Table of Contents

What is cerebral palsy? .................................. 1

What are the early signs? ................................ 3

What causes cerebral palsy? ............................ 5

What are the risk factors? ............................... 7

Can cerebral palsy be prevented?...................... 9

What are the different forms? .........................10

What other conditions are associated with 

cerebral palsy? ............................................12

How is cerebral palsy diagnosed? .....................15

How is cerebral palsy treated?.........................17

Drug treatments .....................................19

Surgery ................................................21

Assistive devices .....................................22

Complementary and alternative therapies .....23

Are there treatments for other conditions 

associated with cerebral palsy? ........................24

Do adults with cerebral palsy face special 

health challenges? ........................................25

What research is being done? ..........................27

Glossary ....................................................33

Information Resources

(see card inside back pocket of this brochure)

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Cerebral Palsy HTR Inside Pages.indd 2 8/18/13 
What is cerebral palsy?

Cerebral palsy refers to a group of neurological 

disorders that appear in infancy or early childhood 

and permanently affect body movement and muscle 

coordination. Cerebral palsy (CP) is caused by 

damage to or abnormalities inside the developing 

brain that disrupt the brain’s ability to control 

movement and maintain posture and balance. 

The term cerebral* refers to the brain; palsy

refers to the loss or impairment of motor function. 

Cerebral palsy affects the motor area of the brain’s 

outer layer (called the cerebral cortex), the part of 

the brain that directs muscle movement.

In some cases, the cerebral motor cortex hasn’t 

developed normally during fetal growth. In others, 

the damage is a result of 

injury to the brain either 

before, during, or after 

birth. In either case, the 

damage is not repairable 

and the disabilities that 

result are permanent. 

Children with CP exhibit a 

wide variety of symptoms, 

including:

• lack of muscle 

coordination when 

performing voluntary 

movements (ataxia); 

• stiff or tight muscles 

and exaggerated 

reflexes (spasticity); 

Infants with cerebral palsy often hav

developmental delay, in which they 

slow to reach normal developmenta

milestones, shown above, such as 

learning to sit, crawl, or walk.

*Terms in italics are defined in the Glossary, page 33. 

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• weakness in one or more arm or leg; 

• walking on the toes, a crouched gait, or a 

“scissored” gait; 

• variations in muscle tone, either too stiff or 

too floppy; 

• excessive drooling or difficulties swallowing 

or speaking; 

• shaking (tremor) or random involuntary 

movements; 

• delays in reaching motor skill milestones; 

and 

• difficulty with precise movements such as 

writing or buttoning a shirt. 

The symptoms of CP differ in type and severity 

from one person to the next, and may even change 

in an individual over time. Symptoms may vary 

greatly among individuals, depending on which 

parts of the brain have been injured. All people 

with cerebral palsy have problems with movement 

and posture, and some also have some level of 

intellectual disability, seizures, and abnormal 

physical sensations or perceptions, as well as 

other medical disorders. People with CP also may 

have impaired vision or hearing, and language, 

and speech problems.

CP is the leading cause of childhood disabilities, 

but it doesn’t always cause profound disabilities. 

While one child with severe CP might be unable 

to walk and need extensive, lifelong care, another 

child with mild CP might be only slightly awkward 

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and require no special assistance. The disorder 

isn’t progressive, meaning it doesn’t get worse 

over time. However, as the child gets older, certain 

symptoms may become more or less evident.

A study by the Centers for Disease Control and 

Prevention shows the average prevalence of 

cerebral palsy is 3.3 children per 1,000 live births. 

There is no cure for cerebral palsy, but supportive 

treatments, medications, and surgery can help many 

individuals improve their motor skills and ability to 

communicate with the world. 

What are the early signs?

The signs of cerebral palsy usually appear in the 

early months of life, although specific diagnosis may 

be delayed until age two years or later. Infants with 

CP frequently have developmental delay, in which 

they are slow to reach developmental milestones 

such as learning to roll over, sit, crawl, or walk. 

Some infants with CP have abnormal muscle tone. 

Decreased muscle tone (hypotonia) can make them 

appear relaxed, even floppy. Increased muscle tone 

(hypertonia) can make them seem stiff or rigid. 

In some cases, an early period of hypotonia will 

progress to hypertonia after the first 2 to 3 months 

of life. Children with CP may also have unusual 

posture or favor one side of the body when they 

reach, crawl, or move. It is important to note that 

some children without CP also might have some 

of these signs.

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Some Early Warning Signs of CP:

In a Baby Younger Than 6 Months of Age 

• His head lags when you pick him up while he’s 

lying on his back

• He feels stiff

• He feels floppy

• When held cradled in your arms, he seems to 

overextend his back and neck, constantly acting 

as if he is pushing away from you.

• When you pick him up, his legs get stiff and they 

cross or scissor

In a Baby Older Than 6 Months of Age 

• She doesn’t roll over in either direction

• She cannot bring her hands together

• She has difficulty bringing her hands to her mouth

• She reaches out with only one hand while keeping 

the other fisted

In a Baby Older Than 10 Months of Age

• He crawls in a lopsided manner, pushing off with 

one hand and leg while dragging the opposite 

hand and leg

• He scoots around on his buttocks or hops on his 

knees, but doesn’t crawl on all fours

Centers for Disease Control and Prevention, June 2013

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What causes cerebral palsy?

Cerebral palsy is caused by abnormal development 

of part of the brain or by damage to parts of the 

brain that control movement. This damage can occur 

before, during, or shortly after birth. The majority 

of children have congenital cerebral palsy (that 

is, they were born with it), although it may not be 

detected until months or years later. A small number 

of children have acquired cerebral palsy, which 

means the disorder begins after birth. Some causes 

of acquired cerebral palsy include brain damage in 

the first few months or years of life, brain infections 

such as bacterial meningitis or viral encephalitis, 

problems with blood flow to the brain, or head injury 

from a motor vehicle accident, a fall, or child abuse. 

