Conditions Associated with Cerebral Palsy
Cerebral palsy is caused by damage to or malformation of the areas of the brain that control motor function during fetal development. Children with CP often have coexisting conditions, which are health conditions that a person has in addition to cerebral palsy. These other conditions may be the result of having cerebral palsy or an unrelated, but common co-occurrence.
There are several categories of conditions associated with cerebral palsy, including:
- Primary conditions
- Secondary conditions
- Associative conditions
- Co-mitigating factors
Primary conditions are the direct result of the brain injury or malformation that causes cerebral palsy. Primary conditions or symptoms of cerebral palsy include impaired motor control (gross, fine and oral), impaired motor coordination and poor muscle tone, balance and posture.
Secondary conditions are the result of primary conditions and are only present because of the cerebral palsy. Secondary conditions often associated with CP include difficulty feeding and swallowing, poor nutrition and respiratory issues, among others.
Oral Motor Impairment (Problems with Feeding, Swallowing and Drooling)
Children with cerebral palsy often have impaired oral motor control, which means they have difficulty controlling the muscles in their mouth and throat. This can lead to problems with feeding (sucking, chewing, etc.) and dysphagia, or difficulty swallowing. In some cases, those with dysphagia may experience pain when swallowing or be unable to swallow at all.
Gastroesophageal reflux disease (GERD) is common among those with cerebral palsy. GERD is a digestive disease in which stomach acid is regurgitated into the esophagus.
Children who have difficulty swallowing and/or GERD are at risk for aspiration, which is when food, liquids, saliva or vomit are inhaled into the lungs. Frequent aspiration can lead to respiratory problems, like aspiration pneumonia, and may be life-threatening.
Those with impaired fine motor skills may also have trouble using their hands to transport food or drink to their mouth. These children may have to rely on a caretaker or assistive equipment to feed them. Feeding and swallowing problems can lead to poor nutrition, dehydration and low weight.
It’s estimated that 85 to 90 percent of children with cerebral palsy experience feeding and swallowing difficulties, especially those with moderate to severe cases of CP.
Oral motor impairment also causes drooling in about 30 percent of cerebral palsy patients. Problems with feeding and swallowing, as well as drooling, can be improved through speech and occupational therapy.
Many children with cerebral palsy have dysarthria, a motor speech disorder. People with dysarthria have difficulty controlling the muscles used for speech, such as as the:
- Vocal folds
Apraxia of speech is another common motor speech disorder that affects children with cerebral palsy. Childhood apraxia of speech, as it’s referred to in children, is when a child has difficulty saying words, sounds and syllables. The child knows what they want to say, but their brain is unable to plan and coordinate the muscle movements needed to do so.
Children with cerebral palsy may also struggle with speech sound disorders. These include problems with articulation and phonological processes, or speech patterns used by children to simplify adult speech.
It’s estimated that more than half of children with cerebral palsy have some sort of speech impairment. Speech disorders can usually be improved through speech therapy.
Associative conditions are those that commonly co-occur with cerebral palsy, but are not caused by the same brain injury or malformation. Associative conditions of CP include vision and hearing impairment (these can be secondary conditions in some cases), intellectual and learning disabilities, and epilepsy, among others.
Intellectual disability, formerly known as mental retardation, is characterized by below average intellectual functioning. A child with an intellectual disability will have limitations in both cognitive functioning—the thinking skills that lead to knowledge—and adaptive behavior—the ability to adapt to the environment and function in daily life. Intellectual disabilities are categorized as mild, moderate or severe.
An estimated two-thirds of children with cerebral palsy have an intellectual disability. Of those children, half have a mild diagnosis and the other half have a moderate to severe intellectual disability.
Children with cerebral palsy sometimes have difficulty learning due to a number of factors. Some have learning disabilities, which are neurological processing problems that interfere with basic learning skills, like reading and writing. Learning disabilities can also affect higher level skills, such as organization and abstract reasoning.
Motor planning difficulties, known as motor dyspraxia, are also common with CP. People with motor dyspraxia have a hard time understanding tasks and planning how to perform them, which makes executing the tasks even harder. A child who has motor planning difficulties knows what they want to do, but they have trouble understanding how to do it. This can make learning new skills a huge effort that requires a lot of concentration.
Perceptual difficulties, which include both auditory (hearing) and visual (seeing) perception, may also affect a child with CP’s ability to learn. Children with perceptual difficulties have a hard time making sense of the information they take in through their eyes and/or ears, which can impact many areas of learning, especially learning to read and working with numbers.
Those with impaired fine motor and gross motor coordination, as well as language and communication problems, may also have trouble learning.
Visual Impairment and Blindness
Visual impairment refers to any kind of vision loss not including blindness, which is when a person is completely visually impaired and can see no light at all.
