Cerebral palsy

==Signs and symptoms==
Cerebral palsy is defined as "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."<ref name="pmid17370477" /> While movement problems are the central feature of CP, difficulties with thinking, learning, feeling, communication and behavior often co-occur,<ref name="pmid17370477" /><ref>{{Cite journal |last=Song |first=Chiang-Soon |date=May 2013 |title=Relationships between Physical and Cognitive Functioning and Activities of Daily Living in Children with Cerebral Palsy |journal=Journal of Physical Therapy Science |volume=25 |issue=5 |pages=619–622 |doi=10.1589/jpts.25.619 |issn=0915-5287 |pmc=3804975 |pmid=24259815}}</ref> with 28% having [[epilepsy]], 58% having difficulties with communication, at least 42% having problems with their vision, and 23{{endash}}56% having [[learning disabilities]].<ref name="kent_2013" /> [[Muscle contractions]] in people with cerebral palsy are commonly thought to arise from overactivation.<ref>{{cite journal | vauthors = Mathewson MA, Lieber RL | title = Pathophysiology of muscle contractures in cerebral palsy | journal = Physical Medicine and Rehabilitation Clinics of North America | volume = 26 | issue = 1 | pages = 57–67 | date = February 2015 | pmid = 25479779 | pmc = 4258234 | doi = 10.1016/j.pmr.2014.09.005 }}</ref>

Cerebral palsy is characterized by abnormal [[muscle tone]], reflexes, or motor development and coordination. The neurological lesion is primary and permanent while orthopedic manifestations are secondary and progressive. In cerebral palsy unequal growth between muscle-tendon units and bone eventually leads to bone and joint deformities. At first, deformities are dynamic. Over time, deformities tend to become static, and joint contractures develop. Deformities in general and static deformities in specific ([[joint contractures]]) cause increasing gait difficulties in the form of [[Toe walking|tip-toeing gait]], due to tightness of the Achilles tendon, and [[Scissor gait|scissoring gait]], due to tightness of the hip adductors. These gait patterns are among the most common gait abnormalities in children with cerebral palsy. However, orthopaedic manifestations of cerebral palsy are diverse.<ref name="elsobky2017" /><ref name="argawal&verma2012" /> Additionally, crouch gait (also described as knee flexion gait)<ref>{{Cite journal |date=January 1997 |title=Volume 1997. No. 20 October 31, 1997 |url=http://dx.doi.org/10.1177/006947709703500120 |journal=Clin-Alert |volume=35 |issue=1 |pages=153–160 |doi=10.1177/006947709703500120 |s2cid=208256249 |issn=0069-4770}}</ref> is prevalent among children who possess the ability to walk.<ref name="Amen2018" />  The effects of cerebral palsy fall on a continuum of motor dysfunction, which may range from slight clumsiness at the mild end of the spectrum to impairments so severe that they render coordinated movement virtually impossible at the other end of the spectrum.<ref>{{cite book | vauthors = Singh A |title=Children With Diverse Needs |date=March 8, 2021 |publisher=Psycho Information Technologies |isbn=978-81-939227-7-4 |pages=159–165 |edition=1st |url=https://books.google.com/books?id=SOYhEAAAQBAJ&q=The+effects+of+cerebral+palsy+fall+on+a+continuum+of+motor+dysfunction%2C+which+may+range+from+slight+clumsiness+at+the+mild+end+of+the+spectrum+to+impairments+so+severe+that+they+render+coordinated+movement+virtually+impossible+at+the+other+end+of+the+spectrum.&pg=PA159 |access-date=21 March 2021}}</ref> Although most people with CP have problems with increased muscle tone, some have normal or low muscle tone. High muscle tone can either be due to [[spasticity]] or [[dystonia]].<ref>{{cite journal| vauthors = Smith M, Kurian MA |title=The medical management of cerebral palsy|journal=[[Paediatrics and Child Health]]|date=September 2016|volume=26|issue=9|pages=378–382|doi=10.1016/j.paed.2016.04.013|url=http://discovery.ucl.ac.uk/1497973/ }}</ref>