In many cases, the cause of cerebral palsy 

is unknown. Possible causes include genetic 

abnormalities, congenital brain malformations, 

maternal infections or fevers, or fetal injury, for 

example. The following types of brain damage 

may cause its characteristic symptoms: 

Damage to the white matter of the brain 

(periventricular leukomalacia, or PVL). The white 

matter of the brain is responsible for transmitting 

signals inside the brain and to the rest of the body. 

Damage from PVL looks like tiny holes in the white 

matter of an infant’s brain. These gaps in brain 

tissue interfere with the normal transmission of 

signals. Researchers have identified a period of 

selective vulnerability in the developing fetal 

brain, a period of time between 26 and 34 weeks of 

gestation, in which periventricular white matter 

is particularly sensitive to insults and injury. 

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Abnormal development of the brain (cerebral 

dysgenesis). Any interruption of the normal process 

of brain growth during fetal development can 

cause brain malformations that interfere with the 

transmission of brain signals. Mutations in the genes 

that control brain development during this early 

period can keep the brain from developing normally. 

Infections, fevers, trauma, or other conditions that 

cause unhealthy conditions in the womb also put 

an unborn baby’s nervous system at risk. 

Bleeding in the brain (intracranial hemorrhage).

Bleeding inside the brain from blocked or broken 

blood vessels is commonly caused by fetal stroke. 

Some babies suffer a stroke while still in the womb 

because of blood clots in the placenta that block 

blood flow in the brain. Other types of fetal stroke 

are caused by malformed or weak blood vessels 

in the brain or by blood-clotting abnormalities. 

Maternal high blood pressure (hypertension) is 

a common medical disorder during pregnancy 

and is more common in babies with fetal stroke. 

Maternal infection, especially pelvic inflammatory 

disease, has also been shown to increase the risk 

of fetal stroke. 

Bleeding in the brain (asphyxia). Asphyxia, a lack 

of oxygen in the brain caused by an interruption 

in breathing or poor oxygen supply, is common for 

a brief period of time in babies due to the stress of 

labor and delivery. If the supply of oxygen is cut 

off or reduced for lengthy periods, an infant can 

develop a type of brain damage called hypoxicischemic encephalopathy, which destroys tissue 

in the cerebral motor cortex and other areas of 

the brain. This kind of damage can also be caused 

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by severe maternal 

low blood pressure, 

rupture of the 

uterus, detachment 

of the placenta, or 

problems involving 

the umbilical cord, 

or severe trauma 

to the head during 

labor and delivery.

What are the risk factors?

There are some medical conditions or events that 

can happen during pregnancy and delivery that may 

increase a baby’s risk of being born with cerebral 

palsy. These risks include: 

Blood type incompatibility between mother 

and child. Rh incompatibility is a condition that 

develops when a mother’s Rh blood type (either 

positive or negative) is different from the blood type 

of her baby. The mother’s system doesn’t tolerate 

the baby’s different blood type and her body will 

begin to make antibodies that will attack and kill her 

baby’s blood cells, which can cause brain damage. 

Exposure to toxic substances. Mothers who have 

been exposed to toxic substances during pregnancy, 

such as methyl mercury, are at a heightened risk of 

having a baby with cerebral palsy. 

Infections during pregnancy. Infections such 

as toxoplasmosis, rubella (German measles), 

cytomegalovirus, and herpes can infect the womb 

and placenta. Inflammation triggered by infection 

The risk of cerebral palsy is higher among low 

birthweight babies and those born prematurely.

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may then go on to damage the developing nervous 

system in an unborn baby. Maternal fever during 

pregnancy or delivery can also set off this kind of 

inflammatory response. 

Low birthweight and premature birth. Premature 

babies (born less than 37 weeks into pregnancy) and 

babies weighing less than 5 1⁄2 pounds at birth have a 

much higher risk of developing cerebral palsy than 

full-term, heavier weight babies. Tiny babies born 

at very early gestational ages are especially at risk.

Mothers with thyroid abnormalities, intellectual 

disability, excess protein in the urine, or seizures.

Mothers with any of these conditions are slightly 

more likely to have a child with CP. 

Multiple births. Twins, triplets, and other multiple 

births — even those born at term — are linked to 

an increased risk of cerebral palsy. The death of a 

baby’s twin or triplet further increases the risk. 

There are also medical conditions during labor 

and delivery, and immediately after delivery, that 

act as warning signs for an increased risk of CP. 

However, most of these children will not develop 

CP. Warning signs include: 

Breech presentation. Babies with cerebral palsy 

are more likely to be in a breech position (feet 

first) instead of head first at the beginning of labor. 

Babies who are unusually floppy as fetuses are 

more likely to be born in the breech position.

Complicated labor and delivery. A baby who has 

vascular or respiratory problems during labor and 

delivery may already have suffered brain damage 

or abnormalities. 

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Jaundice. More than 50 percent of newborns 

develop jaundice (a yellowing of the skin or whites 

of the eyes) after birth when bilirubin, a substance 

normally found in bile, builds up faster than their 

livers can break it down and pass it from the body. 

Severe, untreated jaundice can kill brain cells and 

can cause deafness and CP. 

Low Apgar score. The Apgar score is a numbered 

rating that reflects a newborn’s physical health. 

Doctors periodically score a baby’s heart rate, 

breathing, muscle tone, reflexes, and skin color 

during the first minutes after birth. A low score at 

10-20 minutes after delivery is often considered an 

important sign of potential problems such as CP. 

Seizures. An infant who has seizures faces a higher 

risk of being diagnosed later in childhood with CP.

Small for gestational age. Babies born smaller 

than normal for their gestational age are at risk for 

cerebral palsy because of factors that kept them 

from growing naturally in the womb. 

Can cerebral palsy be prevented?

