Cerebral palsy (CP) was first described in 1861 by an English doctor, William Little, and for many years it was known as “Little’s disease.” Over the years there has been much discussion of the definition of CP, and different definitions have been adopted and later discarded. The most recently adopted definition, published in 2007, is as follows:
Cerebral palsy (CP) describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems .
The following table explains the terms used in this definition.
|Cerebral||Referring to the cerebrum, the front and upper part of the brain, one of the major areas responsible for the control of movement.|
|Palsy||Palsy means paralysis, though paralysis by pure definition is not a feature of CP.|
|Group||CP is not a single condition, unlike conditions such as type 1 diabetes. Rather, CP is a group of conditions. The location, timing, and type of brain injury vary, and the resulting effects of the brain injury are also varied. A simple blood test for glucose confirms a diagnosis of type 1 diabetes. A genetic test confirms Down syndrome. Unfortunately, there is no equivalent single test for CP.|
|Permanent||Refers to the fact that the brain injury remains for life: CP is a lifelong condition.|
|Disorders||A disorder is a disruption in the usual orderly process. To meet the definition of CP, the disorder must cause activity limitation.|
|Posture||The way a person holds their body when standing or sitting.|
|Activity limitation||Activity is the execution of a task or action by an individual. Activity limitationsare difficulties an individual may have in executing activities. Walking with difficulty is an example of an activity limitation.|
|Non-progressive||The brain injury does not worsen, but its effects can develop/evolve over time.|
|Developing fetal or infant brain||The brain injury occurs in an immature, rather than a mature, brain. An injury to the fetal or infant brain happens before the brain is finished developing all of its neural connections.|
|Motor disorders||Motor disorders are conditions affecting the development of movement and posture. The term motor impairment can also be used.|
|Are often accompanied by||The motor problem is often associated with other problems.|
|Sensation, perception, cognition, communication, and behavior||Sensation: Refers to the senses, i.e., vision, hearing, and others. |
Perception: The ability to incorporate and interpret sensory and/or cognitive information.
Cognition: The mental action or process of acquiring knowledge and understanding through thought, experience, and the senses. Communication: The imparting or exchanging of information.
Behavior: The way one acts or conducts oneself.
|Epilepsy||Epilepsy is a seizure disorder. A seizure is an abnormal electrical discharge in brain cells that disrupts normal activity, behavior, or movement. Seizures can vary in length and severity.|
|Secondary musculoskeletal problems||Musculoskeletal refers to both the muscles and the skeleton, i.e., the muscles, bones, and joints. Musculoskeletal problems appear with time and growth, hence they are termed secondary problems or abnormalities. They develop as a consequence of the brain injury. People with CP may develop a variety of musculoskeletal problems, such as muscle/tendon contracture or bone torsion (twist).|
CP is a lifelong condition. There is currently no cure, nor is one imminent, but good management and treatment can help alleviate some or many of the effects of the brain injury.
When the brain injury occurs is important. The consequences of a brain injury to a fetus developing in the womb are generally different from those of a brain injury sustained at birth, which in turn are different from those of a brain injury acquired during infancy. It is generally accepted that only brain injuries occurring before the age of two or three fit the definition of CP. A brain injury occurring after that age is called an acquired brain injury. This cutoff is due to the differences in brain maturity when the injury occurs.
Useful web links
- Cerebral Palsy Alliance (2014) What Is Cerebral Palsy? (video)
- Cerebral Palsy Foundation (2016) What Is Cerebral Palsy? (video)
- Ontario Brain Institute (2017) Meet Jessica. This Is What She Wants You to Know about Cerebral Palsy. (video)
- CP Now (2015) The Cerebral Palsy Toolkit: From Diagnosis to Understanding. (pdf)
- UK National Institute for Health and Care Excellence (NICE) (2017) Cerebral Palsy in Under 25s: Assessment and Management. (online)
- Gillette Children’s Specialty Healthcare (2016) Cerebral Palsy Road Map: What to Expect as Your Child Grows. (pdf) (The road map covers all types of CP and all GMFCS levels. It is organized into four age groups from birth to age 18. It covers 10 areas of interest including mobility, musculoskeletal, and interventions.)
The above is an extract from Spastic Diplegia–Bilateral Cerebral Palsy available here.