Babies born with severe cerebral palsy often have irregular posture; their bodies may be either very floppy or very stiff. Birth defects, such as spinal curvature, a small jawbone, or a small head sometimes occur along with CP. Symptoms may appear or change as a child gets older. Babies born with cerebral palsy do not immediately present with symptoms.<ref>{{cite web |url=http://www.nhs.uk/conditions/cerebral-palsy/pages/symptoms.aspx |title=Symptoms of Cerebral palsy |author=<!--Not stated--> |date=15 March 2017 |website=NHS Choices |publisher=NHS Gov.UK |access-date=6 April 2017 |url-status=live |archive-url=https://web.archive.org/web/20170407054231/http://www.nhs.uk/conditions/cerebral-palsy/pages/symptoms.aspx |archive-date=7 April 2017}}</ref> Classically, CP becomes evident when the baby reaches the developmental stage at 6 to 9 months and is starting to mobilise, where preferential use of limbs, asymmetry, or gross motor developmental delay is seen.<ref name="argawal&verma2012" />

Drooling is common among children with cerebral palsy, which can have a variety of impacts including social rejection, impaired speaking, damage to clothing and books, and mouth infections.<ref>{{cite journal | vauthors = Walshe M, Smith M, Pennington L | title = Interventions for drooling in children with cerebral palsy | journal = The Cochrane Database of Systematic Reviews | volume = 11 | pages = CD008624 | date = November 2012 | pmid = 23152263 | doi = 10.1002/14651858.CD008624.pub3 | veditors = Walshe M }}</ref><ref name=":2">{{Citation |author=National Guideline Alliance (UK) |title=Managing saliva control |date=January 2017 |url=https://www.ncbi.nlm.nih.gov/books/NBK533231/ |work=Cerebral palsy in under 25s: assessment and management |access-date=2024-01-04 |publisher=National Institute for Health and Care Excellence |language=en}}</ref> It can additionally cause choking.<ref name=":2" /><ref name="auto" />

An average of 55.5% of people with cerebral palsy experience [[lower urinary tract symptoms]], more commonly excessive storage issues than voiding issues. Those with voiding issues and [[pelvic floor]] overactivity can deteriorate as adults and experience [[upper urinary tract dysfunction]].<ref>{{cite journal | vauthors = Samijn B, Van Laecke E, Renson C, Hoebeke P, Plasschaert F, Vande Walle J, Van den Broeck C | title = Lower urinary tract symptoms and urodynamic findings in children and adults with cerebral palsy: A systematic review | journal = Neurourology and Urodynamics | volume = 36 | issue = 3 | pages = 541–549 | date = March 2017 | pmid = 26894322 | doi = 10.1002/nau.22982 | type = Submitted manuscript | s2cid = 34807855 | doi-access = free }}</ref>

Children with CP may also have [[sensory processing]] issues.<ref>{{cite book| vauthors = Hinchcliffe A, Rogers C |title=Children with Cerebral Palsy: a manual for therapists, parents and community workers|date=2007|publisher=SAGE Publications|location=New Delhi|isbn=978-81-7829-965-5|edition=2nd ed., rev.|chapter=Sensory integration problems in children with cerebral palsy}}</ref> Adults with cerebral palsy have a higher risk of [[respiratory failure]].<ref>{{cite book |author=((National Guideline Alliance (UK))) |title=Rationale and impact |date=2019 |publisher=National Institute for Health and Care Excellence (UK) |url=https://www.ncbi.nlm.nih.gov/books/NBK542986/ |language=en}}</ref>

