Cerebral palsy is most often due to a problem that affects the development of a

baby's brain while it's growing in the womb.

These include:
periventricular leukomalacia (PVL) damage to part of the brain called white
matter, possibly as a result of a reduction in the baby's blood or oxygen supply
an infection caught by the mother such as cytomegalovirus, rubella,
chickenpox or toxoplasmosis
a stroke in the baby this is where there's bleeding in the baby's brain or the
blood supply to their brain is cut off
an injury to the unborn baby's head

Problems during or after birth

Cerebral palsy is also sometimes caused by damage to a baby's brain during or
shortly after birth.

For example, it can be due to:

the brain temporarily not getting enough oxygen (asphyxiation) during a difficult
birth
an infection of the brain, such as meningitis
a serious head injury
choking or nearly drowning, resulting in the brain not getting enough oxygen
a very low blood sugar level
a stroke

Increased risk
There are some things that can increase a baby's risk of being born with cerebral
palsy.

These include:
being born prematurely (before the 37th week of pregnancy) babies born at 32
weeks or earlier are at a particularly high risk
a low birth weight
a twin or multiple pregnancy
the mother being 35 years of age or older
the mother having unusually low blood pressure or high blood pressure
https://www.nhs.uk/Conditions/Cerebral-palsy/Pages/Causes.aspx

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The NHS describes three different categories of Cerebral Palsy, it is also

possible to have a combination of categories which is referred to as 'Mixed
Cerebral Palsy'.

Spastic Cerebral Palsy This affects muscle stiffness or weakness.

Athetoid Cerebral Palsy This affects muscle tone, causing involuntary
spasms.
Ataxic Cerebral Palsy This affects balance and coordination.
http://www.cerebralpalsy.org.uk/cerebral-palsy.html

The affect Cerebral Palsy has on individuals ranges from the very mild, to more
severe cases that can make it difficult for people to control their limbs.
The severity of symptoms can vary significantly. Some people only have minor
problems, while others may be severely disabled.

People with cerebral palsy are likely to also have other impairments in addition to
their motor disability.
Spastic hemiplegia, where one half of the body has difficulty with voluntary
movement, is the most common presentation of cerebral palsy. Approximately 40%
of people with cerebral palsy have hemiplegia.
There is no known cure.

Interventions for movement difficulties:

Medication:
Medical specialists may prescribe medications that assist movement issues. Some
medications are taken orally (e.g. diazepam) and others are injected or delivered
through surgically implanted pumps (e.g. Baclofen). Many children with cerebral
palsy benefit from Botulinum toxin type A injections into muscles affected by
spasticity. This intervention is used from about two years of age and is most effective
when used in conjunction with therapy.

Surgical procedures:
Selective Dorsal Rhizotomy (SDR) is a neurosurgical procedure that is used in a
small percentage of children with cerebral palsy to permanently reduce spasticity in
their legs.

Physiotherapy and occupational therapy:

Physiotherapists and occupational therapists focus on encouraging a persons day-
to-day movement skills such as sitting, walking, playing, dressing and toileting. They
will use a range of specialist interventions such as movement training and
equipment, e.g. walking frames, wheelchairs, supportive seating, footwear and
orthotics.

Care plan goals for Cerebral Palsy include:

Optimize mobility.
Manage primary conditions.
Control pain.
Prevent and manage complications, associative conditions and co-mitigating
factors.
Maximize independence.
Enhance social and peer interactions.
Foster self-care.
Maximize ability to communicate.
Assess abilities
Mobility and motor impairment assessments will establish severity, extent, and
location of impairment. However, a number of other assessments intellectual skills,
behaviour, emotional, and attention, for example may be required, as well.

A childs diet, eating habits and ability to properly process food will be analysed.
Respiratory conditions, sensory abilities, balance, posture, skin and oral health will
also be evaluated. Assessments may be required in the following areas:

Mobility and motor impairment evaluation:

Muscle tone
Movement coordination and control
Reflexes
Posture
Balance
Gross motor function
Fine motor function
Oral motor function (feeding, swallowing, respiratory, speech, vocal)

Associative conditions and co-mitigating factor assessment:

Cognitive, psychological and behavioural
Gastrointestinal, nutritional and dietary
Neurologic
Oral health
Orthopaedic
Respiratory
Sensory
Skin health

For more information, Associative Conditions and Co-Mitigating Factors

Step 4: Determine goals

Cerebral Palsy is a chronic condition, meaning it will not go away. Since Cerebral
Palsy is a one-time only brain injury, it will not progress. Every childs condition is
unique, and every child may require a customized care plan. The main long-term
goal in treating Cerebral Palsy is to provide an individual with the highest degree of
independence along with optimal quality of life. The care plan will likely include the
following ten goals, as well as a few goals customized specifically to address the
childs unique circumstances.

