Cerebral Palsy is a diverse set of conditions marked by a typical movement and posture due to non-progressive disruptions in brain development during childhood. These disorders stem from a range of factors and exhibit various manifestations, impacting motor skills. Since the disorder is not progressive, the brain damage does not get worse over time, but the symptoms may change as the child gets older.

The main cause of cerebral palsy is often unknown however, it can be related to numerous factors, such as brain damage, infection during pregnancy, genetic abnormalities, premature birth, inadequate oxygen to the brain, or other complications during birth. The symptoms of cerebral palsy can exhibit significant variation depending on the nature and severity of the disorder.

Developmental Symptoms

The most common symptoms associated with cerebral palsy include abnormal muscle tone (either too stiff or too flaccid), delayed motor milestones (such as sitting, crawling, or walking), difficulty with fine motor skills, abnormal movements, balance and coordination issues, speech and swallowing difficulties, and associated conditions like intellectual disability, seizures, or vision and hearing impairments.

Children are only categorically accepted into CP registers until they become 5 year old. Early diagnosis is challenging because neurological symptoms may be transient or change over time, and it may take some time before a disease that starts early and progresses slowly becomes obvious as clearly progressive in the sense of loss of acquired skills. Cerebral palsy can be classified based on several factors, including its type, location, severity, muscle tone, and function.

The types of cerebral palsy include spastic, dyskinetic/athetoid, ataxic, or a combination of these (mixed type). Depending on the involvement of one or both sides of the body, it can be categorized as unilateral or bilateral. The severity can vary from mild to moderate or severe, while muscle tone may be described as hypo- or hypertonic.

Feeding and swallowing problems:

Cerebral palsy, children may demonstrate varied proficiency in communication through speech, vocalization, and aided or unaided Augmentative and Alternative Communication (AAC) systems. The motor disorders associated with cerebral palsy can affect the speed, range, strength, coordination, and accuracy of movements in the vocal tract, leading to a motor speech disorder known as dysarthria.

This condition can impact all aspects of speech control, including respiration, phonation, resonance, articulation, and prosody, often resulting in diminished capabilities. Children with cerebral palsy may exhibit shallow or irregular breathing patterns while speaking, producing speech on minimal residual air.

Their voices may sound harsh with limited pitch variation, and air may escape through their nose while speaking. Additionally, they may have a restricted range of vowels and consonants they can clearly articulate. The severity of dysarthria can range from mild, where speaking movements are slightly weakened, to profound, where coordination of speech subsystems makes it impossible to produce recognizable words. Different speech systems can be affected, for example, breathing might not be adequate for intelligible speech, yet it may still allow for articulation of a limited set of consonants.

In dyskinetic cerebral palsy, typically more severe impairments may be observed compared to spastic forms, but perceptual characteristics in speech, such as roughness of voice and mono-pitch, can be present in children with all types of cerebral palsy.

Neurological Symptoms

Seizures or epilepsy: Nearly half of children with CP may experience seizures due to abnormal brain activity. Seizures can range in severity and may interfere with learning and safety. Hearing and vision impairment: Some children may have trouble seeing clearly or responding to sound cues, which can further complicate communication and educational development.

Intellectual disabilities: Although not present in all cases, some children with CP may experience learning difficulties or delayed cognitive development that require special education support.

Dysarthria (motor speech disorder): Poor control over the muscles used in speech may result in slurred, slow, or difficult-to-understand speech, affecting overall intelligibility and self-confidence.

Drooling, which is defined as “spilling of saliva from the mouth onto the lips, chin, neck, and clothing,” typically happens in newborns and early children, especially while they are taking out a new tooth or learning a new motor skill. Children who are normally growing should be able to do the majority of tasks without drooling by the time they are 24 months old (Morris and Klein 1987). According to estimates, between 10 and 38 percent of people with cerebral palsy continue to drool unintentionally. Drooling can lead to dehydration, irritated facial skin, an unpleasant odour, an increase in oral and perioral infections, and hygiene issues.

When to See a Doctor

Early detection and intervention are key to managing cerebral palsy effectively. You should seek medical advice if you observe any of the following signs.

Drooling might be due to hyper salivation and/or an insufficient mechanism for the removal of saliva.”
So far, researchers have found that children who drool have a harder time producing a bolus.
Drooling and swallowing, chewing ability, and sucking ability have all been demonstrated to be significantly related. Drooling has been found to be significantly positively correlated with poor head control, decreased voluntary control of the lips, decreased voluntary control of the tongue, and decreased voluntary control of the jaw .Other researchers have discovered decreased intraoral sensitivity.

