Does cerebral palsy get worse?
CP is not a progressive disorder (meaning the damage to the brain does not worsen). But the effects of aging may have an impact on associated issues.
People with cerebral palsy may have a number of associated physical and cognitive issues, including:
- Mobility Issues – 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.
- Speech Issues – 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 4 children with cerebral palsy cannot talk.
- Intellectual Disability – 1 in 2 people with cerebral palsy 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.
- 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.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.
- Epilepsy – 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 – 3 in 4 children with cerebral palsy experience 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 Issues – 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.
- Behavior 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 and strong emotional responses to new challenges. Teenagers and adults with cerebral palsy may be more prone to depression and anxiety disorders.
- 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.
- 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. This can sometimes be controlled by medication.1 in 15 children with cerebral palsy are unable to take food through their mouth and need to be fed through a feeding tube.
- Saliva Control – Because cerebral palsy can affect the muscles around the mouth, 1 in 5 children with cerebral palsy have saliva loss (also known as dribbling, drooling or sialorhrea). The saliva loss may be more noticeable when they are concentrating on a fine motor task.
- Continence and Constipation – Continence and constipation are issues for many people with cerebral palsy. 1 in 4 children with cerebral palsy have bladder control problems. 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.
- 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.
- 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.