Cerebral Palsy

Specialists at UT Southwestern Medical Center have experience and expertise in diagnosing and treating cerebral palsy (CP), a group of movement disorders caused by problems in the part of the brain that governs muscle movement and coordination.

We offer the latest medical, surgical, and rehabilitative therapies to relieve symptoms and help people with CP reach their full potential, from childhood through adulthood.

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CP appears in infancy or early childhood and permanently affects a person’s ability to move and to maintain balance and posture.

CP is the leading cause of childhood disabilities, but those disabilities can range from very mild to profound. All people with CP have problems with movement and posture. Some people with CP can walk, and others need assistance or may not walk at all. Some might need lifelong care to manage their symptoms, while others may not need any assistance.

There is no cure for CP, but the disorder does not progress or get worse, though its symptoms can change over a person’s lifetime. Treatment of CP can significantly improve a person’s ability to function and participate in daily life.

At UT Southwestern, our neurology and physical medicine and rehabilitation specialists use the latest therapies to diagnose and treat CP. Our multidisciplinary team of doctors, surgeons, physical therapists, and other health care providers uses the latest tools and technologies to help people with CP navigate school, work, and daily life.

Causes of Cerebral Palsy

CP is caused by abnormal brain development or damage to the developing brain. These problems most often arise before birth, but they can occur during birth or in the first years of life. The cause of the damage varies from person to person, and in many cases the cause of CP is not known.

Many factors can lead to problems with brain development, including:

Gene mutations that affect brain development
Maternal infections that affect the developing fetus
Fetal stroke, which disrupts blood supply to the developing brain
Premature birth earlier than 37 weeks of pregnancy, especially with low birth weight
Infant infections that cause inflammation in or around the brain
Traumatic head injury to an infant, such as from a motor vehicle accident, a fall, or physical abuse

Lack of oxygen to the brain related to difficult labor or delivery can cause CP, but it is a much less common cause than historically thought. Some 85% to 90% of cases of CP are caused by problems that occur before birth.

Types of Cerebral Palsy

CP can be classified based on the person’s main movement disorder:

Stiff muscles (spasticity)
Uncontrollable movements (dyskinesia)
Poor balance and coordination (ataxia)

Spastic CP affects about 80% of people with CP. People with spastic CP have stiff muscles, which makes their movements limited or difficult. Spastic CP can affect different parts of the body:

Spastic diplegia affects mainly the legs, with the arms less affected or not affected at all
Spastic hemiplegia affects only one side of a person’s body, and usually, the arm is more affected than the leg
Spastic quadriplegia affects all four limbs, the trunk, and the face

Dyskinetic CP causes muscle tone to fluctuate from too stiff to too loose and leads to problems controlling the movement of hands, arms, feet, and legs. People with dyskinetic CP may find it difficult to sit and walk. If the face and tongue are affected, the person may have a hard time sucking, swallowing, and talking.

Ataxic CP causes problems with balance and coordination. People with ataxic CP can be unsteady when they walk and may have a hard time with quick movements or movements that need a lot of control, such as writing or reaching for something.

Mixed CP means that a person has symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP.

Symptoms of Cerebral Palsy

The signs and symptoms of CP are different from person to person, depending on the part of the brain that is damaged.

Symptoms of CP appear during infancy or preschool years, and can include:

Delays in reaching motor-skill milestones
Difficulty with precise movements such as writing or buttoning a shirt
Excessive drooling or difficulty swallowing
Lack of muscle coordination
Shaking (tremor) or involuntary movements
Stiff or tight muscles and exaggerated reflexes
Variations in muscle tone, going from too stiff to too floppy
Weakness in one or more arm or leg
Walking on the toes, a crouched gait, or a scissored gait

The damage to the brain that causes CP can also generate other developmental or neurological problems, such as:

Abnormal touch or pain sensations
Bladder and bowel problems
Changes in the spine, such as scoliosis
Intellectual disability
Joint problems, such as contractures
Mental health conditions, such as emotional disorders and behavioral problems
Problems with hearing
Problems with speech
Problems with vision and abnormal eye movements
Seizures

While CP does not get worse over time, symptoms such as muscle shortening and muscle rigidity can worsen if they are not treated. Prompt diagnosis and continuous care of CP can help reduce the severity of its symptoms.