Cerebral palsy related to genetic abnormalities 

cannot be prevented, but a few of the risk factors 

for congenital cerebral palsy can be managed or 

avoided. For example, rubella, or German measles, 

is preventable if women are vaccinated against the 

disease before becoming pregnant. Rh incompatibilities 

can also be managed early in pregnancy. Acquired 

cerebral palsy, often due to head injury, is often 

preventable using common safety tactics, such as 

using car seats for infants and toddlers.

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What are the different forms?

The specific forms of cerebral palsy are determined 

by the extent, type, and location of a child’s 

abnormalities. Doctors classify CP according to 

the type of movement disorder involved — spastic

(stiff muscles), athetoid (writhing movements), or 

ataxic (poor balance and coordination) — plus any 

additional symptoms, such weakness (paresis) or 

paralysis (plegia). For example, hemiparesis (hemi

= half) indicates that only one side of the body is 

weakened. Quadriplegia (quad = four) means all 

four limbs are afffected. 

Spastic cerebral palsy is the most common type of 

the disorder. People have stiff muscles and awkward 

movements. Forms 

of spastic cerebral 

palsy include:

• Spastic hemiplegia/

hemiparesis typically 

affects the arm and 

hand on one side of 

the body, but it can 

also include the leg. 

Children with spastic 

hemiplegia generally 

walk later and on 

tip-toe because of 

tight heel tendons. 

The arm and leg 

of the affected side 

are frequently 

shorter and 

thinner. Some 

Spastic Hemiplegia

Spastic Diplegia Spastic Quadriplegia

The most common forms of cerebral

palsy use Latin terms to describe the

location or number of affected limbs,

combined with the words plegia

(paralysis) or paresis (weak).

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children will develop an abnormal curvature 

of the spine (scoliosis). A child with spastic 

hemiplegia may also have seizures. Speech will 

be delayed and, at best, may be competent, 

but intelligence is usually normal. 

• Spastic diplegia/diparesis involves muscle 

stiffness that is predominantly in the legs and 

less severely affects the arms and face, although 

the hands may be clumsy. Tendon reflexes in 

the legs are hyperactive. Toes point up when the 

bottom of the foot is stimulated. Tightness in 

certain leg muscles makes the legs move like the 

arms of a scissor. Children may require a walker 

or leg braces. Intelligence and language skills 

are usually normal. 

• Spastic quadriplegia/quadriparesis is the 

most severe form of cerebral palsy and is often 

associated with moderate-to-severe intellectual 

disability. It is caused by widespread damage 

to the brain or significant brain malformations. 

Children will often have severe stiffness in their 

limbs but a floppy neck. They are rarely able 

to walk. Speaking and being understood are 

difficult. Seizures can be frequent and hard 

to control. 

Dyskinetic cerebral palsy (also includes athetoid, 

choreoathetoid, and dystonic cerebral palsies) is 

characterized by slow and uncontrollable writhing 

or jerky movements of the hands, feet, arms, or 

legs. Hyperactivity in the muscles of the face and 

tongue makes some children grimace or drool. They 

find it difficult to sit straight or walk. Some children 

have problems hearing, controlling their breathing, 

and/or coordinating the muscle movements required 

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12

for speaking. Intelligence is rarely affected in these 

forms of cerebral palsy. 

Ataxic cerebral palsy affects balance and depth 

perception. Children with ataxic CP will often 

have poor coordination and walk unsteadily with 

a wide-based gait. They have difficulty with quick 

or precise movements, such as writing or buttoning 

a shirt, or a hard time controlling voluntary 

movement such as reaching for a book. 

Mixed types of cerebral palsy refer to symptoms 

that don’t correspond to any single type of CP 

but are a mix of types. For example, a child with 

mixed CP may have some muscles that are too tight 

and others that are too relaxed, creating a mix of 

stiffness and floppiness. 

What other conditions are associated with 

cerebral palsy?

Abnormal sensations and perceptions. Some 

individuals with CP experience pain or have 

difficulty feeling simple sensations, such as touch. 

Contractures. Muscles can become painfully 

fixed into abnormal positions, called contractures, 

which can increase muscle spasticity and joint 

deformities in people with CP. 

Delayed growth and development. Children with 

moderate to severe CP, especially those with spastic 

quadriparesis, often lag behind in growth and 

development. In babies this lag usually takes the 

form of too little weight gain. In young children it 

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can appear as abnormal shortness, and in teenagers 

it may appear as a combination of shortness and 

lack of sexual development. The muscles and limbs 

affected by CP tend to be smaller than normal, 

especially in children with spastic hemiplegia, whose 

limbs on the affected side of the body may not grow 

as quickly or as long as those on the normal side. 

Dental problems. Many children with CP are at 

risk of developing gum disease and cavities because 

of poor dental hygiene. Certain medications, such 

as seizure drugs, can exacerbate these problems.

Drooling. Some individuals with CP drool 

because they have poor control of the muscles 

of the throat, mouth, and tongue.

Hearing loss. Impaired hearing is also more 

frequent among those with CP than in the general 

population. Some children have partial or complete 

hearing loss, particularly as the result of jaundice 

or lack of oxygen to the developing brain. 

Impaired vision. Many children with CP have 

strabismus, commonly called “cross eyes,” which 

left untreated can lead to poor vision in one eye and 

can interfere with the ability to judge distance. Some 

children with CP have difficulty understanding and 

organizing visual information. Other children may 

have defective vision or blindness that blurs the 

normal field of vision in one or both eyes. 

Inactivity. Childhood inactivity is magnified in 

children with CP due to impairment of the motor 

centers of the brain that produce and control 

voluntary movement. While children with CP may 

exhibit increased energy expenditure during activities 

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14

of daily living, movement impairments make it 

difficult for them to participate in sports and other 

activities at a level of intensity sufficient to develop 

and maintain strength and fitness. Inactive adults 

with disability exhibit increased severity of disease 

and reduced overall health and well-being.

Incontinence. A possible complication of CP 

is incontinence, caused by poor control of the 

muscles that keep the bladder closed. 

Infections and long-term illnesses. Many adults 

with CP have a higher risk of heart and lung 

disease, and pneumonia (often from inhaling 

bits of food into the lungs), than those without 

the disorder.

