Cerebral palsy is the musculoskeletal manifestation of a non-progressive central nervous system lesion that usually occurs due to a perinatal insult to the brain. Though the cerebral insult is static, the musculoskeletal pathology is progressive. Spasticity leads to shortening of musculoskeletal units, which in turn causes fixed contractures and eventually leads to torsional abnormalities of long bones, joint instability, deformity, and degenerative arthritis.¹
1 in 1,500 live births
Causes of Cerebral Palsy:
- cerebral malformations:
- holoprosencephaly
- micro- and macro-gyria
- hydranencephaly
- porencephaly
- perinatal causes
- hypoxia
- asphyxia
- postnatal causes
- trauma
- infection – CMV, toxoplasmosis
- hypoxia
- hyperbilirubinaemia
There are two broad pathophysiological types of Cerebral Palsy:
Spastic cerebral palsy (80-85%)
Approximately half of people with a spastic cerebral palsy are developmentally delayed.
- prematurity – low birth weight: ? periventricular leukomalacia
- multiple births
- prolonged labour or traumatic delivery
- asphyxia neonatorum – spastic quadraparesis
- intrauterine growth retardation (IUGR)
Extrapyramidal cerebral palsy
Extrapyramidal cerebral palsy is associated with involuntary movements and most people are intellectually normal:
- athetosis
- persistent Asymmetrical Tonic Neck Reflex (ATNR)
- tonic extensor great toe
- hyperextension fingers, flexion, pronation
- speech / swallowing problems
- prematurity ≅ 15%
- cerebral malformations
- asphyxia
- hyperbilirubinaemia (kernicterus)
Complications:
- developmental delay: head circumference, speech development
- convulsions (25-35%)
- visual (40-60%) and auditory (10%) abnormalities:
- strabismus (50%)
- homonymous hemianopia
- nystagmus
- orthopaedic: muscle contractures; arrested growth of affected limb
- speech and feeding (50%): pseudobulbar palsy
- swallowing
- dysarthria
- drooling
- psychological (sheltered workshops)
Reference
- Bhardwaj P, Sabapathy SR. “Assessment of the hand in cerebral palsy.” Indian J Plast Surg. 2011 May;44(2):348-56. doi: 10.4103/0970-0358.85356. PMID: 22022045; PMCID: PMC3193647.