===Skeleton===
For bones to attain their normal shape and size, they require the stresses from normal musculature.<ref name="Mughal2014" /> People with cerebral palsy are at risk of low [[bone mineral density]].<ref>{{cite journal | vauthors = Ozel S, Switzer L, Macintosh A, Fehlings D | title = Informing evidence-based clinical practice guidelines for children with cerebral palsy at risk of osteoporosis: an update | journal = Developmental Medicine and Child Neurology | volume = 58 | issue = 9 | pages = 918–923 | date = September 2016 | pmid = 27435427 | doi = 10.1111/dmcn.13196 | doi-access = free }}</ref> The shafts of the bones are often thin (gracile),<ref name="Mughal2014" /> and become thinner during growth. When compared to these thin shafts ([[diaphyses]]), the centres ([[metaphyses]]) often appear quite enlarged (ballooning).<ref>{{Cite thesis |title=Postural control in children with cerebral palsy: a comprehensive definition, framework and reproducible assessment. |url=http://dx.doi.org/10.14264/90c2cf3 |publisher=University of Queensland Library |first=Rosalee Maree |last=Dewar|year=2020 |doi=10.14264/90c2cf3 }}</ref> Due to more than normal joint compression caused by muscular imbalances, [[articular cartilage]] may atrophy,<ref name="Kerkovich, D 2009, pp. 41-53" />{{rp|46}} leading to narrowed joint spaces. Depending on the degree of spasticity, a person with CP may exhibit a variety of angular joint deformities. Because vertebral bodies need vertical gravitational loading forces to develop properly, spasticity and an abnormal gait can hinder proper or full bone and skeletal development. People with CP tend to be shorter in height than the average person because their bones are not allowed to grow to their full potential. Sometimes bones grow to different lengths, so the person may have one leg longer than the other.<ref>{{cite journal | vauthors = Riad J, Finnbogason T, Broström E | title = Leg length discrepancy in spastic hemiplegic cerebral palsy: a magnetic resonance imaging study | journal = Journal of Pediatric Orthopedics | volume = 30 | issue = 8 | pages = 846–850 | date = December 2010 | pmid = 21102211 | doi = 10.1097/BPO.0b013e3181fc35dd | hdl-access = free | s2cid = 46608602 | hdl = 10616/40477 }}</ref><ref>{{Cite journal |last1=Kim |first1=Hyo Sung |last2=Son |first2=Su Min |date=2022-08-10 |title=Limb Length Discrepancy and Corticospinal Tract Disruption in Hemiplegic Cerebral Palsy |journal=Children |volume=9 |issue=8 |pages=1198 |doi=10.3390/children9081198 |doi-access=free |issn=2227-9067 |pmc=9406518 |pmid=36010088}}</ref>

Children with CP are prone to [[low trauma fractures]], particularly children with higher [[Gross Motor Function Classification System]] (GMFCS) levels who cannot walk. This further affects a child's mobility, strength, and experience of pain, and can lead to missed schooling or child abuse suspicions.<ref name="Mughal2014" /> These children generally have fractures in the legs, whereas non-affected children mostly fracture their arms in the context of sporting activities.<ref>{{cite journal | vauthors = Veilleux LN, Rauch F | title = Muscle-Bone Interactions in Pediatric Bone Diseases | journal = Current Osteoporosis Reports | volume = 15 | issue = 5 | pages = 425–432 | date = October 2017 | pmid = 28856575 | doi = 10.1007/s11914-017-0396-6 | s2cid = 39445049 }}</ref>

[[Hip dislocation]] and [[toe walking|ankle equinus]] or [[pes cavus|plantar flexion deformity]] are the two most common deformities among children with cerebral palsy. Additionally, flexion deformity of the hip and knee can occur. Torsional deformities of long bones such as the [[femur]] and [[tibia]] are also encountered, among others.<ref name="elsobky2017" /><ref name="shore2010" /> Children may develop [[scoliosis]] before the age of 10 – estimated [[prevalence]] of scoliosis in children with CP is between 21% and 64%.<ref name="Cloake2016" /> Higher levels of impairment on the GMFCS are associated with scoliosis and hip dislocation.<ref name="elsobky2017" /><ref>{{cite journal | vauthors = Rutz E, Brunner R | title = Management of spinal deformity in cerebral palsy: conservative treatment | journal = Journal of Children's Orthopaedics | volume = 7 | issue = 5 | pages = 415–418 | date = November 2013 | pmid = 24432104 | pmc = 3838520 | doi = 10.1007/s11832-013-0516-5 }}</ref> Scoliosis can be corrected with surgery, but CP makes surgical complications more likely, even with improved techniques.<ref name="Cloake2016" /> Hip migration can be managed by soft tissue procedures such as adductor musculature release. Advanced degrees of hip migration or dislocation can be managed by more extensive procedures such as femoral and pelvic corrective [[osteotomy|osteotomies]]. Both soft tissue and bony procedures aim at prevention of hip dislocation in the early phases or aim at hip containment and restoration of anatomy in the late phases of disease.<ref name="elsobky2017" /> Equinus deformity is managed by conservative methods especially when dynamic. If fixed/static deformity ensues surgery may become mandatory.<ref name="shore2010" />

[[Adolescence#Growth spurt|Growth spurts]] during [[puberty]] can make walking more difficult for people with CP.<ref>{{cite journal| vauthors = Roberts A |title=The surgical treatment of cerebral palsy|journal=[[Paediatrics and Child Health]]|date=September 2012|volume=22|issue=9|pages=377–383|doi=10.1016/j.paed.2012.03.004}}</ref>

