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Cerebral Palsy

Children with Cerebral Palsy often have difficulty walking and using their arms. The NYU Hospital for Joint Diseases Center for Children has helped numerous children walk independently and improve use of their hands. Our Cerebral Palsy program aims to help the child reach his or her full potential. Children with Cerebral Palsy can grow to adulthood and may be able to work and live independently.

Definition
Cerebral Palsy is a group of chronic disorders impairing control of movement that appear in the first few years of life and generally do not worsen over time. These disorders are caused by faulty development of, or, damage to motor areas in the brain that disrupts the brain's ability to control movement and posture. One of the problems associated with Cerebral Palsy is Spasticity. Spasticity is an abnormal response of muscle that results in contractures (when the hips, knees, ankles, shoulders, elbows and wrists become so tight that they no longer bend or straighten).  The most effective way to treat Spasticity is through a multi-disciplinary approach, which consists of participation from many different medical specialties. At NYUHJD Center for Children this condition is treated at our Spasticity Center.

Causes
Failure of the brain to develop properly, or neurological damage to the child's brain. 

Risk Factors
Risk factors can pertain to the parents and the child. For parents risk factors can include: 

  • If the mother is 40 years or older
  • If the mother is 20 years or younger
  • If the father is 20 years or younger
  • African-American ethnic background

The following risk factors that can increase the risk of Cerebral Palsy relating to children are:

  • A first child or a child born later in the family
  • One of a pair of twins (Especially if one twin dies)
  • Low birth weight (Less than 3.5 pounds)
  • A premature birth

There are other known risk factors that can increase the risk of Cerebral Palsy:

  • RH or A-B-O blood type incompatibility between the mother and baby
  • Mother being infected with a virus early during her pregnancy
  • Baby’s central nervous system being attacked by micro-organisms such as bacteria, fungi or viruses

Symptoms
While there are different types of Cerebral Palsy, all conditions have the following symptoms: abnormal muscle tone, poor posture such as slouching while sitting, and difficulties with reflexes, coordination and motor development. In addition there can be other symptoms such as spasticity or stiff or rigid muscles, spasms as well as problems walking or with balance. Some patients with Cerebral Palsy also experience seizures or epilepsy. Others have learning disabilities or experience mental retardation.

Diagnosis
There are a variety of tests for Cerebral Palsy at the HJD Center for Children: 

  • X-rays
  • MRI (Magnetic Resonance Imaging)
  • EEG (Electroencephalogram)

Treatment
Surgical Care
Certain operations may improve the ability to sit, stand, and walk. One type of surgery used at the Center for Children is Tendon Surgery which is often percutaneous and minimally invasive which requires minimal or no casting. Improvements in gait in children with cerebral palsy can be obtained through Soft-Tissue and/or Bony Surgery done on the spine and hips.

Non-surgical Care
Medication can help control muscle spasms and seizures. Botox, alcohol and baclofen, a muscle relaxer and an anti-spastic agent, can be administered via implantable pumps for increased muscle tone. There is also a variety of physical therapy methods such as Neuro-Developmental Treatment (NDT) which is a hands-on approach used in patients who have difficulties in controlling movement. The HJD Center for Children also employs using MEDEC Resistive Straps as well as manual stretch and serial casting.

Prevention
The cause of Cerebral Palsy is sometimes not known but links have been identified between CP and certain conditions during pregnancy, birth, and early childhood.

Resources

Also see: More on Cerebral Palsy.

Elly Hammerman Center for the Treatment of Neuromuscular Disorders
http://www.med.nyu.edu/hjd/centerforchildren/patient/hammerman.html

The Wallace B. Lehman, M.D. Center for Pediatric Orthopedic Surgery
http://www.nyuhjd.org/hjd/centerforchildren/patient/wallace.html

The New York Institute for Limb Lengthening and Reconstruction http://www.nyuhjd.org/hjd/centerforchildren/patient/limb.html

The Center for Pediatric Rehabilitation and Pediatric Medicine
http://www.nyuhjd.org/hjd/centerforchildren/patient/ped_rehab.html

The NYU Hospital for Joint Diseases Pediatric Physical and Occupational Therapy Department
http://www.nyuhjd.org/hjd/centerforchildren/patient/rehabilitation.html

Child Life Program at Center for Children
http://www.nyuhjd.org/hjd/centerforchildren/patient/child_life.html

Music Therapy at Center for Children
http://www.nyuhjd.org/hjd/centerforchildren/patient/music_therapy.html

Relevant Publications

Chu ML, Sala DA. The use of tiagabine in pediatric spasticity management. Developmental Medicine and Child Neurology 2006;48:456-459.

Blate M, Bodden A, Leonard KF, Chu ML, Feldman DS, Goldstein H, Rabito M, Sala DA, Weiner HL.  Weight change associated with intrathecal baclofen.  Presented at American Academy for Cerebral Palsy and Developmental Medicine, New Orleans, Louisiana, September, 2002.

Chu ML, Sala DA, Weiner HL. Intrathecal baclofen in X-linked adrenoleukodystrophy. Pediatric Neurology 2001;24:156-158.

Kopell BH, Sala DA, Doyle WK, Feldman DS, Wisoff JH, Weiner HL. Subfascial implantation of intrathecal baclofen pumps in children: a technical note. Neurosurgery 2001;49:753-757.

Sala DA, Grant AD, Kummer KJ. Equinus deformity in cerebral palsy: recurrence after tendo Achillis lengthening. Developmental Medicine and Child Neurology 1997;39:45-48.

Grant AD, Sala DA, Kummer FJ, Kiriakatis A. A simple technique for assessing heel contact in orthoses. Journal of Pediatric Orthopaedics 1996;16:385-387.

Sala DA, Grant AD. Prognosis for ambulation in cerebral palsy. Developmental  Medicine and Child Neurology1995;37:1020-1026.