One in ten children with cerebral palsy have severe visual impairment. Nearly half of all children with spastic cerebral palsy have strabismus, better known as cross-eye. As many as 75 to 90 percent of children with CP have a vision impairment, including:
- Amblyopia (lazy eye)
- Optic atrophy (deterioration of the optic nerve due to damage)
- Nystagmus (repetitive, uncontrollable eye movements in a vertical or horizontal direction)
- Visual field defects (loss of one side of the visual field)
- Refractive errors (near and farsightedness and astigmatism or blurred vision)
Hearing impairment, also known as hearing loss, refers to any degree of impairment of the ability to hear sound. The degree of one’s hearing loss is measured on a scale and can be slight, mild, moderate, severe or profound. There are three main types of hearing loss, including:
Conductive hearing loss occurs when there is a problem in the outer or middle ear, which results in hearing only faint sounds. With this type of hearing impairment, sound is not properly carried (conducted) through the outer ear canal to the middle ear (the eardrum and the ossicles or the tiny bones of the middle ear) and inner ear. Conductive hearing loss can usually be corrected by medical or surgical intervention.
Sensorineural hearing loss occurs when the inner ear (cochlea) or the auditory nerve are damaged. This type of hearing impairment reduces the ability to hear faint sounds and speech often sounds muffled. It usually cannot be corrected medically or surgically and is the most common type of permanent hearing loss.
A person has mixed hearing loss if they have both conductive and sensorineural hearing loss in an ear. In this case, there is damage in the outer or middle ear and in the inner ear.
Central hearing loss is a rare form of hearing impairment. With central hearing loss, the issue is in the central nervous system, not the ear. The person may be able to hear perfectly, but they cannot interpret or understand the language.
An estimated 20 percent of children with cerebral palsy have a hearing impairment. Early intervention is important because hearing problems can also affect the child’s speech and communication skills.
A seizure is a sudden surge of electrical activity in the brain that can cause involuntary movements and/or behavior changes, as well as a change in awareness. Epilepsy, also known as seizure disorders, is not a disease. It is a spectrum condition characterized by unpredictable, recurrent seizures.
Thirty to 50 percent of children with CP have co-occurring epilepsy. It’s more common among children who are unable to walk or have limited mobility.
A child’s ability to process information received from the senses may also be affected depending on the severity and extent of their brain injury. This is called sensory processing disorder. Children with sensory processing disorder can experience increased or decreased sensory reactions, which can lead to problems with development and behavior.
For example, a child who has an increased sensitivity to touch (known as hypersensitivity) may not like the feeling of certain textiles and will act out or scream if they come in contact with one. On the other hand, a child with a decreased sensitivity to touch (known as hyposensitivity) may play aggressively or bump into things without showing pain.
Sensory problems are common among children with other neurodevelopmental disorders, like autism.
Co-mitigating factors are conditions that are unrelated to cerebral palsy. These conditions often coexist with cerebral palsy, but the reason why is not yet known. Co-mitigating factors of cerebral palsy include autism and ADHD.
Attention-deficit hyperactivity disorder (ADHD) is a developmental disability characterized by inattention, distractibility and impulsivity. Children with ADHD may have a hard time staying focused and paying attention, which can make learning a challenge. They may also have trouble controlling their behavior and struggle with hyperactivity—a higher than normal activity level. Children with ADHD often have issues in school and with social skills.
Approximately three to five percent of children have ADHD and it’s more common in children with cerebral palsy or other brain disorders.
Autism spectrum disorder is an umbrella term that describes a group of brain development disorders. Autism is characterized by social impairments, verbal and nonverbal communication difficulties and repetitive patterns of behavior.
Approximately one to two percent of American children have an autism spectrum disorder. An estimated seven percent of children with cerebral palsy have co-occurring autism. While it seems that autism is more common among children with cerebral palsy, the link between the two disorders is not yet known.
Treatment for Coexisting Conditions
Treatment for cerebral palsy is different in each case. When determining the best course of treatment, it’s important to evaluate the severity of one’s CP, as well as secondary and associative conditions and co-mitigating factors.
Many of the symptoms associated with cerebral palsy and coexisting conditions can be managed or improved with a comprehensive treatment plan. In most cases, a team of various medical specialists are needed, including a/an:
- Orthopedic surgeon
- Sleep medicine specialist
- Dietician (nutrition therapy)
- Assistive technology expert (orthotists, prosthetists, seating practitioners, etc.)
A comprehensive treatment plan that addresses the child’s primary, secondary and associative conditions and co-mitigating factors will provide the best chance for an improved quality of life.
To learn more about coexisting conditions, try downloading our free Cerebral Palsy Guide. This guide includes 12 pages of in-depth information for children and parents of a child with CP.