Diagnosing Cerebral Palsy

Signs and symptoms of CP often become more apparent over time, so a diagnosis of CP might not be made until a few months after birth. In cases where the symptoms are mild, diagnosis may take longer.

If a doctor believes a child might have cerebral palsy, he or she may order a series of tests, including:

Developmental screening to identify specific developmental delays, such as motor or movement delays
Brain imaging to reveal areas of damage or abnormal development in the brain, such as MRI, cranial ultrasound, or electroencephalogram (EEG)
Laboratory tests of the blood, urine, or skin to screen for genetic or metabolic problems
Additional tests to identify any problems with vision, hearing, speech, intellect, development, or movement

Doctors often use a rating scale tool, such as the Gross Motor Function Classification System, to determine a child’s function and the severity of any mobility, posture, and balance problems. This information helps specialists select the best treatments for each patient.

Cerebral Palsy Treatment

There is no cure for CP, but early intervention can significantly improve the lives of those who have the condition. Treatment for CP depends on the specific symptoms and needs of each person, and those needs may change over time.

At UT Southwestern we bring together a team of specialists trained in treating children and adults with CP. Our team includes:

Physicians, such as pediatric neurologists, physiatrists, orthopedic surgeons, neurosurgeons, and GI specialists
Child developmental specialists
Mental health specialists
Occupational, physical, recreational, and vocational therapists
Speech-language pathologists
Adaptive equipment specialists
Orthotics specialists

These experts work together with patients and their families to develop a personalized treatment plan to improve motor skills and overall function. Each treatment plan is based on the individual’s symptoms and needs.

Medications are often used to lessen muscle tightness, improve functional abilities, treat pain, and manage drooling, complications related to spasticity, or other symptoms. These medications can include:

Muscle injections with botulinum toxin or nerve injections with phenol to treat tightening of a specific muscle
Oral muscle relaxers
An intrathecal baclofen pump to manage severe spasticity or dystonia
Medications or botulinum toxin injections to reduce drooling

Rehabilitative therapies often play an important role in treating CP, including:

Physical therapy such as muscle training and exercises to improve strength, flexibility, balance, motor development, and mobility. Physical therapists also guide parents on how to safely care for their child's everyday needs at home and continue muscle training and exercise at home between therapy visits.
Occupational therapy to develop independence in daily activities and routines at home and school and in the community. Occupational therapists may recommend adaptive equipment such as braces, splints, walkers, wide-based canes, standing and seating systems, or electric wheelchairs.
Speech and language therapy to improve speech or to learn communication through sign language or devices such as a computer and voice synthesizer. Speech therapists can also address difficulties with eating and swallowing.
Recreational therapy to improve sensory and motor skills. Both adults and children benefit from regular physical activity.

Surgical procedures may be needed to lessen pain, improve mobility, or make it easier to use a walker, braces, or crutches. These treatments include:

Orthopaedic surgery to address joint or bone deformities, to lengthen muscles, or to lengthen or reposition tendons
Neurosurgery to cut nerve fibers to specific spastic muscles (selective dorsal rhizotomy) and intrathecal baclofen (ITB) pump placement, or deep brain stimulation (DBS) surgery

Other treatments may be recommended for other issues such as seizures, osteoporosis, and problems with mental health, sleep, oral health, nutrition, incontinence, vision, or hearing.

Support Services for Cerebral Palsy

Whether symptoms are mild or severe, children and adults with CP can benefit from rehabilitation services at UT Southwestern.

Our multidisciplinary team approach to rehabilitation helps patients and families find ways to maximize quality of life and participate in activities at school, at home, at work, and in the community.

For patients who require a wheelchair, our multidisciplinary Wheelchair and Durable Medical Equipment Clinic evaluates patients for their equipment needs. The team makes sure the equipment is fitted properly and can be easily transported by patients and their family members.

Clinical Trials for Cerebral Palsy

As an academic medical center, UT Southwestern is dedicated to improving understanding and treatment of diseases such as cerebral palsy.

Current and planned research includes upper limb paralysis, including pediatric stroke and CP, and a pilot study on diplegia CP and robot-assisted training.

Find clinical trials.