Cerebral Palsy

Cerebral palsy is a group of neurological disorders that begin in infancy or early childhood and that mainly affect the body’s ability to move. Cerebral palsy is caused by damage to the developing brain before, during, or shortly after birth.

Overview

Cerebral palsy is a group of neurological disorders that begin in infancy or early childhood and mainly affect the body’s ability to move. In more severe cases, cerebral palsy may also be associated with other developmental disabilities.

Cerebral palsy is the leading cause of childhood disability in the United States. The severity of the disability differs from person to person. Some people with cerebral palsy may not be able to walk and need intensive, lifelong care, while others can walk and move with little or no help.

Signs and symptoms usually appear in infancy or early childhood and last throughout a person’s life. Cerebral palsy is not progressive, which means the underlying cause does not worsen over time. However, symptoms can change over time and sometimes get worse as a person ages.

There is no cure for cerebral palsy, but the brain can adapt to brain injury from cerebral palsy, especially in childhood. Therapy can help improve movement and function. For example, over time, people may learn new ways to move and manage daily tasks, use assistive tools or therapies, and adjust their expectations and coping strategies.

Signs and Symptoms

Symptoms of cerebral palsy vary in type and can range from mild to severe. Symptoms can also change over time. All people with cerebral palsy have problems with movement and body position (posture).

Common symptoms include:

  • Ataxia (loss of muscle coordination when making movements)
  • Spasticity (stiff or tight muscles; jerky, repeated movements; and stronger-than-normal reflexes)
  • Weakness in one or more arm or leg
  • Unusual walking style, including walking on the toes, a crouched gait, or a “scissored” gait
  • Muscle tone that is either too stiff or too loose
  • Drooling
  • Trouble with swallowing or speaking
  • Shaking (tremors) of the arms, legs, hands, or feet
  • Sudden, uncontrolled movements
  • In infants and toddlers, delays in motor skills such as sitting, crawling, and walking
  • Trouble with precise movements such as writing or buttoning a shirt

Many of these symptoms result from problems with nerves and muscles, not from problems with thinking or cognition. For example, a person with cerebral palsy may have trouble speaking because they cannot control the muscles involved in speaking — not because of brain problems with language.

In addition to movement problems, symptoms sometimes include:

  • Developmental or intellectual disabilities
  • Epilepsy
  • Delays in growth and development
  • Problems with the spine, including scoliosis
  • Osteoarthritis
  • Problems with hearing and vision
  • Speech and language difficulties
  • Incontinence

Early signs of cerebral palsy

Signs of cerebral palsy usually appear in the first few months of life, but many children are not diagnosed until age 2 or later. General early signs include:

  • Developmental delays: A child is slow to reach developmental milestones such as rolling over, sitting, crawling, and walking. Developmental delays are the main clues that a child might have cerebral palsy.
  • Abnormal muscle tone: Body parts are too loose or too stiff.
  • Abnormal posture: A child might use one side of the body more than the other when reaching, crawling, or moving.

Age-Specific Signs of Cerebral Palsy

Some age-specific signs may include:

Infants younger than 6 months:

  • Cannot hold up their head when picked up from lying on their back
  • May feel stiff or loose
  • When picked up, their legs tighten or cross over each other
  • When held, they may overextend their back and neck, constantly acting as though they are pushing away

Infants older than 6 months:

  • Cannot roll over
  • Cannot bring their hands to their mouth
  • Have a hard time bringing their hands together
  • Reach out with only one hand while holding the other in a fist

Infants older than 10 months:

  • Crawl in a lopsided way, pushing with one hand and leg while dragging the opposite hand and leg
  • Scoot around on their bottom or hop on their knees but do not crawl on all fours
  • Cannot stand even when holding onto support

Children without cerebral palsy may also show some of these signs. If you notice any of these signs, talk to your child’s healthcare provider.

Types of Cerebral Palsy

Doctors classify cerebral palsy according to the type of movement disorder involved. There are several different types.