Care plan goals for Cerebral Palsy include:

Optimize mobility
Manage primary conditions
Control pain
Prevent and manage complications, associative conditions and co-mitigating
factors
Maximize independence
Enhance social and peer interactions
Foster self-care
Maximize ability to communicate
Maximize learning potential
Enhance quality of life
Research has proven the life expectancy of a child with Cerebral Palsy can be
optimized when his or her conditions are properly managed. With the exception of
some severe cases, most individuals diagnosed with Cerebral Palsy are expected to
live the span of a normal life. Research also indicates the life expectancy of a child
with Cerebral Palsy is affected by his or her level of mobility, as well as the ability to
communicate, socialize, feed, clothe and bathe his or her self and control pain. Other
important factors include seizure control, prevention of respiratory disease and
optimization of cognitive functioning, learning opportunities and the ability to see.

For more information, Life Expectancy of Cerebral Palsy

In order to maximize the childs future potential and impact his or her quality of life,
parents are encouraged to embrace a treatment plan that incorporates these goals
to the fullest ability of the child.
Step 5: Create, implement and monitor a coordinated comprehensive medical care
plan

Unfortunately, no standard treatment protocol exists for a child with Cerebral Palsy;
since every childs condition is unique, every child will require a customized
approach to treatment. Parents work closely with the childs primary care physician
to implement a coordinated and comprehensive medical care plan that may contain:

Conventional medical treatment

Complementary medical treatment
Alternative interventions

All treatment should be coordinated with the primary care physician so one
procedure does not adversely affect another or place the childs health or safety in
jeopardy. Treatment and therapy programs will likely involve one or more, of the
following:

Therapy
Surgery
Medications and Drug Therapy
Assistive Technology Global Perspective
Assistive Technology National Perspective
Complementary and Alternative Medicine

Medical treatment for Cerebral Palsy is not a one-time treatment cure. Medical
needs for those with Cerebral Palsy are dependent upon severity, extent, level,
location and co-mitigating factors and may vary as the child develops and grows into
adulthood.

Treatment coincides with the childs development needs. For example, early
intervention usually consists of early diagnosis and information passed from doctor
to parent in an effort to encourage the whole family to embrace the childs health
condition. With this information, parents will prepare to cope for the childs welfare
with new demands placed on the family.

Between the age of two and five, concentration may be placed on optimizing
opportunities for mobility. From age five-10 the child will be enrolled in school and
under the guidance of the Individualized Education Plan provided by the school
system. From the age of 11-15, emphasis is placed on opportunities to enhance the
childs socialization and optimize his or her ability to function independently. At age
15, focus is placed on transitioning the child into adulthood with independent living,
college or trade school opportunities, and workforce development.

Even after the child becomes an adult, circumstances such as the natural aging
process, the onset of other health conditions and the demands of daily living may
lead to revised care goals. As the individual ages, decisions need to be made as to
who will provide his or her care and how that care will be subsidized.

Still, medical care is only one component of the childs total life care plan.

Step 6: Maintain Records

Most states mandate that medical professionals who originally order or prescribe
treatment maintain medical records only a certain number of years. Not all medical
professionals or medical facilities provide patients with the option of obtaining
records before they can be legally destroyed. Maintaining medical records for a child
diagnosed with Cerebral Palsy has many advantages:
Evaluate progress
Update treatment goals and plans
Share with new care team members
Reference when caring for the child
Reduce duplication costs when medical records are requested for insurance,
treatment or benefit consideration
Document diagnosis
Record exam and assessment results
Provide a history of care
Avoid the need to mentally catalogue years of cumbersome medical information

For best results, parents should ask for a copy of the childs medical records at the
time a physician is explaining test results or prescribing treatment. At this time, it is
generally assumed that you and your insurance carriers are already paying for the
test and the interpretation of the test results, and are therefore entitled to the
corresponding medical records.