===Eating===
Due to sensory and motor impairments, those with CP may have difficulty preparing food, holding utensils, or chewing and swallowing. An infant with CP may not be able to suck, swallow or chew.<ref name="Klingels2010" /> [[Gastro-oesophageal reflux]] is common in children with CP.<ref name="auto" /> Children with CP may have too little or too much sensitivity around and in the mouth.<ref name="Klingels2010" /> Poor balance when sitting, lack of control of the head, mouth, and trunk, not being able to bend the hips enough to allow the arms to stretch forward to reach and grasp food or utensils, and lack of [[hand-eye coordination]] can make self-feeding difficult.<ref name="oxfordnutritionchapter" /> Feeding difficulties are related to higher GMFCS levels.<ref name="auto" /> Dental problems can also contribute to difficulties with eating.<ref name="oxfordnutritionchapter" /> [[Pneumonia]] is also common where eating difficulties exist, caused by undetected aspiration of food or liquids.<ref name="auto" /> Fine finger dexterity, like that needed for picking up a utensil, is more frequently impaired than gross manual dexterity, like that needed for spooning food onto a plate.<ref name="Donkervoort2007" />{{Primary source inline|date=February 2014}} Grip strength impairments are less common.<ref name="Donkervoort2007" />{{Primary source inline|date=February 2014}}

Children with severe cerebral palsy, particularly with [[oropharyngeal]] issues, are at risk of [[Undernutrition in children|undernutrition]].<ref>{{cite journal | vauthors = Bell KL, Samson-Fang L | title = Nutritional management of children with cerebral palsy | journal = European Journal of Clinical Nutrition | volume = 67 | issue = Suppl 2 | pages = S13–S16 | date = December 2013 | pmid = 24301003 | doi = 10.1038/ejcn.2013.225 | doi-access = free }}</ref> [[Triceps skin fold]] tests have been found to be a very reliable indicator of [[malnutrition]] in children with cerebral palsy.<ref name="oxfordnutritionchapter" /> Due to challenges in feeding, evidence has shown that children with cerebral palsy are at a greater risk of malnutrition.<ref>{{Cite journal |last1=Donkor |first1=Claudia Mary |last2=Lee |first2=Jackie |last3=Lelijveld |first3=Natasha |last4=Adams |first4=Melanie |last5=Baltussen |first5=Marjolein Meande |last6=Nyante |first6=Gifty Gyamah |last7=Kerac |first7=Marko |last8=Polack |first8=Sarah |last9=Zuurmond |first9=Maria |date=2018-11-15 |title=Improving nutritional status of children with Cerebral palsy: a qualitative study of caregiver experiences and community-based training in Ghana |journal=Food Science & Nutrition |volume=7 |issue=1 |pages=35–43 |doi=10.1002/fsn3.788 |issn=2048-7177 |pmc=6341142 |pmid=30680157}}</ref>

===Language===
Speech and language disorders are common in people with cerebral palsy. The incidence of [[dysarthria]] is estimated to range from 31% to 88%,<ref name="hirsch_2013" /> and around a quarter of people with CP are non-verbal.<ref name="Myrdenetal2014" /> Speech problems are associated with poor [[respiratory]] control, [[larynx|laryngeal]] and [[velopharyngeal insufficiency|velopharyngeal]] dysfunction, and oral [[manner of articulation|articulation]] disorders that are due to restricted movement in the oral-facial muscles. There are three major types of dysarthria in cerebral palsy: spastic, dyskinetic (athetotic), and ataxic.<ref>{{cite book| vauthors = Love RJ, Webb WG |title=Neurology for the Speech-Language Pathologist|date=2013|publisher=Butterworth-Heinemann|isbn=978-1-4831-4199-2|page=250|edition=2nd |url=https://books.google.com/books?id=FJ3pAgAAQBAJ&pg=PA250}}</ref>

Early use of [[augmentative and alternative communication]] systems may assist the child in developing spoken language skills.<ref name="Myrdenetal2014" /> Overall [[language delay]] is associated with problems of cognition, [[hearing loss|deafness]], and [[learned helplessness]].<ref name="CPBeuk" /> Children with cerebral palsy are at risk of learned helplessness and becoming passive communicators, initiating little communication.<ref name="CPBeuk" /><ref>{{Cite journal |last=Pennington |first=Lindsay |date=2008-09-01 |title=Cerebral palsy and communication |url=https://www.paediatricsandchildhealthjournal.co.uk/article/S1751-7222(08)00130-3/abstract |journal=Paediatrics and Child Health |language=English |volume=18 |issue=9 |pages=405–409 |doi=10.1016/j.paed.2008.05.013 |issn=1751-7222}}</ref> Early intervention with this clientele, and their parents, often targets situations in which children communicate with others so that they learn that they can control people and objects in their environment through this communication, including making choices, decisions, and mistakes.<ref name="CPBeuk" />