Speech intelligibility refers to a speaker’s capability to make their speech understandable to a listener. During a child’s developmental stages, their speech gradually becomes more intelligible. At around 18 months, a child’s speech is typically 25% intelligible. By the age of 24 months, it improves to about 50% to 75% intelligibility. As their speech continues to develop, by the age of 36 months, it becomes typically 75% to 100% intelligible.

Approximately half of all children with cerebral palsy are affected by dysarthria, a speech problem resulting from impaired speech motor control that is related to neurological factors. Imprecise articulation, intelligible speech, irregular or short breath groups, a harsh or breathy voice tone, decreased prosody, and a slowed speech rate are all characteristics of dysarthria, which can impact one or more speech subsystems. Reduced intelligibility might lead to frustration, isolation, and decreased self-esteem, making it essential to address these challenges early in the children’s lives to foster better communication and overall development in Cerebral Palsy.

Prevention

Although not all cases of cerebral palsy can be prevented, several measures can reduce risk:

Prenatal care and infection control: Regular prenatal visits, timely vaccinations (like rubella), and proper hygiene help minimize infections that could harm fetal brain development.

Healthy maternal lifestyle: Avoiding smoking, alcohol, or exposure to environmental toxins, and managing chronic conditions during pregnancy can significantly lower the risk of birth-related complications.

Safe delivery practices: Monitoring fetal distress during labor and responding to emergencies with appropriate interventions such as C-section can help prevent oxygen deprivation during birth.

Immediate newborn care: Treating jaundice promptly, protecting against head injuries, and ensuring proper infant nutrition and hydration are vital in preventing brain damage after birth.

Treatment and Management

Cerebral palsy is a lifelong condition, but many individuals can lead active, fulfilling lives with the right treatments and support strategies:

Medications for muscle control: Drugs like baclofen, botulinum toxin, or diazepam are often prescribed to reduce spasticity and make daily movements more manageable and less painful.

Physical and occupational therapy: These therapies help improve strength, flexibility, posture, and independence in daily tasks like dressing, feeding, and hygiene.

Speech and language therapy: Specialists work on articulation, breath control, and using assistive communication tools like picture boards or speech-generating devices for children with severe speech difficulties.

Assistive devices and technology: Braces, walkers, wheelchairs, and adaptive tools support mobility and independence, while communication aids enable social participation and learning.

Surgical interventions: In some cases, procedures may be needed to correct musculoskeletal deformities or reduce nerve-related muscle stiffness for improved function and comfort.

According to a speech pathologist, persistent drooling could be a sign of weak oral muscles. Because low muscle tone can also damage speech intelligibility, it takes a concerted effort to find a way to stop the drooling. Speech therapist uses oral motor therapy to help children stop drooling. Before the age of 18 to 24 months, when their jaw, lip, and tongue muscles are still developing, it is common for children to drool. The intelligibility of speech may also be impacted by this deficit.

FAQs

Can cerebral palsy be cured?
No, cerebral palsy is a lifelong condition caused by permanent brain damage. While it cannot be cured, early diagnosis and supportive treatments such as physical therapy, medications, and assistive technologies can significantly improve mobility, communication, and quality of life.

At what age is cerebral palsy usually diagnosed?

Cerebral palsy is often diagnosed between 12 to 24 months of age, when motor delays become more noticeable. However, in more severe cases, signs may appear earlier, while milder forms may take longer to identify due to subtle symptoms.

Is cerebral palsy hereditary?

Most cases of cerebral palsy are not inherited. It typically results from brain injury or abnormal development during pregnancy or shortly after birth. However, some genetic factors may increase vulnerability to conditions that can lead to cerebral palsy.

Can a child with cerebral palsy attend regular school?

Yes, many children with cerebral palsy can attend regular schools with or without accommodations. Those with additional learning needs may benefit from individualized education plans (IEPs) or supportive services like speech and occupational therapy.

Is cerebral palsy painful?

Cerebral palsy itself is not painful, but associated conditions—like tight muscles, joint stiffness, or poor posture can cause discomfort or chronic pain. Physical therapy and proper positioning can help reduce pain and improve daily functioning.