A medical professional will usually provide the documents upon request at the time
of check-out. If medical records are requested after considerable time has passed,
parents may be asked to pay an administrative fee and wait, usually one to four
weeks, for fulfillment of the request.

States have set guidelines related to the number of years a medical professional is
required to keep medical records, usually seven years after the last visit. They are
not obligated to inform patients when disposing of records. Medical records of a child
with Cerebral Palsy can be useful at many points in the childs development and
treatment.
http://www.cerebralpalsy.org/about-cerebral-palsy/treatment/six-step-
treatment-plan

Care Plan
A plan of care is a road map that will improve a childs physical, developmental and
psychological development. The care plans scope involves the input of several
professionals that work to assess a childs abilities and limitations, and devise
treatments and accommodations that help expand a childs capabilities.

Many individuals come to the aid of a family touched by Cerebral Palsy. Since every
childs condition and circumstances are unique, their needs will be, as well. The
types of services a family can afford or need and the level of support they receive
depends upon many factors.

Access to health care facilities, health insurance, adequate shelter, financial stability,
government assistance, community support, effective education plans, and funding
can be extremely beneficial. The care plan outlines various aspects a parent may
want to explore while managing their childs journey with Cerebral Palsy.

The Care Plan Process for Managing Cerebral Palsy

This process is not meant to be all-inclusive. It is to present a guide which will

provide insight into the many aspects of care, whether at home, at the doctors office,
during education evaluations, or simply for planning for the future.

Components of the care plan process include:

The Team
The Diagnosis
The Evaluation
The Goals
The Plan
The Record Keeping

Since every childs condition and circumstances are unique, their needs will be as
well.

The types of services a family can afford and the level of support they receive
depend upon many factors. Often the family dynamics play an important role.

Being aware of the support systems that are available is the first line of defence in
obtaining assistance. Qualifying, applying and following program guidelines are
additional steps often required.

Following, MyChild provides an overview of the types of services and the providers
that are available, in hopes of creating awareness of providers which may assist
parents in caring for their child.

The following is a list of some of the types of providers that may be of assistance.
This is not intended to be a fully comprehensive list, but instead to provide a few of
the types of providers the parents may deploy for assistance in managing their
childs condition during the childs life span. Gaining knowledge of available
resources is a powerful tool towards providing the care the family needs and the
child deserves.

The service teams include:

Care at Home Team
Medical Care Team
Government Services Team
Education Team
 Community Support and Funding Team
Legal Service Team
Professional Service Team
Product and Service Provider Team

The Diagnosis
Parents or legal guardians work closely with the childs primary care physician to
obtain a formal diagnosis. The diagnosis will attempt to discover the cause and form
of Cerebral Palsy. During the diagnosis process, many screens and tests provide
relevant information to confirm or rule-out a diagnosis of Cerebral Palsy. In addition,
children may have associative conditions or co-mitigating factors that may also be
diagnosed during this process.

For efficient retrieval, these should be stored in a childs home health records. You
will refer to these documents often for many different purposes.

In particular, the following documents are extremely useful:

Document Cause of Cerebral Palsy
Radiological findings of brain injury or abnormality PVL, IVH, HIE, Cerebral
Dysgenesis
Cause of brain damage or abnormality prematurity, low birth weight, lack of
oxygen, malformation, shaken baby, accident, medical malpractice, infection,
prematurity, etc.
Timing of brain damage prenatal, perinatal, postnatal, acquired, congenital, or
genetic predisposition

Document Form of Cerebral Palsy

Severity mild, moderate, severe, and no CP
Extent plegia or paresis
Location/anatomical distribution mono, di, hemi, para, tri, tetra, quad, and
penta
Gross Motor Function Classification Level Level I, Level II, Level III, and Level
IV

Obtain Medical Records

Fill out The Cerebral Palsy Risk Factor Checklist, discuss with your childs
doctor, and maintain a copy in your childs health records.
Fill out The Cerebral Palsy Diagnosis Checklist as you receive diagnosis and
test results, and maintain a copy in your childs health records.
Obtain medical records from your childs various doctors for diagnosis, lab
results, test results, specialist recommendations, and immunization records, and
keep a copy in your childs health records. (Note, these results are usually
provided free at the time the doctor discloses the information to the parents,
however asking for medical records after the fact may require a formal written
request and a nominal cost for record retrieval.)
File medical records obtained in your childs health records for future reference.
These documents help a parent to document their childs care, but may also be
retrieved when reviewing your childs condition with other doctors, for tax
preparation, for bill payments, creating trusts, financial planning, caregiving,
government benefit applications, or education eligibility consideration.

