Cerebral palsy (CP) is a physical impairment that affects movement and motor skills. It is caused by abnormalities in the developing brain, often before birth. Common causes include low birth weight, premature birth, infections, and lack of oxygen. CP affects areas like the cortex, basal ganglia, and cerebellum. It can cause spasticity, ataxia, or dyskinesia. Symptoms vary from mild to severe and may include issues with mobility, muscle tone, coordination, speech, and secondary effects like pain, fatigue, and depression. As people with CP age, secondary effects can worsen earlier than normal. Challenging behaviors are also common, especially for those with intellectual disabilities or

1. CEREBRAL PALSY
SUMMARY
 What is it?
 How common is it?
 The development of cerebral palsy.
 Why does it happen?
 Contributing factors or cause.
 What happens physically.
 The main effects.
 How cp affect development.
 Areas of the brain affected.
 Parts of the body affected.
 Getting older.
 Secondary ageing effects.
 Depression and cp.
 Challenging behaviour and cp.
 Risk factors.

2. What is it?
 Cerebral palsy (cp) is not a disease or an illness.
 It is the description of a physical impairment that
affects movement.
 The movement problems vary from barely
noticeable to extremely severe.
 It is as individual as people themselves.

3. How common is it?
 In recent years there has been a slight increase
in the proportion of children who have cp.
 Currently about one in every 400 child is
affected.
 Among these, the percentage of severely and
multiply disabled people needing support is
growing.
 those people will need continue need support
throughout their lives.

4. How common is it?
 There has never been a single explanation of
what cerebral palsy is.
 1984 P. Scrutton wrote, “The almost infinite
variety (and the lack of common language to
describe this variety accurately) makes learning
about it very difficult indeed.”
 It is not specific condition - unlike Down’s
Syndrome for example, which is an identifiable
chromosomal disorder.

5. How common is it?
Cerebral palsy can be defined as “a
persistent disorder of movement and
posture, as the result of one or more non-
progressive abnormalities in the brain.”

6. The development of cp
 The characteristics of the motor disorder, the way
the person is affected and muscle tone may alter
significantly, particularly during the early years of
life.
 In the first few months any potential difficulties
may not be immediately obvious.
 It is possible for some signs not to show until the
child is between 12 and 18 months or older.

7. Why does it happen?
 Studies suggest that cerebral palsy is due
mostly to factors affecting the brain before
birth.
 It is commonly the result of one or more
abnormalities in the brain, before growth
and development are complete.

8. Contributing factors or cause
 Some of the factors associated with the incidence of
cerebral palsy are:
• Low birth-weight
• Premature birth
• Multiple births
• Asphyxia (lack of oxygen)
• Infection
• Cerebral bleed
• Infection in the early part of pregnancy;
• Infection or accident in the early years of a child’s life.
There may also be a genetic link, but this is quite rare.

9. What happens physically?
 The brain impairment is
non-progressive.
 It is not necessarily that
the physical capacity and
function will remain the
same throughout the life.
 Can be maturational,
developmental or aging
changes, that can affect
the individual’s ability.

10. What are the main effects?
 Cerebral palsy is primarily a disorder of voluntary
movement and co-ordination, due to a defect or
lesion of the immature brain.
 Because of other areas of the brain may also
have been affected there is a possibility of
‘associated’ or ‘related’ difficulties such as
sensory or perceptual impairment.
 Other associated difficulties may include learning
difficulties or epilepsy (seizures).

11. How can cp affect development
 The brain ‘learn’ how to position and focus the
eyes, make noises and sounds, chew food,
control the muscle used when going to the toilet
and those used for breathing.
 Growing babies and children have to learn to use
many other muscle besides those concerned with
the co-ordination and movement of arms, legs,
trunk, and so on.

12. Areas of the brain affected
 Cortex:
Spastic cerebral palsy
(spasticity). Disorder
control of movements.
• Increase muscle tone
or hypertonia.
• Some muscle become
very stiff and weak.

13. Areas of the brain affected
 Basal Ganglia:
Athetoid cerebral palsy
(athetosis).
• Also called Dyskinetic cerebral
palsy.
• Usually comprises slow
writhing.
• Loss of control of the posture.
• Tend to make unwanted
movements.
• Involuntary spasms,
• jerky arm and leg
movements.