===Pain and sleep===
Pain is common and may result from the inherent deficits associated with the condition, along with the numerous procedures children typically face.<ref name="McKearnan_2004" /> When children with cerebral palsy are in pain, they experience worse muscle spasms.<ref>{{cite journal | vauthors = Hauer J, Houtrow AJ | title = Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System | journal = Pediatrics | volume = 139 | issue = 6 | pages = e20171002 | date = June 2017 | pmid = 28562301 | doi = 10.1542/peds.2017-1002 | doi-access = free }}</ref> Pain is associated with tight or shortened muscles, abnormal posture, stiff joints, unsuitable [[orthotics|orthosis]], etc. Hip migration or dislocation is a recognizable source of pain in CP children and especially in the adolescent population. Nevertheless, the adequate scoring and scaling of pain in CP children remains challenging.<ref name="elsobky2017" /> Pain in CP has a number of different causes, and different pains respond to different treatments.<ref>{{cite journal | vauthors = Blackman JA, Svensson CI, Marchand S | title = Pathophysiology of chronic pain in cerebral palsy: implications for pharmacological treatment and research | journal = Developmental Medicine and Child Neurology | volume = 60 | issue = 9 | pages = 861–865 | date = September 2018 | pmid = 29882358 | doi = 10.1111/dmcn.13930 | doi-access = free }}</ref>

There is also a high likelihood of chronic [[sleep disorders]] secondary to both physical and environmental factors.<ref name="newman_2006" /> Children with cerebral palsy have significantly higher rates of sleep disturbance than typically developing children.<ref>{{cite journal | vauthors = Dutt R, Roduta-Roberts M, Brown CA | title = Sleep and Children with Cerebral Palsy: A Review of Current Evidence and Environmental Non-Pharmacological Interventions | journal = Children | volume = 2 | issue = 1 | pages = 78–88 | date = February 2015 | pmid = 27417351 | pmc = 4928749 | doi = 10.3390/children2010078 | doi-access = free }}</ref> Babies with cerebral palsy who have stiffness issues might cry more and be harder to put to sleep than non-disabled babies, or "floppy" babies might be lethargic.<ref>{{cite book| vauthors = Stanton M |title=Understanding cerebral palsy : a guide for parents and professionals|chapter=Special Considerations|page=70|date=2012|publisher=[[Jessica Kingsley Publishers]]|location=London|isbn=978-1-84905-060-9}}</ref> [[Chronic pain]] is under-recognized in children with cerebral palsy,<ref>{{cite journal | vauthors = Kingsnorth S, Orava T, Provvidenza C, Adler E, Ami N, Gresley-Jones T, Mankad D, Slonim N, Fay L, Joachimides N, Hoffman A, Hung R, Fehlings D | title = Chronic Pain Assessment Tools for Cerebral Palsy: A Systematic Review | journal = Pediatrics | volume = 136 | issue = 4 | pages = e947–e960 | date = October 2015 | pmid = 26416940 | doi = 10.1542/peds.2015-0273 | doi-access = free }}</ref> even though three out of four children with cerebral palsy experience pain.<ref>{{cite journal | vauthors = Novak I, Hines M, Goldsmith S, Barclay R | title = Clinical prognostic messages from a systematic review on cerebral palsy | journal = Pediatrics | volume = 130 | issue = 5 | pages = e1285–e1312 | date = November 2012 | pmid = 23045562 | doi = 10.1542/peds.2012-0924 | doi-access = free }}</ref>  Adults with CP also experience more pain than the general population.<ref>{{cite journal | vauthors = van der Slot WM, Benner JL, Brunton L, Engel JM, Gallien P, Hilberink SR, Månum G, Morgan P, Opheim A, Riquelme I, Rodby-Bousquet E, Şimşek TT, Thorpe DE, van den Berg-Emons RJ, Vogtle LK, Papageorgiou G, Roebroeck ME | title = Pain in adults with cerebral palsy: A systematic review and meta-analysis of individual participant data | journal = Annals of Physical and Rehabilitation Medicine | volume = 64 | issue = 3 | pages = 101359 | date = May 2021 | pmid = 32061920 | doi = 10.1016/j.rehab.2019.12.011 | hdl-access = free | s2cid = 211134380 | hdl = 10852/83636 }}</ref>