Spastic Cerebral Palsy

Spastic cerebral palsy is the most common type. There are three subtypes:

  • Spastic hemiplegia or hemiparesis affects arms, hands, and sometimes legs on only one side of the body. Children with this form of cerebral palsy may have delays in learning to talk, but their cognitive abilities are usually not affected. People with this type of cerebral palsy usually walk on their tiptoes and start walking later than other children without cerebral palsy. Their arms and legs on the affected side are often shorter and thinner than limbs on the other side.
  • Spastic diplegia or diparesis causes muscle stiffness mainly in the legs compared to the arms and face. People with this type of cerebral palsy often have tightness in their leg muscles and may need a walker or leg braces. Cognitive abilities and language skills are usually normal compared to people without cerebral palsy.
  • Spastic quadriplegia or quadriparesis is the most severe form of cerebral palsy, causing severe stiffness of the arms and legs and a loose or weak neck. People with this type of cerebral palsy are usually unable to walk and often have trouble speaking. This form may affect intellectual development and cause other disabilities. Frequent seizures may not respond well to medicines.

Dyskinetic Cerebral Palsy

Dyskinetic cerebral palsy Involves slow and uncontrollable, jerky movements of the hands, feet, arms, or legs. Face and tongue muscles may be overactive, causing some children to drool or make certain types of facial movements. People with this type of cerebral palsy often have trouble sitting straight or walking, and cognitive abilities are affected in rare cases.

Ataxic Cerebral Palsy

Ataxic cerebral palsy affects balance and depth perception. People with ataxic cerebral palsy walk in an unsteady manner and have a hard time with quick or precise movements such as writing, buttoning a shirt, or reaching for a book.

Mixed Cerebral Palsy

Mixed cerebral palsy is when a person has symptoms that don’t match any single type of cerebral palsy but are a mix of types. For example, a child with mixed cerebral palsy may have some muscles that are too tight and others that are too relaxed, creating a mix of stiffness and looseness.

Related Health Effects

In addition to the main symptoms, people with cerebral palsy sometimes have related conditions:

  • Intellectual and developmental disability (IDD): Up to one-half of people with cerebral palsy have IDD.
  • Seizures and epilepsy: About half of all children with cerebral palsy have one or more seizures during their lifetime.
  • Delayed growth: Children with moderate to severe cerebral palsy are often very small for their age.
  • Malnutrition: Because people with cerebral palsy can have trouble swallowing, sucking, or feeding, it can be hard to get proper nutrition or eat enough to gain or maintain weight.
  • Dental problems: Some people with cerebral palsy may have movement problems that prevent them from being able to take care of their teeth.
  • Heart and lung problems: People with cerebral palsy are at higher risk of heart and lung disease and pneumonia.

Health Challenges for Adults with Cerebral Palsy

Although cerebral palsy diagnosis and treatment often focus on children, adults with cerebral palsy can develop unique health problems that may get worse with age.

  • Premature aging: Most people with cerebral palsy experience some form of early aging by the time they reach their 40s because of the extra stress and strain the condition puts on their bodies.
  • Depression: The rate of depression is three to four times higher in people with disabilities such as cerebral palsy than in the general population.
  • Post-impairment syndrome: This syndrome involves a combination of pain, fatigue, and weakness due to problems with muscles and bones. Overuse injuries and arthritis are common. People with cerebral palsy may use up to five times the amount of energy that people without cerebral palsy use when they walk and move, making them tired.
  • Skin breakdown: Limited movement, muscle tightness, and extra pressure on certain areas of the body can damage skin.
  • Other medical conditions: Adults with cerebral palsy have higher rates of high blood pressure, and trouble swallowing and going to the bathroom.

Causes and Risk Factors

Cerebral palsy is caused by damage or abnormal development in the parts of the brain that control movement. These events can happen before, during, or shortly after birth, or in the first few years of life when the brain is still developing. In many cases, the exact cause is not known.

Congenital Cerebral Palsy

The majority of children with cerebral palsy are born with the condition, called congenital cerebral palsy. Causes that occur before birth include:

  • Damage to the white matter of the brain: The brain’s white matter protects and insulates nerve cells that send signals throughout the brain and the rest of the body. The white matter in a fetus’s brain is more sensitive to injury between 26 weeks and 34 weeks of pregnancy, but damage can happen at any time during pregnancy.
  • Abnormal brain development: Disruptions in the fetus’s brain’s growth can cause problems with brain communication. Infections or fever during pregnancy, fetal injury, or gene changes (mutations) can cause the developing brain to develop abnormally.
  • Bleeding in the brain: Conditions that affect blood flow to the brain include having a stroke, blood clotting problems, abnormally formed blood vessels, and heart defects.
  • Lack of oxygen in the brain: A mother’s very low blood pressure during pregnancy, a torn uterus, detachment of the placenta, problems with the umbilical cord, or severe trauma to an infant’s head during labor and delivery can prevent oxygen from reaching the brain.

