Cerebral Palsy (CP) is a group of disorders that affect a child’s ability to move and maintain balance and posture. It is caused by brain damage or abnormal brain development that happens before, during, or shortly after birth.
1. Core Characteristics
- Non-Progressive: The injury to the brain does not get worse over time. However, the effect on the muscles and joints (like stiffness or bone deformities) can change or worsen as the child grows.
- Muscular, Not Structural: The muscles and spinal cord are usually structurally normal at birth; the problem lies in the brain's "wiring" and its ability to send correct signals to those muscles.
- Variability: Symptoms range from very mild (a slight limp) to severe (requiring a wheelchair and lifelong care).
2. Classification Systems
Orthopaedic surgeons often classify CP in two ways: by the type of movement and by which parts of the body are involved.
By Movement Type
- Spastic (Most Common): Muscles are stiff and tight, making movements jerky.
- Dyskinetic (Athetoid): Involuntary, slow, or writhing movements. It can be hard for the child to sit upright or walk.
- Ataxic: Affects balance and depth perception, leading to an unsteady, wide-based gait.
- Mixed: A combination of the above, most often spastic and dyskinetic.
By Body Part Involved
- Hemiplegia: Only one side of the body is affected (usually the arm more than the leg).
- Diplegia: Both legs are affected; the arms are affected much less or not at all.
- Quadriplegia: All four limbs, the trunk, and often the face/mouth muscles are affected.
3. Orthopaedic Concerns
Because the brain sends constant "tighten" signals to the muscles, children with CP often face secondary musculoskeletal issues:
- Contractures: Muscles become permanently shortened, which can pull joints into fixed, painful positions.
- Hip Displacement: High muscle tone can pull the hip bone out of its socket. POSNA emphasizes Hip Surveillance (regular X-rays) to catch this early.
- Gait Abnormalities: Common patterns include "scissoring" (legs crossing), toe-walking, or a "crouch gait" (walking with knees bent).
- Spine Issues: Neuromuscular scoliosis (curvature of the spine) is common, especially in children who cannot walk.
4. Treatment Options
The goal of treatment is to maximize independence and improve quality of life.
Treatment Type
- Non-Surgical: Physical therapy (stretching/strengthening), bracing (AFOs), and occupational therapy.
- Medication: Botox injections to relax specific muscles; oral medications or baclofen pumps for generalized stiffness.
- Surgical: Muscle/Tendon lengthening to improve range of motion; Osteotomies to realign bones; Spinal fusion for scoliosis.
- Neurological: Selective Dorsal Rhizotomy (SDR): A surgery on the spinal nerve roots to permanently reduce spasticity in the legs.
5. The "GMFCS" Scale
POSNA often refers to the Gross Motor Function Classification System (GMFCS), a 5-level scale that helps doctors and parents understand a child’s long-term functional outlook:
- Level I: Walks without limitations.
- Level III: Walks using a hand-held mobility device (like a walker).
- Level V: Transported in a manual wheelchair.
Note: Early diagnosis is the key. If a baby is "floppy," "stiff," or significantly delayed in reaching milestones like sitting or crawling, an evaluation by a paediatric orthopaedist or neurologist is recommended.