Intellectual disability. Approximately 30 – 50 percent 

of individuals with CP will be intellectually impaired. 

Mental impairment is more common among those 

with spastic quadriplegia than in those with other 

types of cerebral palsy. 

Learning difficulties. Children with CP may 

have difficulty processing particular types of 

spatial and auditory information. Brain damage 

may affect the development of language and 

intellectual functioning. 

Malnutrition. Swallowing, sucking, or feeding 

difficulties can make it difficult for many individuals 

with CP, particularly infants, to get proper nutrition 

and gain or maintain weight.

Seizure disorder. As many as half of all children 

with CP have one or more seizures. Children with 

both cerebral palsy and epilepsy are more likely 

to have intellectual disability.

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Spinal deformities and 

osteoarthritis. Deformities 

of the spine — curvature 

(scoliosis), humpback (kyphosis), and saddle 

back (lordosis) — are associated with CP. Spinal 

deformities can make sitting, standing, and walking 

difficult and cause chronic back pain. Pressure 

on and misalignment of the joints may result in 

osteoporosis (a breakdown of cartilage in the joints 

and bone enlargement).

Speech and language disorders. Speech and 

language disorders, such as difficulty forming words 

and speaking clearly, are present in more than 

a third of persons with CP. Poor speech impairs 

communication and is often interpreted as a sign of 

cognitive impairment, which can be very frustrating 

to children with CP, especially the majority who 

have average to above average intelligence, 

How is cerebral palsy diagnosed?

Most children with cerebral palsy are diagnosed 

during the first 2 years of life. But if a child’s 

symptoms are mild, it can be difficult for a doctor to 

make a reliable diagnosis before the age of 4 or 5. 

Doctors will order a series of tests to evaluate 

the child’s motor skills. During regular visits, 

the doctor will monitor the child’s development, 

growth, muscle tone, age-appropriate motor control, 

hearing and vision, posture, and coordination, 

in order to rule out other disorders that could 

cause similar symptoms. Although symptoms may 

change over time, CP is not progressive. If a child is 

Although symptoms 

may change over time, 

CP is not progressive.

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16

continuously losing motor skills, the problem 

more likely is a condition other than CP — such as 

a genetic or muscle disease, metabolism disorder, 

or tumors in the nervous system. 

Lab tests can identify other conditions that may 

cause symptoms similar to those associated with CP.

Neuroimaging techniques that allow doctors to look 

into the brain (such as an MRI scan) can detect 

abnormalities that indicate a potentially treatable 

movement disorder. Neuroimaging methods include:

• Cranial ultrasound uses high-frequency sound 

waves to produce pictures of the brains of young 

babies. It is used for high-risk premature infants 

because it is the least intrusive of the imaging 

techniques, although it is not as successful as 

computed tomography or magnetic resonance 

imaging at capturing subtle changes in white 

matter — the type of brain tissue that is 

damaged in CP. 

• Computed tomography (CT) uses x-rays to 

create images that show the structure of the 

brain and the areas of damage. 

• Magnetic resonance imaging (MRI) uses a 

computer, a magnetic field, and radio waves 

to create an anatomical picture of the brain’s 

tissues and structures. MRI can show the 

location and type of damage and offers finer 

levels of details than CT. 

Another test, an electroencephalogram, uses 

a series of electrodes that are either taped or 

temporarily pasted to the scalp to detect electrical 

activity in the brain. Changes in the normal 

electrical pattern may help to identify epilepsy.

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Some metabolic disorders can masquerade as CP. 

Most of the childhood metabolic disorders have 

characteristic brain abnormalities or malformations 

that will show up on an MRI. 

Other types of disorders can also be mistaken for 

CP or can cause specific types of CP. For example, 

coagulation disorders (which prevent blood from 

clotting or lead to excessive clotting) can cause 

prenatal or perinatal strokes that damage the brain 

and produce symptoms characteristic of CP, most 

commonly hemiparetic CP. Referrals to specialists 

such as a child neurologist, developmental 

pediatrician, ophthalmologist, or otologist aid 

in a more accurate diagnosis and help doctors 

develop a specific treatment plan.

How is cerebral palsy treated?

Cerebral palsy can’t be cured, but treatment will 

often improve a child’s capabilities. Many children 

go on to enjoy near-normal adult lives if their 

disabilities are properly managed. In general, the 

earlier treatment begins, the better chance children 

have of overcoming developmental disabilities or 

learning new ways to accomplish the tasks that 

challenge them. 

There is no standard therapy that works for every 

individual with cerebral palsy. Once the diagnosis is 

made, and the type of CP is determined, a team of 

health care professionals will work with a child and 

his or her parents to identify specific impairments 

and needs, and then develop an appropriate plan 

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18

to tackle the core disabilities that affect the child’s 

quality of life. 

Physical therapy, usually begun in the first few 

years of life or soon after the diagnosis is made, 

is a cornerstone of CP treatment. Specific sets of 

exercises (such as resistive, or strength training 

programs) and activities can maintain or improve 

muscle strength, balance, and motor skills, and 

prevent contractures. Special braces (called 

orthotic devices) may be used to improve mobility 

and stretch spastic muscles. 

Occupational therapy focuses on optimizing upper 

body function, improving posture, and making the 

most of a child’s mobility. Occupational therapists 

help individuals address new ways to meet everyday 

activities such as dressing, going to school, and 

participating in day-to-day activities. 

Recreation therapy

encourages participation in 

art and cultural programs, 

sports, and other events that 

help an individual expand 

physical and cognitive skills 

and abilities. Parents of 

children who participate in 

recreational therapies usually 

notice an improvement in their 

child’s speech, self-esteem, 

and emotional well-being.

Speech and language therapy

can improve a child’s ability 

to speak, more clearly, help 

with swallowing disorders, 

and learn new ways to 

The treatment team for children with cerebral 

palsy may include an occupational therapist 

to teach the skills necessary for day-to-day 

living. Above, an 18-month-old boy learns 

to feed himself.