Some events or medical problems during pregnancy can increase the risk of congenital cerebral palsy:

  • Low birth weight or preterm birth: Infants born before 37 weeks of pregnancy and infants who weigh less than 5.5 pounds at birth are at greater risk for cerebral palsy. The earlier the birth and the lower the birthweight, the greater the risk.
  • Multiple gestations: Twins, triplets, and other multiple births are at higher risk for cerebral palsy. The risk is also greater for an infant whose twin or triplet dies before or shortly after birth.
  • Infertility treatments: Infants born from pregnancies resulting from certain infertility treatments are at higher risk for cerebral palsy, partly because these treatments are more likely to cause preterm birth and multiple pregnancies.
  • Infections during pregnancy: Infection with parasites, rubella (German measles), cytomegalovirus, Zika virus, and herpes can infect the womb and placenta, leading to brain damage in the fetus.
  • Fever during pregnancy: Fever in the mother during pregnancy or delivery can sometimes lead to brain damage in the fetus.
  • Rh blood factor mismatch: If a mother’s Rh factor differs from that of the fetus, her immune system may attack blood cells of the fetus, including in the brain, which can lead to brain damage.
  • Exposure to toxic chemicals: A fetus is at higher risk for cerebral palsy if a mother is exposed to a toxic substance during pregnancy, such as high levels of methyl mercury (found in some thermometers and in some seafood).
  • Maternal medical conditions: These include abnormal thyroid function, intellectual and developmental disability, too much protein in the urine, and seizures.
  • Complicated labor and delivery: Infant heart or breathing problems during labor and delivery and immediately after birth increase risk for cerebral palsy.
  • Yellowing of the skin and eyes: Severe, untreated jaundice caused by a buildup of bilirubin in the blood because the liver can’t clear it can damage the brain and cause cerebral palsy.
  • Seizures: Infants who have seizures are more likely to be diagnosed with cerebral palsy later in childhood, probably because of an underlying genetic syndrome.

Acquired Cerebral Palsy

A small number of children have acquired cerebral palsy, meaning the disorder begins more than 28 days after birth. Causes may include:

  • Brain damage in the first few months or years of life
  • Infections, such as meningitis or encephalitis
  • Problems with blood flow to the brain due to stroke, blood clotting problems, abnormal blood vessels, a heart defect present at birth, or sickle cell disease
  • Head injury from a car accident, a fall, or child abuse

Risk factors for acquired cerebral palsy include:

  • Preterm birth or low birthweight
  • Not getting certain vaccinations: Childhood vaccinations can prevent brain infections that can cause cerebral palsy
  • Injury: Not taking safety precautions for infants or lack of adult supervision can lead to injury that can cause cerebral palsy

Prevention Guidance

While cerebral palsy is not a genetic disorder, certain genetic factors are thought to increase the risk. Cerebral palsy related to genetic abnormalities cannot be prevented, but some risk factors can be managed or avoided.

Steps that may help reduce the risk of cerebral palsy include:

  • Good care and support during pregnancy, since cerebral palsy is associated with preterm and low birth weight infants
  • Getting vaccinated against rubella (German measles) before becoming pregnant, since rubella is preventable with vaccination
  • Using safety equipment to prevent head injuries that can cause acquired cerebral palsy, such as correctly installed car seats for infants and toddlers and helmets during certain activities

Diagnosis

Most children with cerebral palsy are diagnosed before age 2. If symptoms are mild, a healthcare provider may not be able to make a diagnosis until age 4 or 5.