14. Areas of the brain affected
 Cerebellum:
Ataxia cerebral palsy (ataxia).
• Disordered movements.
• Short and jerky movements.
• Often muscle tone is normal
or decreased.
• Shaky hand movements.
• irregular speech.
• Unsteady walking.
• Problem with balance.
• Spatial awareness.

15. Parts of the body affected:
 Diplegia
Is where both legs are
affected more than
the hands and arms.

16. Parts of the body affected:
 Hemiplegia
One side of the body
(including arm and
leg) is affected.

17. Parts of the body affected:
 Quadriplegia/Tetraplegia
All four limbs are involved, usually trunk and
neck.

18. Getting Older
 For those who have lived a lifetime with a
physical impairment, the effects of ageing
can become apparent earlier than
expected.
 Cerebral palsy is an example of
developmental disorder in which physical
functioning can deteriorate with ageing as
a result of poor mechanical efficiency.

19. Getting Older
 What is clear is that people with cerebral
palsy age in the same way as non-disable
people (primary ageing) but some people
with cerebral palsy may also experience
secondary ageing effects.
 These are likely to be long-term effects of
the original impairment.

20. Secondary Ageing Effects
 Unfortunately the effects of cp can bring
problems of secondary ageing much
earlier than in the general population.
 Following are some of the more common
problems reported by people in their
thirties and forties or, sometimes, a little
earlier.

21. Secondary Ageing effect in cp
 Increased levels of pain and discomfort.
 Osteoarthritis (pain and stiffness in the joints).
 Increase in spasms.
 Increase in contractures (shortening of muscles).
 Less efficient motor control (body parts involved in
movements).
 Joint problems.
 Tight muscles.
 Gastro-intestinal (digestive system) problems.
 New back pain and increase in back pain.
 Emergence / increase in incontinence.
 Loss of joint flexibility.
 Reduced energy levels and fatigue.

22. Depression and cp
 Sometimes changes of mood can be related to
depression in a person who has cerebral palsy.
 Depression is twice as common in women, with
men being more likely to show anti-social
behaviour.
 In some cases of depression a review of the
person’s lifestyle can be helpful but for others,
anti-depressant drugs or counselling may be
necessary.

23. Challenging behaviour an cp
 There are four main categories of challenging behaviour and
actions can range from moderate to severe.
 Self-injurious behaviour includes had-banging, scratching, pulling, eye
poking, picking, grinding teeth, eating non-foodstuffs.
 Aggressive behaviour toward others includes biting and scratching,
hitting , pinching, grabbing, hair pulling, throwing objects, verbal abuse,
screaming, spitting.
 Stereotyped behaviour including repetitive movements, rocking,
repetitive speech, and repetitive manipulation of objects.
 Non-person directed behaviour includes damage to property,
hyperactivity, stealing, inappropriate sexualised behaviour, destruction of
clothing, incontinence, temper tantrums, lack of awareness of danger
withdrawal.

24. The link between cp and challenging
behaviour
 A large proportion of people with cerebral palsy also have a learning
disability.
 Many people will also have a severe cognitive impairment, which means
they cannot reason well or understand their environment fully.
The most common aims of challenging behaviour are:
 Self-stimulation
 Gaining the attention of others
 Avoidance
In most people who have severe learning disability, these behaviour are
not premeditated and are not designed to purposely upset.

25. Risk Factors
Three significant indicators for challenging
behaviour in cerebral palsy can be indentified.
These are:
 Damage to the nervous system
 Learning disability
 Epilepsy (especially if poorly controlled)

26. Risk Factors
Additional factors are:
 Age (reaching a peak between age 15 – 34 with a reduction in challenging
behaviour in the mid-thirties).
 Gender (men exhibit more challenging behaviour than women).
 Multiple disabilities.
 Communication difficulties.
 Challenging behaviour is not unusual especially where someone cannot
communicate effectively.
 Challenging behaviour can, however, occur across the whole range of
intelligence and can be severe in people with mild or no intellectual
disability with cp, mainly out of sheer frustration.

27. Cerebral palsy
Luciano Souza
Psychology student
lucianosouza77@hotmail.co.uk
August 2013 - UK