Cerebral Palsy HTR Inside Pages.indd 18 8/18/13 
communicate — using sign 

language and/or special 

communication devices such 

as a computer with a voice 

synthesizer, or a special 

board covered with symbols of 

everyday objects and activities 

to which a child can point to 

indicate his or her wishes.

Treatments for problems with eating and drooling

are often necessary when children with CP have 

difficulty eating and drinking because they have little 

control over the muscles that move their mouth, jaw, 

and tongue. They are also at risk for breathing food 

or fluid into the lungs, as well as for malnutrition, 

recurrent lung infections, and progressive lung disease. 

Drug treatments

Oral medications such as diazepam, baclofen, 

dantrolene sodium, and tizanidine are usually 

used as the first line of treatment to relax stiff, 

contracted, or overactive muscles. Some drugs have 

some risk side effects such as drowsiness, changes 

in blood pressure, and risk of liver damage that 

require continuous monitoring. Oral medications 

are most appropriate for children who need 

only mild reduction in muscle tone or who have 

widespread spasticity. 

• Botulinum toxin (BT-A), injected locally, has 

become a standard treatment for overactive 

muscles in children with spastic movement 

disorders such as CP. BT-A relaxes contracted 

muscles by keeping nerve cells from overactivating muscle. The relaxing effect of a 

Speech and language therapy 

can help treat the communicat

disorders associated with 

cerebral palsy.

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20

BT-A injection lasts approximately 3 months. 

Undesirable side effects are mild and shortlived, consisting of pain upon injection and 

occasionally mild flu-like symptoms. BT-A 

injections are most effective when followed 

by a stretching program including physical 

therapy and splinting. BT-A injections work 

best for children who have some control over 

their motor movements and have a limited 

number of muscles to treat, none of which 

is fixed or rigid. 

• Intrathecal baclofen therapy uses an 

implantable pump to deliver baclofen, 

a muscle relaxant, into 

the fluid surrounding 

the spinal cord. 

Baclofen decreases the 

excitability of nerve 

cells in the spinal cord, 

which then reduces 

muscle spasticity 

throughout the body. 

The pump can be 

adjusted if muscle 

tone is worse at 

certain times of the 

day or night. The 

baclofen pump is 

most appropriate 

for individuals with 

chronic, severe 

stiffness or uncontrolled 

muscle movement 

throughout the body. 

The intrathecal baclofen pump 

system (shown above) delivers 

the muscle relaxant to the 

fluid surrounding the spinal 

cord. Baclofen decreases the

excitability of nerve cells in the 

spinal cord, reducing muscle 

spasticity throughout the body.

Cerebral Palsy HTR Inside Pages.indd 20 8/18/13 
Surgery

Orthopedic surgery is often recommended 

when spasticity and stiffness are severe enough 

to make walking and moving about difficult or 

painful. For many people with CP, improving the 

appearance of how they walk — their gait — is 

also important. Surgeons can lengthen muscles 

and tendons that are proportionately too short, 

which can improve mobility and lessen pain. 

Tendon surgery may help the symptoms for some 

children with CP but could also have negative 

long-term consequences. Orthopedic surgeries may 

be staggered at times appropriate to a child’s age 

and level of motor development. Surgery can also 

correct or greatly improve spinal deformities in 

people with CP. Surgery may not be indicated for 

all gait abnormalities and the surgeon may request a 

quantitative gait analysis before surgery.

Surgery to cut nerves. Selective dorsal rhizotomy

(SDR) is a surgical procedure recommended for 

cases of severe spasticity when all of the more 

conservative treatments — physical therapy, oral 

medications, and intrathecal baclofen — have 

failed to reduce spasticity or chronic pain. A 

surgeon locates and selectively severs overactivated 

nerves at the base of the spinal column. SDR is 

most commonly used to relax muscles and decrease 

chronic pain in one or both of the lower or upper 

limbs. It is also sometimes used to correct an 

overactive bladder. Potential side effects include 

sensory loss, numbness, or uncomfortable sensations 

in limb areas once supplied by the severed nerve. 

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22

Assistive devices

Assistive devices such devices as computers, 

computer software, voice synthesizers, and picture 

books can greatly help some individuals with CP 

improve communications skills. Other devices 

around the home or workplace make it easier for 

people with CP to adapt to activities of daily living. 

Orthotic devices help to compensate for muscle 

imbalance and increase independent mobility. 

Braces and splints use external force to correct 

muscle abnormalities and improve function such 

as sitting or walking. Other orthotics help stretch 

muscles or the positioning of a joint. Braces, wedges, 

special chairs, and other devices can help people 

sit more comfortably and make it easier to perform 

daily functions.

Wheelchairs, rolling 

walkers, and powered 

scooters can help 

individuals who are 

not independently 

mobile. Vision aids 

include glasses, 

magnifiers, and 

large-print books and 

computer typeface. 

Some individuals with 

CP may need surgery 

to correct vision 

problems. Hearing 

aids and telephone 

amplifiers may 

help people hear 

more clearly.

Computers have made a big difference

in the lives of people with cerebral palsy.

Above, a teenager uses a computer to

communicate and learn new words.

Cerebral Palsy HTR Inside Pages.indd 22 8/18/13 
Complementary and alternative therapies

Many children and adolescents with CP use some 

form of complementary or alternative medicine. 

Controlled clinical trials involving some of the 

therapies have been inconclusive or showed no 

benefit and the therapies have not been accepted 

in mainstream clinical practice. Although there 

are anecdotal reports of some benefit in some 

children with CP, these therapies have not 

been approved by the U.S. Food and Drug 

Administration for the treatment of CP. Such 

therapies include hyperbaric oxygen therapy, 

special clothing worn during resistance exercise 

training, certain forms of electrical stimulation, 

assisting children in completing certain motions 

several times a day, and specialized learning 

strategies. Also, dietary supplements, including 

herbal products, may interact with other products 

or medications a child with CP may be taking or 

have unwanted side effects on their own. Families 

of children with CP should discuss all therapies 

with their doctor.