During regular well-baby and well-child visits, a child’s healthcare provider will examine:

  • Growth and development
  • Muscle tone
  • Control of movement
  • Hearing and vision
  • Posture
  • Coordination and balance

If a healthcare provider finds signs of cerebral palsy during an examination, they may use one or more brain scanning methods to look for damage in the brain. These methods may include:

  • Ultrasound: Used most commonly in high-risk babies born before full term to take pictures of the brain. Ultrasound is not as detailed as other scanning methods, but it is the safest way to look at the brains of these infants.
  • Computed tomography (CT): CT uses X-rays to take pictures of the brain and show damaged areas.
  • Magnetic resonance imaging (MRI): MRI creates an image of the brain. It can show the location and type of damage in better detail than CT.
  • Electroencephalogram (EEG): If a child has had seizures, a healthcare provider may order an EEG scan test to rule out another disorder such as epilepsy. This scan involves measuring the brain’s electrical activity.

A healthcare provider who thinks a child may have cerebral palsy may refer them to specialists such as a pediatric neurologist, a developmental pediatrician, or eye or hearing doctors, depending on the child’s symptoms. These specialists can help give a more accurate diagnosis and create a treatment plan.

Treatment and Management

Cerebral palsy cannot be cured, but treatment can help improve a child’s abilities. There is no standard therapy that works for every person with cerebral palsy. The earlier treatment begins, the better chance children have of adapting to developmental disabilities.

Although initial brain damage from cerebral palsy cannot be reversed, earlier and more aggressive treatments may help improve function and support the developing nerves, muscles, and bones. Talking with healthcare providers and school staff can help families develop personalized care and treatment programs.

Physical and Occupational Therapy

Physical therapy is one of the most important parts of cerebral palsy treatment. A child with cerebral palsy usually starts physical therapy in the first few years of life or soon after being diagnosed. Exercises and activities can maintain or improve muscle strength, balance, and movement and prevent muscles from shortening.

Other therapies include:

  • Occupational therapy: Helps a child learn to do everyday activities such as dressing and going to school, and helps families manage routines at home, school, and in the community
  • Recreational therapy: Participation in art programs, cultural activities, and sports can help improve a child’s physical and intellectual skills
  • Speech and language therapy: A speech therapist can help a child learn to speak more clearly, help with swallowing problems, and teach new ways to communicate — such as using sign language or a special communication device

Medicines

Several medicines can help manage symptoms in people with cerebral palsy. Medicines that can relax stiff muscles include diazepam, baclofen, dantrolene sodium, and tizanidine. These medicines work best for children with mild muscle or body stiffness.

Botulinum toxin (commonly known as Botox), which is injected directly into muscles, is often used in children with spastic cerebral palsy. This medicine treats symptoms for about three months and works best when a person with cerebral palsy has physical therapy and arm or leg braces.

Baclofen, a medicine that relaxes muscles, can be injected by a pump into the fluid around the spinal cord. The pump can be adjusted if muscle tone is worse at certain times of the day or night and works best for people with cerebral palsy who have long-lasting, severe stiffness or uncontrolled muscle movement throughout their body.

For children who have cerebral palsy and epilepsy, standard medicines to control seizures might be used, but they can affect the developing brain.

Surgery

Surgery is often recommended for people with cerebral palsy who have muscle stiffness bad enough to make walking difficult or painful. Surgeons can make muscles and tendons longer to make it easier and less painful to move. Surgery can also correct or greatly improve changes in the shape of the spine. Sometimes, if other treatments have not worked, a surgeon can cut certain nerves to treat abnormal muscle movements.

Orthotic and Assistive Devices

Orthotic devices, including braces, splints, and casts, can help affected limbs with movement and balance. Other mobility devices include wheelchairs, rolling walkers, and powered scooters.

Assistive devices and technologies, such as computer-based communication machines, Velcro-fastened shoes, and crutches, can help make daily life easier for people with cerebral palsy. Some people with cerebral palsy may need glasses, surgery to correct vision problems, or hearing aids for hearing issues.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on cerebral palsy.

Find Treatment

The American Academy for Cerebral Palsy and Developmental Medicine focuses on the scientific education of health professionals and researchers who treat and study childhood disabilities. You can find a healthcare provider through their website.

Community Support

The following organizations provide information and support for people with cerebral palsy and their families:

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.  

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.  

Much of what we now know about cerebral palsy came from NIH-sponsored research, including:

  • The identification of new causes and risk factors for cerebral palsy
  • The discovery of medicines to control stiff muscles and more precise methods to deliver these treatments
  • Improved surgical techniques to correct muscle and bone problems
  • A better understanding of how and why brain damage during pregnancy causes cerebral palsy in a developing fetus

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.