The Evaluation
Upon diagnosis, an orthopedic surgeon will likely define the extent, location and
severity of the childs motor impairment. The childs primary care physician will
document any associative conditions or co-mitigating factors. Some associative
conditions and co-mitigating factors may develop over the childs lifespan and can be
added to this plan. A child with special needs is urged to begin early intervention.

During early intervention and school evaluations the childs activities of daily living
will be evaluated for services and adaptive device consideration. Family dynamics
and socio-economic status will be assessed by school, government agencies or
specialists to assist with services and possible funding and support. Educational
plans will be made during the childs school years in the Individualized Education
Plan (IEP) process.

Evaluation includes:
Mobility/Motor Impairment Evaluation
Abnormal muscle tone
Movement coordination and control difficulties
Reflex irregularity
Abnormal posture
Abnormal balance
Gross motor dysfunction
Fine motor dysfunction
Oral motor dysfunction (Feeding, swallowing, respiratory, speech and vocal)

Associative Conditions and Co-Mitigating Factors Assessment

Behaviour
Cognition
Communication
Developmental Delay
Digestive Health
Dysphagia
Hearing
Mobility
Neurologic Health
Nutrition Health
Oral Health
orthopaedic Health
Respiratory Health
Seizure Control
Sensory
Skin Health
Socialization
Vision

Activities of Daily Living Evaluation

Bathing
Dressing and undressing
Eating
Food preparation
Grooming
Housekeeping
Leisure
 Mobility
Personal hygiene
Recreation
Self-care
Shopping
Transferring (bed, chair, toiletry, etc)
Walking
Work

Family Dynamics and Socio-Economic Status Assessment

Access to health care
Access to health insurance
Socio-economic situation (financial, educational, parental status, language
barriers)
Caretaking capacity
Support network
Housing situation
Transportation situation
Extenuating circumstances

Education Assessments
Academic Performance
Adaptive Delay or Impairment
Capacity to Learn/Learning Impairments
Communication Level
Emotional Status
Health
Intelligence
Motor Abilities
Social Ability
Vision and Hearing

The Goal
The childs care team will provide parents with health care goals. Each provider may
have certain goals that relate to particular treatment objectives. Some may be short-
term goals, while others are long-term. School administrators may concentrate on
educational goals, while an orthopaedic surgeon may be more interested in mobility
goals. Home care providers may concentrate on skill sets required to obtain self-
care, independence and quality of life. In general, the top ten long-term goals for an
individual with Cerebral Palsy include:
Top Ten Goals
1. Manage primary conditions
2. Prevent and manage complications, associative conditions and co-mitigating
factors
3. Control pain
4. Optimize mobility
5. Maximize communication
6. Maximize learning potential and special education opportunities
7. Encourage social and peer interactions
8. Foster self-care and promote life skills
9. Maximize independence and Self-Sufficiency
10. Enhance quality of life and well-being
Most children with Cerebral Palsy can live long, happy, quality lives. Admittedly, their
care may involve more visits to the doctor, require therapy or medications, and
perhaps surgery. The severity level, extent and location of impairment, pain levels
and ability to function all play a significant role in a persons life span. In addition,
managing Cerebral Palsy involves proper management of the childs primary and
associative conditions. Co-mitigating factors like chocking as a result of oral motor
dysfunction, weight loss as a result of improper nutrient levels, or complications from
seizures are all co-mitigating factors that are emergent and require proper and timely
management, or it may put the child at risk for diminished life span.

As is the case with all conditions, acknowledging and managing symptoms will help
to minimize risk, maintain quality of life, and optimize life span.

The Plan
Once care plan goals are created, they can be categorized in the following ways.
These categories were chosen as they pertain to the specific needs of medical
treatment, care at home, government assistance, community support and funding,
education, or various services which may be required.
Care at Home
Care at home
Home health care services
Child care and respite
Personal assistance and service dogs
Nutrition and Meal plans
Mobility and rehabilitation plan
Sports, recreation and play
Socialization plan
Accessible homes and home modifications
Vehicle modifications and adapted drivers licensure

http://www.cerebralpalsy.org/information/care-plan