Stem cell therapy is being investigated as a 

treatment for cerebral palsy, but research is in 

early stages and large-scale clinical trials are 

needed to learn if stem cell therapy is safe and 

effective in humans. Stem cells are capable of 

becoming other cell types in the body. Scientists 

are hopeful that stem cells may be able to repair 

damaged nerves and brain tissues. Studies in the 

U.S. are examining the safety and tolerability 

of umbilical cord blood stem cell infusion in 

children with CP.

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24

Are there treatments for other conditions 

associated with cerebral palsy?

Epilepsy. Many children with intellectual disability 

and CP also have epilepsy. In general, drugs are 

prescribed based on the type of seizures an individual 

experiences, since no one drug controls all types. 

Some individuals may need a combination of two 

or more drugs to achieve good seizure control. 

Incontinence. Medical treatments for incontinence 

include special exercises, biofeedback, prescription 

drugs, surgery, or surgically implanted devices to 

replace or aid muscles. 

Osteopenia. Children with CP who are unable 

to walk risk developing poor bone density 

(osteopenia), which makes them more likely to 

break bones. In a study of older Americans funded 

by the National Institutes of Health (NIH), a family 

of drugs called bisphosphonates, which has been 

approved by the FDA to treat mineral loss in the 

elderly, also appeared to increase bone mineral 

density. Doctors may choose to selectively prescribe 

the drug off-label to children to prevent osteopenia. 

Pain. Pain can be a problem for people with CP 

due to spastic muscles and the stress and strain on 

parts of the body that are compensating for muscle 

abnormalities. Some individuals may also have 

frequent and irregular muscle spasms that can’t be 

predicted or medicated in advance. Diazepam can 

reduce the pain associated with muscle spasms and 

gabapentin has been used successfully to decrease 

the severity and frequency of painful spasms. 

Botulinum toxin injections have also been shown 

to decrease spasticity and pain. Intrathecal baclofen 

Cerebral Palsy HTR Inside Pages.indd 24 8/18/13 
has shown good results in reducing pain. Some 

children and adults have been able to decrease pain 

by using noninvasive and drug-free interventions 

such as distraction, relaxation training, 

biofeedback, and therapeutic massage.

Do adults with cerebral palsy face special 

health challenges?

Premature aging. The majority of individuals 

with CP will experience some form of premature 

aging by the time they reach their 40s because of 

the extra stress and strain the disease puts upon 

their bodies. The developmental delays that 

often accompany CP keep some organ systems 

from developing to their full capacity and level 

of performance. As a consequence, organ systems 

such as the cardiovascular system (the heart, 

veins, and arteries) and pulmonary system (lungs) 

have to work harder and they age prematurely. 

Functional issues at 

work. The day-today challenges of the 

workplace are likely to 

increase as an employed 

individual with CP 

reaches middle age. 

Some individuals will be 

able to continue working 

with accommodations 

such as an adjusted 

work schedule, assistive 

equipment, or frequent rest periods. 

The amount of emotional 

support someone has, 

how successful they are a 

coping with disappointmen

and stress, and whether o

not they have an optimisti

outlook about the future a

have a significant impact 

on mental health.

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26

Depression. Mental health issues can also be of 

concern as someone with cerebral palsy grows 

older. The rate of depression is three to four times 

higher in people with disabilities such as cerebral 

palsy. It appears to be related not so much to the 

severity of their disabilities, but to how well they 

cope with them. The amount of emotional support 

someone has, how successful they are at coping with 

disappointment and stress, and whether or not they 

have an optimistic outlook about the future all 

have a significant impact on mental health. 

Post-impairment syndrome. This syndrome is marked 

by a combination of pain, fatigue, and weakness due 

to muscle abnormalities, bone deformities, overuse 

syndromes (sometimes also called repetitive motion 

injuries), and arthritis. Fatigue is often a challenge, 

since individuals with CP may use up to three to five 

times the amount of energy that able-bodied people 

use when they walk and move about. 

Osteoarthritis and degenerative arthritis. 

Musculoskeletal abnormalities that may not 

produce discomfort during childhood can cause 

pain in adulthood. For example, the abnormal 

relationships between joint surfaces and excessive 

joint compression can lead to the early development 

of painful osteoarthritis and degenerative arthritis. 

Individuals with CP also may have limited strength 

and restricted patterns of movement, which 

puts them at risk for overuse syndromes and 

nerve entrapments. 

Pain. Individuals with CP may have pain that can 

be acute (usually comes on quickly and lasts a short 

while) or chronic, and is experienced most commonly 

in the hips, knees, ankles, and the upper and lower 

Cerebral Palsy HTR Inside Pages.indd 26 8/18/13 
back. Individuals with spastic CP may have an 

increased number of painful sites and worse pain 

than those with other types of cerebral palsy. 

Preventive treatment aimed at correcting skeletal 

and muscle abnormalities early in life may help to 

avoid the progressive accumulation of stress and 

strain that causes pain. Dislocated hips, which 

are particularly likely to cause pain, can be 

surgically repaired. 

Other medical conditions. Adults have higher than 

normal rates of other medical conditions secondary 

to their cerebral palsy, such as hypertension, 

incontinence, bladder dysfunction, and swallowing 

difficulties. Scoliosis is likely to progress after 

puberty, when bones have matured into their final 

shape and size. People with CP also have a higher 

incidence of bone fractures, occurring most 

frequently during physical therapy sessions. 

What research is being done?

The National Institute of Neurological Disorders and 

Stroke, (NINDS), a part of the National Institutes of 

Health (NIH), is the nation’s leading funder of basic, 

clinical, and translational research on brain and 

nervous system disorders. Another NIH agency, the 

Eunice Kennedy Shriver National Institute of Child 

Health and Human Development (NICHD), also 

conducts and supports research on cerebral palsy. 

