of damage in the brain.
- MRI (magnetic resonance imaging) to see the brain’s structure.
- Cranial ultrasound, which shows the brain’s structure. It is often used with babies born early because it is easier on the baby than other tests.
After testing, your child’s doctor may ask you to see specialists who can help confirm a diagnosis of cerebral palsy and plan your child’s treatment.
At Seattle Children’s, we coordinate the specialists your child needs.
These may include:
- A specialist in the central nervous system (neurologist)
- A specialist in how the nervous system develops (neurodevelopmental doctor)
- An eye doctor (ophthalmologist)
- An ear doctor (otologist)
- A doctor who specializes in helping children get used to conditions that affect their function (rehabilitation doctor)
Treating Cerebral Palsy
Cerebral palsy can’t be cured. But treatment can help your child move more easily and feel more comfortable.
At Seattle Children’s, many children with CP receive care from a team of experts from Neurodevelopmental, Rehabilitation Medicine, Orthopedics and Neurosurgery. We offer many nonsurgical treatments, as well as surgical options for children who need them.
Nonsurgical treatments for cerebral palsy
Many children with CP have a combination of nonsurgical treatments that help them stay healthy, do what they want and need to do and be more comfortable in their body.
Our Neurodevelopmental team works with your child, your family, your child’s primary care doctor and other specialists to address your child’s nutrition, sleep, behavior and other health issues and to prescribe therapies that can help your child’s function.
The doctors, nurse practitioners and therapists in Rehabilitation Medicine provide a range of options to help with function, including these:
- Physical therapy (such as serial casting and gait training), speech therapy and occupational therapy (including constraint-induced therapy, CIT) to improve your child’s ability to move, speak and perform everyday activities, such as going to school. Learn more about CIT (PDF) at Seattle Children’s.
- Orthotics – braces and other devices that can help with balance, walking and movement.
- Medicines taken by mouth to help relax your child’s muscles.
- Botulinum toxin (Botox) injections and phenol injections to relax muscles. Learn more about Botox (PDF) at Seattle Children’s.
Orthopedic surgery for cerebral palsy
Some children with CP need surgery:
- To release muscles, tendons and ligaments that keep their joints from moving (contractures)
- To prevent contractures from getting worse
- To change the shape of bones deformed by contractures
- To align bones to improve the child’s function, comfort or position, such as how they sit in a wheelchair
The Ortho Rehab Clinic brings together orthopedic surgeons and rehabilitation doctors to evaluate your child and decide whether orthopedic surgery might be helpful along with medicine, therapy, bracing and other treatments.
Seattle Children’s provides a full range of orthopedic surgeries for children with CP, including these:
If daily activities, like getting dressed or writing, are challenging for your child because CP affects their hands and arms, surgery might be an option. Orthopedic and plastic surgeons and occupational therapists work as a team in our Hand and Upper Extremity Program to help children with CP use their hands and arms. For example, surgeons might release muscles, tendons and ligaments in the hand and arm to change your child’s hand position, making daily activities easier.
Often children with CP develop a sideways curve in their spine (scoliosis). Bracing may be used when the curve is small. If bracing is not enough, our orthopedic surgeons offer surgeries to stop the curve from getting worse. For example, if your child develops a curve that makes it hard for them to sit in their wheelchair, we may recommend spinal surgery to make sitting easier. Read more about scoliosis treatment.
High tone in some muscles and lower tone in other muscles may lead to hip problems (hip dysplasia) that cause pain or make it hard to move or sit. The ball of the hip joint may be loose in the hip socket or come out of the hip socket. Our orthopedic surgeons offer surgeries to reshape and realign the ball, socket and pelvis to make your child more comfortable, help with moving or sitting and keep hip problems from getting worse.
If your child has several contractures or deformed bones – such as in their hips, knees, ankles and feet – they might benefit from having surgery to address many or all of these concerns at once. This approach is called single-event multilevel surgery (SEMLS).
SEMLS requires the expertise and careful coordination you will find at Seattle Children’s.
Our Orthopedics and Rehabilitation Medicine teams work together closely to develop a detailed SEMLS plan that is right for your child. We map out every part of your child’s surgery as well as the physical therapy, occupational therapy and other care your child will need after surgery to get the best results. Some children stay in our inpatient rehabilitation unit for intensive therapy after SEMLS.
Neurosurgery for cerebral palsy
If your child needs more relief from spasticity than they can get with nonsurgical treatments, neurosurgery may be an option.
The Tone Management Program evaluates and treats children with spasticity who might benefit from neurosurgery. Rehabilitation and neurosurgery experts work together to understand your child’s needs and to plan and provide their care, including the therapy they will need after surgery.
Neurosurgeons at Seattle Children’s do 2 surgeries to lessen spasticity in children with cerebral palsy.
Selective dorsal rhizotomy is a surgery done on the lower spinal cord to reduce spasticity or high muscle tone in the legs. Certain nerve fibers that lead to high muscle tone are cut.
The goal of SDR is to relax the muscles by finding and cutting those nerve fibers that are causing the abnormal tone. This can improve your child’s ability to move as well as their quality of movement.
Our team of doctors, surgeons and rehabilitation therapists will carefully screen your child, talk with you and get input from your child’s community therapist to decide if this surgery might help your child.
After SDR, we provide intensive inpatient rehabilitation. Then we work with you and your child’s therapists to transition to outpatient therapy to improve your child’s ability to move and control their muscles.
Learn more about selective dorsal rhizotomy.
In this surgery, neurosurgeons place a pump about the size of a hockey puck under the skin in your child’s belly (abdomen). The pump delivers a medicine called baclofen all of the time into the fluid around your child’s spine.
Baclofen relaxes muscles and reduces spasticity throughout your child’s body. Since the medicine goes straight into your child’s nervous system, your child can have a much lower dose than if they took baclofen by mouth. A lower dose reduces side effects, such as feeling too relaxed or sleepy.
Before putting in the pump, we check that baclofen is the right medicine for your child. We use a needle to inject a test dose of baclofen into your child’s spinal canal (lumbar puncture). Then a physical therapist watches for several hours to see how the medicine affects your child’s body.
If you and your child’s team agree that your child can benefit from a baclofen pump:
- The neurosurgeon does surgery to put the pump under the skin of your child’s belly.
- The neurosurgeon attaches a thin tube (catheter) to the pump.
- The neurosurgeon threads the catheter under the skin at waist level to your child’s spine and inserts the catheter into the spinal canal.
- The neurosurgery team fills the pump with baclofen and sets it to deliver the exact amount of medicine your child needs.
- The pump begins slowly releasing the medicine through the tube and into the spinal canal.
The baclofen pump must be filled with medicine every 1 to 6 months, depending on your child’s dose. You can refill it at Seattle Children’s Rehabilitation Medicine or at another medical facility.
The pump lasts about 5 years. Then it must be removed and replaced during another surgery.