Information for Your Doctor
What is cerebral palsy?
Cerebral palsy (CP) is an umbrella term that refers to a group of disorders affecting a
person’s ability to move. It is a permanent life-long condition, but generally does not
worsen over time. It is due to damage to the developing brain either during pregnancy
or shortly after birth.
Cerebral palsy affects people in different ways and can affect body movement, muscle
control, muscle coordination, muscle tone, reflex, posture and balance.
People who have cerebral palsy may also have visual, learning, hearing, speech, epilepsy
and intellectual impairments.
Cerebral palsy, except in its mildest forms, can be seen in the first 12 months of life.
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Behaviour
Bladder and
Bowel Control
1 in 4 children with cerebral palsy have a
•
Behavioural assessment
behaviour disorder.
•
The rate of abnormal behaviour in children with
cerebral palsy is 2-4 x higher than the population.
Pain assessment Pain control may remediate or minimise the
behavioural problem.
•
Standard psychometric IQ assessment is also recommended
in the presence of behavioural problems to enable the family
to understand the prognosis of the behavioural problem.
1 in 4 children with cerebral palsy do not have
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Medical investigations are warranted as abnormal
anatomical findings are common
•
Children with cerebral palsy should be offered standard
toilet training but over a longer period of time
•
Prescription of incontinence aides will be required for 1 in
3-4 and this will be for longer periods of time that children
without physical disabilities
bladder control.
The rate of bladder control problems in children
with cerebral palsy under 4 years old is 2-3 times
higher than the population.
1 in 3-4 children with cerebral palsy have
constipation.
Dribbling
1 in 5 children with cerebral palsy dribble
•
Botulinum toxin A or surgical interventions should be
explored.
Eating
1 in 15 children with cerebral palsy are tube fed.
•
Infants with cerebral palsy and poor sucking should have
their eating comprehensively monitored.
•
Referral to Speech Pathologist should be considered.
Children with cerebral palsy are 3 times more likely
to have feeding problems at 6 months of age
•
Weight should also be measured regularly as those
with more severe physical disability have higher risk for
malnutrition.
1 in 4 children with cerebral palsy have active
•
Anti-epileptic medications are usually effective for
managing seizures and are considered standard practice for
managing epilepsy in children with cerebral palsy
•
Early screening, assessment and accommodation for hearing
impairment is recommended
•
6-12month hip surveillance is recommended and is effective
for ensuring access to early treatment.
•
X-ray & clinical assessment should commence very early.
•
For those that receive hip surveillance the rate of salvage
orthopaedic surgery is lower
•
Formal assessment and diagnosis of an intellectual disability
is an important prognostic indicator for walking, bladder
control, school performance and likelihood of independent
living.
•
If multiple impairments exist, psychometric screening of
intelligence is highly recommended for intervention and
school planning.
•
Parents and children report levels of pain differently and
therefore the child’s perceptions should always be sought.
•
Investigate a wide range of pain origins e.g. dental,
gastrointestinal, muscular, neuropathic, rheumatology,
skeletal, and tonal.
•
Comprehensive pain management should be instigated to
minimise the likelihood of secondary behavioural problems
from developing.
Epilepsy
epilepsy
1 in 3 children with cerebral palsy have had
epilepsy at some time)
Hearing
1 in 25 children with cerebral palsy have severe
hearing impairment or are deaf
Hips and Spine
1 in 3 children with cerebral palsy have hip
displacement
1 in 10 children with cerebral palsy have hip
dislocation without hip surveillance
Intellect
1 in 2 children with cerebral palsy have an
intellectual disability
1 in 4 children with cerebral palsy have a severe
intellectual disability
Pain
3 in 4 children with cerebral palsy are in pain
Sleeping
1 in 5 children with cerebral palsy have a sleep
•
Thorough and specialist assessment of sleep problems are
recommended.
•
Early treatment of sleep problems (both medical and
behavioural) is advisable before secondary academic and
behavioural problems emerge or are established.
•
Early assessment and recommendations of augmentative
and alternative communication options for speech
impairment is recommended
•
Children that walk using aides and their families should be
emotionally prepared for potential loss of motor function in
adolescence
•
Children that walk using aides require mobility assessments
at the commencement of adolescence to enable prescription
of appropriate mobility devices to accommodate declining
motor function
•
Early screening, assessment and treatment for vision
impairment is recommended
disorder
The rate of sleep disorders in children with cerebral
palsy is 5 times higher than the population
Talking
1 in 4 children with cerebral palsy cannot talk
1 in 3 children with cerebral palsy have some
speech impairment
Walking
1 in 3 children with cerebral palsy cannot walk
1 in 6 children with cerebral palsy walk using
aides
1 in 2 children with cerebral palsy walk
independently
Vision
1 in 10 children with cerebral palsy have a severe
visual impairment or are blind
1 in 4 children with cerebral palsy have a vision
impairment
Table 1. Conditions and activities commonly and easily missed in people
with intellectual disability
Psychiatric disorders
Medication issues
Health maintenance activities
• Depression
• Overuse of tranquillisers
• Immunisation
• Schizophrenia
• Unrecognised side effects
• Screening for infectious conditions
including hepatitis B
• Bipolar affective disorder
• Anxiety disorders
• Post-traumatic stress disorder
Gastrointestinal disorders
• Constipation/atonic bowel
• Bowel obstruction
of medication
Epilepsy management
• Inadequate review of anticonvulsant
medication
• Breast checks and Pap tests
• Failure to consider medication
• Screening for osteoporosis and vitamin
D deficiency where appropriate
interactions and toxicity
• Reflux oesophagitis
Sensory impairment
• H. Pylori infection
• Hearing impairment
Undescended testis/hypogonadism
• Visual impairment
• Ear and eye pathology
Unrecognised pain or infection
• Dental pathology
• Chest infection
• Urinary tract infection
• Nutritional assessment (exclude
malnutrition and obesity)
• Blood pressure and skin checks
• Physical activity assessment
People with cerebral palsy often need the doctor to:
• Engage directly with the person with cerebral palsy and ask about their preferred
method for communicating
• Listen to the person with cerebral palsy and attend to their body language
• Prompt the person to contribute – persist if the person’s communication style is difficult
• Use age appropriate speech be mindful of fears during the examination, and possible
previous history of trauma associated with medical interventions
• Be mindful of movement disorders and potential inhibitors for examinations
• Ask specific questions to prompt carers
• Explain instructions clearly and check for understanding
• Write down a summary and actions from the consultation
• Discuss and explain the need for further investigations and referral
• Routine screening may require additional equipment – e.g hoisting equipment;
consultation at home on custom made bed ; using a bed with bedrails, wider bed
References:
Field B, et al, (2010) Australian Family Physician Vol. 39, No. 3.
Ghasia F, Brunstrom J, Gordon M, Tychsen L (2008). Frequency and severity of visual sensory and motor deficits in children with cerebral palsy: gross motor
function classification scale. Investigative Ophthalmology and Visual Science, Feb; 49 (2) : 572-80.
Lennox, N. et al (2004) Adults with Intellectual Disability and the GP, Australian Family Physician Vol. 33, No.8 (.Table 1)
Novak, I, Hines, M, Goldsmith, S, Barclay, R (2012). Clinical prognostic messages from a systematic review of cerebral palsy. Pediatrics, 130 (5)