Much of what we now know about CP came from 

research sponsored by the NINDS, including the 

identification of new causes and risk factors for 

cerebral palsy, the discovery of drugs to control stiff 

Cerebral Palsy HTR Inside Pages.indd 27 8/18/13 
28

and spastic muscles and more precise methods to 

deliver them, refined surgical techniques to correct 

abnormalities in muscle and bone, and a greater 

understanding of how and why brain damage at 

critical stages of fetal development causes CP. 

Many scientists think that a significant number 

of children develop CP because of mishaps early 

in brain development. They are examining how 

neurons (nerve cells) in the brain specialize and 

form the right connections with other brain cells, 

and they are looking for ways to prevent the 

factors that disrupt the normal processes of 

brain development. 

Genetic defects are sometimes responsible for the 

brain malformations and abnormalities that cause 

cerebral palsy. Scientists are searching for the genes 

responsible for these abnormalities by collecting 

DNA samples from people with cerebral palsy and 

their families and using genetic screening techniques 

to discover linkages between 

individual genes and specific 

types of abnormality — 

primarily those associated 

with the process in the 

developing brain in which 

neurons migrate from where 

they are born to where they 

settle into neural circuits 

(called neural migration).

Scientists are scrutinizing 

events in newborn babies’ 

brains, such as bleeding, 

epileptic seizures, and 

The brain chemical glutamate is necessary

to help neurons communicate. But too much 

glutamate — called glutamate toxicity —

overexcites and kills neurons. In the search

for causes of cerebral palsy, scientists are

studying conditions that result in high levels

of glutamate in the brain.

Cerebral Palsy HTR Inside Pages.indd 28 8/18/13 
breathing and circulation problems, which can 

cause the abnormal release of chemicals that 

triggers the kind of damage that causes cerebral 

palsy. For example, research has shown that 

bleeding in the brain unleashes dangerously high 

amounts of glutamate, a chemical that helps neurons 

communicate. However, too much glutamate 

overexcites and kills neurons. By learning how 

brain chemicals that are normally helpful become 

dangerously toxic, scientists will have opportunities 

to develop new drugs to block their harmful effects.

Researchers are using imaging techniques and 

neurobehavioral tests to predict those preterm 

infants who will develop cerebral palsy. If these 

screening techniques are successful, doctors will 

be able to identify infants at risk for cerebral 

palsy before they are born. 

Periventricular white matter damage — the most 

common cause of CP — is characterized by death of 

the white matter around the fluid-filled ventricles 

in the brain. The periventricular area contains 

nerve fibers that carry messages from the brain to 

the body’s muscles. NINDS-sponsored researchers 

are hoping to develop preventative strategies for 

white matter damage. For example, researchers 

are examining the role the brain chemicals play 

on white matter development in the brain. Another 

NINDS-funded project involves the development 

of a novel mouse model and cell-based therapies 

for perinatal white matter injury. Researchers 

funded by NINDS are studying a chemical found 

naturally in the body, called erythropoietin to 

see if it decreases the risk of CP in prematurely 

born infants.

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30

NIH-funded scientists 

continue to look at 

new therapies and 

novel ways to use 

existing options to 

treat individuals 

with CP, including:

Constraint-induced 

therapy (CIT) is a 

promising therapy 

for CP. CIT typically 

involves restraining the stronger limb (such as the 

“good” arm in a person who has been affected by a 

stroke on one side of the body) in a cast and forcing 

the weaker arm to perform intensive activities 

every day over a period of weeks. A clinical study 

sponsored by the NICHD is examining the use of 

different dosage levels of daily training using either 

full-time cast immobilization vs. part-time splint 

restraint in improving upper body extremity skills in 

children with weakness on both sides of their body. 

Study findings will establish evidence-based practice 

standards to improve lifelong neuromotor capacity 

in individuals with CP. 

Functional electrical stimulation (FES) — the 

therapeutic use of low-level electrical current to 

stimulate muscle movement and restore useful 

movements such as standing or stepping — is 

an effective way to target and strengthen spastic 

muscles. Researchers are evaluating how FESassisted stationary cycling can improve physical 

conditioning and general lower extremity muscle 

strength in adolescents. Robotic therapy that 

One type of physical therapy called constraint-resistant 

therapy — which involves restraining the stronger arm and 

forcing the weaker arm to perform intensive activities — has 

been shown effective for some children with cerebral palsy.

Cerebral Palsy HTR Inside Pages.indd 30 8/18/13 
applies controlled force to the leg during the swing 

phase of gait is may improve the efficacy of body 

weight supported treadmill training in children with 

CP. The results from this NICHD study will lead to 

an innovative clinical therapy aimed at improving 

locomotor function in children with CP. 

Botulinum toxin (Botox), injected locally, has 

become a standard treatment in children with 

spastic movement disorders such as CP. Recent 

animal studies suggest Botox degrades bone but 

there are no studies of its skeletal consequences 

in humans. Other research shows a low intensity 

vibration treatment can improve bone structure 

in the lower extremity leg bones of children with 

CP. In a novel clinical study being conducted by 

NICHD, researchers are determining the effect 

of Botox treatment in conjunction with a daily 

vibration treatment on bone mass and bone 

structure in children with spastic CP. 

Systemic hypothermia — the controlled medical 

cooling of the body’s core temperature — appears 

to protect the brain and decrease the rate of 

death and disability from certain disorders and 

brain injuries. Previous studies have shown that 

hypothermia is effective in treating neurologic 

symptoms in term or late preterm babies less 

than one month old that are attributed to hypoxicischemia (HIE, brain injury due to a severe 

decrease in the oxygen supply to the body), 

which can cause quadriplegic CP, with or without 

movement disorder. In an effort to determine 

the most effective cooling strategies, NICHDfunded researchers are studying different cooling 

Cerebral Palsy HTR Inside Pages.indd 31 8/18/13 
32

treatments to improve the chance of survival and 

neurodevelopment outcomes 18-22 months posttreatment in infants with neurologic symptoms 

attributed to HIE. Other researchers are examining 

if combined therapy using hypothermia and 

recombinant erythropoietin (a hormone that 

promotes the growth of new red blood cells and 

increases oxygen levels in the blood) is more 

effective than either therapy alone in treating 

neurodevelopmental handicaps in an animal 

model involving lack of oxygen before, during, 

or just after birth. 

