Common Issues

Issues

Mobility

1 in 3 children with cerebral palsy will be unable to walk. At greatest risk are those who have spastic quadriplegia, intellectual disability, epilepsy, vision impairment and an inability to sit independently at 2 years of age.

A child’s GMFCS (Gross Motor Classification System) level is a good predictor of mobility.

Some children may need ankle foot orthoses (sometimes referred to as splints or AFOs) to help maintain balance when walking while others will use a walking frame or walking sticks. Children and adults may use a mixture of walking aids depending on the distance they need to move. Others may use a manual or powered wheelchair for mobility.

Speech

Cerebral palsy can affect a person’s ability to finely coordinate the muscles around the mouth and tongue that are needed for speech. The respiratory coordination that is needed to support speech can also be affected, e.g. some people may sound ‘breathy’ when they speak. Some children with cerebral palsy may not be able to produce any sounds, others may be able to produce sounds but have difficulty controlling their movement enough to produce speech that is clear and understood by others. 1 in 5 children with cerebral palsy cannot speak.

For those with restricted speech, an augmentative or alternative communication system may assist (e.g. communication board or book, gesture or sign language, or electronic voice output device).

Intellectual Disability

1 in 2 people with cerebral palsy will have an intellectual disability. 1 in 5 people have a moderate to severe intellectual disability.

Generally, the greater the level of a person’s physical impairment, the more likely it is that they will have an intellectual disability.

However, there are sometimes people who have a profound level of physical impairment, who do not have an intellectual disability. Conversely, there can be others with a mild physical impairment who have an intellectual disability.

Psychologists can help by assessing the level of a child’s intellectual impairment. They and other professionals can then work with the family to plan and implement the support needed to enable the child to learn new skills and achieve their full potential.

Learning Difficulties

Children with cerebral palsy may experience specific learning difficulties. These may include a short attention span, motor planning difficulties (organisation and sequencing), perceptual difficulties and language difficulties. These can impact on literacy, numeracy and other skills.

In schools, it is important to recognise that some children and teenagers who display disruptive or avoidance behaviours and low self esteem may have underlying learning problems.

Learning may also be affected by difficulties in fine motor and gross motor coordination and communication. Students with cerebral palsy need to put more effort into concentrating on their movements and sequence of actions than others, so they may tire more easily.

Seizures

1 in 4 children with cerebral palsy have epilepsy. When children have cerebral palsy and an intellectual disability, the incidence of epilepsy is higher – 48%.

Seizures can affect speech, intellectual functioning and physical functioning. Medication is the most effective intervention for epilepsy and the child’s doctor or therapist may also recommended modifications to the student’s school supports and equipment. Some medications have side effects which cause drowsiness or irritability. Both epilepsy and the related medication can affect a person’s behaviour and attention span.

Pain

1 in 2 children with cerebral palsy experience chronic pain.

Pain is often a result of the impairments that are associated with cerebral palsy, e.g. contractures, abnormal postures, dystonia, skin breakdown, hip subluxation (partial dislocation of the hip) and scoliosis.

This pain can affect a child’s behaviour, their ability to do things for themselves and their social relationships. Children might avoid day-to-day tasks that are important for independence, such as attending school and social events.

Pain can be relieved, so it is best to be guided by your medical practitioner.

Sleep

1 in 5 children with cerebral palsy have a sleep disorder. There are a range of contributing factors, including the muscle spasms associated with cerebral palsy, other forms of musculo-skeletal pain, and decreased ability to change body position during the night. Epilepsy is also known to disturb sleep and is likely to predispose to sleep disorders. Blindness or severe visual impairment can affect the timing and maintenance of sleep through their effect on melatonin secretion and the lack of light perception.

Sleep issues can be addressed in various ways, so seek help from your therapist or general practitioner.

Behaviour and Emotional Issues

Behavioural problems occur in 1 in 4 children with cerebral palsy. At greatest risk are those with an intellectual disability, epilepsy, severe pain or a milder level of physical disability.

Problem behaviours include dependency, being headstrong, hyperactive, anxious, or prone to conflict with their peer group, or exhibiting antisocial behaviours.

Children with cerebral palsy may also have emotional problems such as difficulties with their peer group, hyperactivity and strong emotional responses to new challenges.

Teenagers and adults with cerebral palsy may be more prone to depression and anxiety disorders.

There are many effective interventions for behavioural and emotional problems, so seek advice from your doctor or therapist.

Spinal and Hip Abnormalities

Abnormalities of the spine and hips are associated with cerebral palsy and can make sitting, standing and walking difficult, and cause chronic pain. 1 in 3 children with cerebral palsy have hip displacement.

Children and adults who have a severe physical disability or those whose body is affected on both sides are at greater risk of hip problems. This means that people who use wheelchairs most of the time are more at risk of hip problems than those who walk with assistive devices or independently.

There are various surgical interventions for spinal and hip abnormalities and seating systems that can help to reposition people so that they can undertake everyday activities more comfortably.

Eating and Drinking Difficulties

Cerebral palsy can affect the muscles that open and close the mouth and move the lips and the tongue. Some people with cerebral palsy may have difficulties in chewing and swallowing food and drink – a condition known as dysphagia.

Because cerebral palsy often impacts fine motor skills, many people are unable to easily use cutlery, hold a cup, or transfer food from a plate to their mouth using their hands.

Others may suffer from gastroesophageal reflux - where acid from the stomach rises into the esophagus – which makes eating uncomfortable or painful. Thus can sometimes be controlled by medication.

1 in 10 children with cerebral palsy are unable to take food through their mouth and need to be fed through a feeding tube.

Speech pathologists and occupational therapists can help people with cerebral palsy who have eating and drinking difficulties.

Saliva Control

Because cerebral palsy can affect the muscles around the mouth, some people with cerebral palsy may have varying degrees of saliva loss (also known as sialorhrea or drooling). The saliva loss may be more noticeable when they are concentrating on a fine motor task.

Saliva loss may be treated through various interventions, including behaviour management (helping people to manage their own saliva loss by, for example, wiping their mouth), sensory motor therapy, medication, surgery and botulinum toxin.

Continence and Constipation

Continence and constipation are issues for many people with cerebral palsy. 1 in 3 children with cerebral palsy have urinary incontinence. Children with intellectual disability and/or a severe form of cerebral palsy are most at risk.

Lack of mobility and difficulty eating can predispose people with cerebral palsy to constipation.

Both these issues can be addressed with the support of a general practitioner or therapist.

Vision Impairment

Vision impairment is not uncommon in people with cerebral palsy. Children with the more severe forms of cerebral palsy are more likely than others to experience high myopia, absence of binocular fusion, dyskinetic strabismus (also known as ‘turned eye’ or ‘squint’), severe gaze dysfunction, and optic neuropathy or cerebral visual impairment (CVI). 1 in 10 children with cerebral palsy are blind.

Ophthalmologists and orthoptists may be able to assist and provide management strategies for some of these vision difficulties.

Hearing Impairment

1 in 20 people with cerebral palsy also have some level of hearing impairment. 1 in 50 children with cerebral palsy are deaf.

Hearing impairment can be managed through an audiologist or hearing specialist.