Cerebral Palsy Attorney in Houston

What is cerebral palsy?

Cerebral palsy (CP) is an umbrella term referring to a group of disorders that affect a child’s ability to move and maintain posture and balance. The National Institutes of Health defines cerebral palsy as a group of neurological disorders appearing in infancy or early childhood that permanently affect muscular coordination, balance and body movement.

Children with cerebral palsy experience motor impairments, which can range from mild to very severe. They may also have cognitive (thinking) or intellectual impairments, speech impairments, seizures and problems with vision and hearing.

There are different classifications of cerebral palsy depending on the parts of the body that are affected, the types of motor abnormalities and the severity of the abnormalities.

Spastic CP

Spastic cerebral palsy is the most common type of CP. Children who have spastic cerebral palsy may look stiff and their movements may be jerky and uncontrolled. Spasticity is a form of “hypertonia,” or increased muscle tone. In cerebral palsy, spasticity is caused by damage to the brain’s motor cortex before, during or shortly after birth.

Normally, muscles have enough tone to maintain a person’s posture or to move with appropriate flexibility and speed of movement. The commands from the brain to tense and increase muscle tone, or to relax and decrease muscle tone, travel between the brain and the muscles via nerves. In order for muscles to function normally, the commands back and forth must be well coordinated. In a child with cerebral palsy, there is damage to the parts of the brain that control this coordination of nerve impulses and movement. As a result, many of the muscles are too tense or spastic.

The spastic forms of CP have variable expressions. They may be symmetric, which means that both sides of the body (left and right) are affected, or asymmetric where only 1 side (right or left) is affected. It may involve 1 or more extremities —arms, legs or both.

• Spastic diplegia. This is a form of spastic CP that affects the legs more than the arms. The legs have increased spasticity and often run in and cross at the knees, causing a scissor-type gait. The first indication of spastic diplegia is usually noted when an affected infant begins to crawl. The child uses their arms in a normal reciprocal fashion but tends to drag the legs behind more as a rudder (commando crawl), rather than using the normal 4-limbed crawling movement.
• Spastic quadriplegia. This is the most severe form of cerebral palsy, marked by motor impairment of all 4 limbs and the high association with mental retardation and seizures. The muscles of the child’s trunk are affected, so the child may have poor trunk and head control and difficulties sitting independently. The muscles of the face and mouth may also be affected, and the child may drool. Swallowing difficulties are common and may lead to aspiration pneumonia.
  
  The most common lesions seen on pathologic examinations or MRI scannings are periventricular leukomalacia and multicystic cortical encephalomalacia. Neurologic examination shows increased tone (hypertonicity) and spasticity in all extremities, as well as decreased spontaneous movements, brisk reflexes and plantar extensor responses. Flexion contractures of the knees and elbows are often present by late childhood. Associated developmental disabilities, including speech and visual abnormalities, are particularly common in children with spastic quadriplegia.
• Spastic hemiplegia. This is a form of spastic cerebral palsy that affects the muscles on 1 side of the body. The arm is often more involved than the leg, and difficulty in hand manipulation may be obvious by age 12 months. Walking is usually delayed until 18-24 months. Spasticity is apparent in the affected extremities, particularly the ankle. An affected child often walks on tiptoes because of the increased tone, and the affected upper extremity assumes a dystonic posture when the child runs.
  
  About a third of patients with spastic hemiplegia have a seizure disorder that usually develops between ages 1-2, and approximately 25 percent have cognitive abnormalities including mental retardation. A CT scan or MRI may show an atrophic cerebral hemisphere with a dilated lateral ventricle opposite to the side of the affected extremities.

Athetoid (dyskinetic) CP

Athetoid cerebral palsy (also sometimes called choreoathetoid, dyskinetic or extrapyramidal CP) is less common than spastic CP. Children with this form of cerebral palsy experience variable movement that is involuntary or uncontrollable.

Involuntary dyskinetic movements include:

• Dystonia. A repetitive or twisting motion.
• Athetosis. Slow, continuous, involuntary movements causing the child to appear restless.
• Chorea. Irregular, unpredictable movements.

Children who have athetoid cerebral palsy typically have low muscle tone (hypotonic) with poor head control and marked head lag. They may develop increased variable muscle tone with rigidity and dystonia over several years. Feeding may be difficult, and tongue thrust and drooling may be prominent. Speech is typically affected. Seizures are uncommon, and intellect is preserved in many children.

Athetoid or dyskinetic CP is the result of damage to the basal ganglia of the brain. The basal ganglia is a control center or switchboard that reads messages from the brain’s movement center and the spinal cord. When the basal ganglia is damaged, the body cannot regulate voluntary movements.

Ataxic CP

Ataxia is the least common form of cerebral palsy. Children with ataxic CP appear very uncoordinated, clumsy, unstable or jerky. Language skills, motor development and motor milestones may be delayed. Speech is typically slow, jerky and explosive. Ataxic cerebral palsy is not common and must be distinguished from progressive neurodegenerative disorders, which may have some of the same clinical features.

Ataxia results from damage to the cerebellum of the brain, which is the part of the brain that controls balance.

Mixed CP

Some children may have symptoms of more than 1 type of cerebral palsy. For example, spastic-dyskinetic cerebral palsy is a common type of mixed cerebral palsy.