As researchers continue to explore new treatments 

for cerebral palsy and to expand our knowledge 

of brain development, we can expect significant 

improvements in the care of children with cerebral 

palsy and many other disorders that strike in 

early life. 

Cerebral Palsy HTR Inside Pages.indd 32 8/18/13 
Glossary

acquired cerebral palsy — cerebral palsy that 

occurs as a result of injury to the brain after birth 

or during early childhood. 

Apgar score — a numbered scoring system doctors 

use to assess a baby’s physical state at the time 

of birth. 

asphyxia — a lack of oxygen due to trouble with 

breathing or poor oxygen supply in the air. 

ataxia — the loss of muscle control. 

athetoid — making slow, sinuous, involuntary, 

writhing movements, especially with the hands. 

bilirubin — a bile pigment produced by the liver of 

the human body as a byproduct of digestion. 

bisphosphonates — a family of drugs that 

strengthen bones and reduce the risk of bone 

fracture in elderly adults. 

botulinum toxin — a drug commonly used to 

relax spastic muscles; it blocks the release of 

acetylcholine, a neurotransmitter that energizes 

muscle tissue. 

cerebral — relating to the two hemispheres of the 

human brain. 

cerebral dysgenesis — defective brain development. 

choreoathetoid — a condition characterized by 

aimless muscle movements and involuntary motions. 

Cerebral Palsy HTR Inside Pages.indd 33 8/18/13 
34

congenital cerebral palsy — cerebral palsy that 

is present at birth from causes that have occurred 

during fetal development. 

contracture — a condition in which muscles become 

fixed in a rigid, abnormal position, which causes 

distortion or deformity. 

developmental delay — behind schedule in 

reaching the milestones of early childhood 

development. 

dyskinetic — the impairment of the ability to 

perform voluntary movements, which results in 

awkward or incomplete movements. 

dystonia (dystonic) — a condition of abnormal 

muscle tone. 

gait analysis — a technique that uses cameras, 

force plates, electromyography, and computer 

analysis to objectively measure an individual’s 

pattern of walking. 

gestation — the period of fetal development from 

the time of conception until birth. 

hemiparesis — paralysis affecting only one side of 

the body. 

hypertonia — increased muscle tone. 

hypotonia — decreased muscle tone. 

hypoxic-ischemic encephalopathy — brain damage 

caused by poor blood flow or insufficient oxygen 

supply to the brain. 

intracranial hemorrhage — bleeding in the brain. 

Cerebral Palsy HTR Inside Pages.indd 34 8/18/13 
intrathecal baclofen — baclofen that is injected 

into the cerebrospinal fluid of the spinal cord to 

reduce spasticity.

jaundice — a blood disorder caused by the 

abnormal buildup of bilirubin in the bloodstream. 

kyphosis — a humpback-like outward curvature of 

the upper spine. 

lordosis — an increased inward curvature of the 

lower spine. 

orthotic devices — special devices, such as splints 

or braces, used to treat posture problems involving 

the muscles, ligaments, or bones. 

osteopenia — reduced density and mass of the bones. 

palsy — paralysis, or the lack of control over 

voluntary movement. 

-paresis or -plegia — weakness or paralysis. In 

cerebral palsy, these terms are typically combined 

with other phrases that describe the distribution of 

paralysis and weakness; for example, quadriplegia 

means paralysis of all four limbs. 

periventricular leukomalacia (PVL) — “peri” 

means near; “ventricular” refers to the ventricles 

or fluid spaces of the brain; and “leukomalacia” 

refers to softening of the white matter of the brain. 

PVL is a condition in which the cells that make 

up white matter die near the ventricles. Under a 

microscope, the tissue looks soft and sponge-like. 

placenta — an organ that joins a mother with 

her unborn baby and provides nourishment 

and sustenance. 

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36

quadriplegia — paralysis of both the arms and legs. 

Rh incompatibility — a blood condition in which 

antibodies in a pregnant woman’s blood attack fetal 

blood cells and impair an unborn baby’s supply of 

oxygen and nutrients. 

rubella — (also known as German measles) a viral 

infection that can damage the nervous system of 

an unborn baby if a mother contracts the disease 

during pregnancy. 

scoliosis — a disease of the spine in which the spinal 

column tilts or curves to one side of the body. 

selective dorsal rhizotomy — a surgical procedure 

in which selected nerves are severed to reduce 

spasticity in the legs. 

spastic (or spasticity) — describes stiff muscles 

and awkward movements. 

spastic diplegia (or diparesis) — a form of cerebral 

palsy in which spasticity affects both legs, but the 

arms are relatively or completely spared. 

spastic hemiplegia (or hemiparesis) — a form of 

cerebral palsy in which spasticity affects an arm 

and leg on one side of the body. 

spastic quadriplegia (or quadriparesis) — a 

form of cerebral palsy in which all four limbs are 

paralyzed or weakened equally. 

tremor — an involuntary trembling or quivering.

Cerebral Palsy HTR Inside Pages.indd 36 8/18/13 
Cerebral Palsy HTR Inside Pages.indd 37 8/18/13 
Credits

Illustrations and photos:

National Institute of Child Health and Human Development—page 7

Kennedy Krieger Institute; William K. Geiger, photographer, 

for NINDS—page 18, 22

United Cerebral Palsy Research and Educational Foundation—page 20

Dr. Andrew Gordon, Center for Celebral Palsy Research in Hand Motor 

Control, Columbia University—page 30

Cerebral Palsy HTR Inside Pages.indd 38 8/18/13