The Early Years: Understanding cerebral palsy

Cerebral palsy is an umbrella term that refers to a group of disorders affecting a child’s ability to move. It occurs as a result of damage to the developing brain either during pregnancy or shortly after birth. Cerebral palsy affects children in different ways and can affect body movement, muscle control, muscle coordination, muscle tone, reflexes, posture and balance. Although cerebral palsy is a life span condition and cannot be cured, every child with appropriate care and necessary supports can live a fulfilled life.

Cerebral palsy is the most common physical childhood disability and is more common among boys than girls. Over 60 per cent of children with cerebral palsy walk independently and are independent in most life skills. Some children with cerebral palsy may have epilepsy; vision, speech and hearing impairments and/or behaviour issues. All children with cerebral palsy have a right to and gain tremendously from early intervention and inclusive education.

Early child development is a powerful determinant of health in adult life as indicated by the strong relationship between measures of educational attainment and adult disease. The period of child development from birth to age five years is critical for normal brain development and establishment of a foundation for adult cognitive and emotional function. Because access to resources mediates the effects of childhood impairments including cerebral palsy, early intervention including nurturing care, cognitive stimulation, adequate nutrition, health, safety and security is crucial for a child with cerebral palsy.

The aim of early childhood intervention is to encourage the child to develop his/her gross and fine motor skills, self-help skills, social emotional skills, thinking and creative play skills. Some children who have mild cerebral palsy will have no problems with this. Others may need consistent assistive technology and appropriate assistance and in some with severe difficulties, considerable assistance from others may be needed. It is important to encourage and allow the child to do as much as possible for him or herself.

Early signs of cerebral palsy

From birth to five years of age, a child should reach movement goals―also known as milestones―such as rolling over, sitting up, standing and walking. A delay in reaching these movement milestones could be a sign of CP. It is important to note that some children without CP also might have some of these signs. The following are some other signs of possible CP.

In a baby 3 to 6 months of age:

• Head falls back when picked up while lying on back.
• Feels stiff.
• Feels floppy.
• Seems to overextend back and neck when cradled in someone’s arms.
• Legs get stiff and cross or scissor when picked up.

In a baby older than 6 months of age:

• Doesn’t roll over in either direction.
• Cannot bring hands together.
• Has difficulty bringing hands to mouth.
• Reaches out with only one hand while keeping the other fisted.

In a baby older than 10 months of age:

• Crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg.
• Scoots around on buttocks or hops on knees, but does not crawl on all fours.

The earlier these signs are identified the earlier intervention can and should be initiated. Ensuring transition into a regular play school at three years and into a regular K-12 School at six years will provide remarkable opportunities for the child’s development and education.

(The writer is an occupational therapist.)