===Associated disorders===
Associated disorders include [[intellectual disability|intellectual disabilities]], seizures, [[muscle contracture]]s, abnormal gait, [[osteoporosis]], communication disorders, malnutrition, sleep disorders, and mental health disorders, such as depression and anxiety.<ref>{{cite journal | vauthors = Jones KB, Wilson B, Weedon D, Bilder D | title = Care of Adults With Intellectual and Developmental Disabilities: Cerebral Palsy | journal = FP Essentials | volume = 439 | pages = 26–30 | date = December 2015 | pmid = 26669212 }}</ref> Epilepsy is often found in the child before they are 1 year old, or also before they are four or five.<ref>{{cite journal |last1=Sadowska |first1=Małgorzata |last2=Sarecka-Hujar |first2=Beata |last3=Kopyta |first3=Ilona |title=Cerebral Palsy: Current Opinions on Definition, Epidemiology, Risk Factors, Classification and Treatment Options |journal=[[Neuropsychiatric Disease and Treatment]] |date=12 June 2020 |volume=16 |pages=1505–1518 |doi=10.2147/NDT.S235165|doi-access=free |pmid=32606703 |pmc=7297454 }}</ref>  In addition to these, functional gastrointestinal abnormalities contributing to bowel obstruction, vomiting, and [[constipation]] may also arise. Adults with cerebral palsy may have [[coronary artery disease|ischemic heart disease]], [[cerebrovascular disease]], [[cancer]], and [[major trauma|trauma]] more often.<ref>{{cite journal | vauthors = Krigger KW | title = Cerebral palsy: an overview | journal = American Family Physician | volume = 73 | issue = 1 | pages = 91–100 | date = January 2006 | pmid = 16417071 }}</ref> [[Obesity]] in people with cerebral palsy or a more severe [[Gross Motor Function Classification System]] assessment in particular are considered risk factors for [[multimorbidity]].<ref>{{cite journal | vauthors = Cremer N, Hurvitz EA, Peterson MD | title = Multimorbidity in Middle-Aged Adults with Cerebral Palsy | journal = The American Journal of Medicine | volume = 130 | issue = 6 | pages = 744.e9–744.e15 | date = June 2017 | pmid = 28065772 | pmc = 5502778 | doi = 10.1016/j.amjmed.2016.11.044 }}</ref> Other medical issues can be mistaken for being symptoms of cerebral palsy, and so may not be treated correctly.<ref>{{cite web|title=Women's Health Initiative – Cerebral Palsy Foundation|url=http://yourcpf.org/womens-health-initiative/|website=[[Cerebral Palsy Foundation]]|access-date=23 December 2016|url-status=dead|archive-url=https://web.archive.org/web/20161224095224/http://yourcpf.org/womens-health-initiative/|archive-date=24 December 2016|date=10 July 2015}}</ref>

Related conditions can include [[apraxia]], sensory impairments, [[urinary incontinence]], [[fecal incontinence]], or behavioural disorders.<ref>{{Cite journal |last1=Ozturk |first1=Mustafa |last2=Oktem |first2=Faruk |last3=Kisioglu |first3=Nesimi |last4=Demirci |first4=Mustafa |last5=Altuntas |first5=Irfan |last6=Kutluhan |first6=Suleyman |last7=Dogan |first7=Malik |date=April 2, 2006 |title=Bladder and Bowel Control in Children with Cerebral Palsy: Case-Control Study |journal=Croatian Medical Journal |volume=47 |issue=2 |pages=264–270 |issn=0353-9504 |pmc=2080400 |pmid=16625691 }}</ref>

Seizure management is more difficult in people with CP as seizures often last longer.<ref>{{cite journal | vauthors = Wimalasundera N, Stevenson VL | title = Cerebral palsy | journal = Practical Neurology | volume = 16 | issue = 3 | pages = 184–194 | date = June 2016 | pmid = 26837375 | doi = 10.1136/practneurol-2015-001184 | s2cid = 4488035 }}</ref> Epilepsy and [[asthma]] are common co-occurring diseases in adults with CP.<ref name="The epidemiology of cerebral palsy" /> The associated disorders that co-occur with cerebral palsy may be more disabling than the motor function problems.<ref name="auto" />