What is cerebral palsy and can it be prevented?

Cerebral palsy is a condition that results from injury to the brain.  The word "cerebral" refers to the brain and "palsy" is difficulty in control of movement.  Depending on what part of the brain has been injured, different areas of the body will be involved or affected.

The diagnosis of cerebral palsy is generally made based on the clinical picture.  There are no tests or scans that can detect cerebral palsy. The diagnosis is based on motor movements. Cerebral palsy causes motor or postural abnormalities that are noticeable during early childhood development.

The diagnosis of cerebral palsy usually begins with a history of gross motor delay in the first year of life.  Cerebral palsy frequently manifests as early hypotonia (lack of muscle tone) for the first six months to one year followed by spasticity. Cerebral palsy can be classified by mild, moderate and severe depending on functional limitations.  For example, a child with mild cerebral palsy can walk without the use of aids and has a normal tolerance for walking.

There are different kinds of cerebral palsy.  Spastic quadriplegia is cerebral palsy affecting all four extremities (all body); hemiplegic cerebral palsy affects one side of the body, such as the right hand and arm and foot and leg, or the left hand and arm and foot and leg; spastic cerebral palsy is typified by stiff contracted muscles and difficult movements; and spastic diplegia is cerebral palsy affecting the lower extremities more than the upper extremities. Mixed cerebral palsy involves two or more types of cerebral palsy.

While the cause of cerebral palsy is unknown in many cases, it is well established that birth asphyxia (or lack of oxygen to the baby at birth) can cause cerebral palsy.  Cases of cerebral palsy caused by birth asphyxia must have evidence of acidosis (high level of acid in the blood), Apgar scores of less than 4 at 5 minutes, multi-organ damage related to tissue hypoxia and early imaging abnormalities, i.e., brain damage revealed by a CT scan or MRI of the brain.

In 2003, the American College of Obstetrics and Gynecology issued a bulletin that established the criteria necessary to prove that birth asphyxia was the cause of cerebral palsy.  When the ACOG criteria are met (see paragraph above for criteria), the cerebral palsy has been caused by birth asphyxia.  In that scenario, a failure by the attending obstetrician or nurse midwife to timely deliver the baby can cause permanent brain damage.  This is a preventable form of cerebral palsy.

The most common type of cerebral palsy caused by birth asphyxia is spastic quadriplegia, which entails motor difficulties in all four extremities.  Persons afflicted with spastic quadriplegia are often confined to a wheelchair and have substantial cognitive problems.