Cerebral palsy

{{short description|Group of movement disorders that appear in early childhood}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Use dmy dates|date=October 2019}}
{{Infobox medical condition (new)
| name          =
| image         = US Navy 081028-N-3173B-027 Cmdr. John King assesses the reflexes of a Cerebral Palsy patient at the Arima District Health Facility as part of the humanitarian-civic assistance mission Continuing Promise (CP) 2008.jpg
| caption       = A child with cerebral palsy being assessed by a physician
| field         = {{plainlist|
* [[Pediatrics]]
* [[Neurology]]
* [[Physiatry]]
}}
| symptoms      = {{plainlist|
* Poor coordination
* [[spasticity|Stiff]] or [[hypotonia|loose]] muscles
* Weak muscles
* [[Tremor]]s<ref name="NINDS2013" />
}}
| complications = {{plainlist|
* [[Epilepsy]]
* [[Intellectual disability]]<ref name="NINDS2013" />
* [[Learning disability]]
}}
| onset         = Prenatal to early childhood<ref name="NINDS2013" />
| duration      = Lifelong<ref name="NINDS2013" />
| causes        = Often unknown<ref name="NINDS2013" /><!-- Quote = In many cases, the cause of cerebral palsy is unknown. --> or brain injury
| risks         = {{plainlist|
* [[Brain damage]] during [[infancy]]
* [[Preterm birth]]
* Being a [[twin]]
* Certain infections during pregnancy
* Difficult delivery<ref name="NINDS2013" />
}}
| diagnosis     = Based on child's development<ref name="NINDS2013" />
| differential  =
| prevention    =
| treatment     = {{plainlist|
* [[Physical therapy]]
* [[Occupational therapy]]
* [[Speech therapy]]
* [[Conductive education]]
* [[Brace (orthopaedic)|External braces]]
* [[Orthopedic surgery]]<ref name="NINDS2013" />
}}
| medication    = {{plainlist|
* [[Diazepam]]
* [[Baclofen]]
* [[Botulinum toxin]]<ref name="NINDS2013" />
}}
| prognosis     =
| frequency     = 2.1 per 1,000<ref name="Osk2013" />
| deaths        =
| alt           =
}}
<!-- Definition and symptoms -->
'''Cerebral palsy''' ('''CP''') is a group of [[movement disorder]]s that appear in early childhood.<ref name="NINDS2013" /> Signs and symptoms vary among people and over time,<ref name="NINDS2013" /><ref>{{cite journal | vauthors = Haak P, Lenski M, Hidecker MJ, Li M, Paneth N | title = Cerebral palsy and aging | journal = Developmental Medicine and Child Neurology | volume = 51 | issue = 4 | pages = 16–23 | date = October 2009 | pmid = 19740206 | pmc = 4183123 | doi = 10.1111/j.1469-8749.2009.03428.x }}</ref> but include poor coordination, [[spasticity|stiff muscles]], [[Paresis|weak muscles]], and [[tremor]]s.<ref name="NINDS2013" /> There may be problems with [[sense|sensation]], [[visual perception|vision]], [[hearing]], and [[speech]].<ref name="NINDS2013" /> Often, babies with cerebral palsy do not roll over, sit, crawl or walk as early as other children.<ref name="NINDS2013" /> Other symptoms include [[seizures]] and problems with [[cognition|thinking or reasoning]]. While symptoms may get more noticeable over the first years of life, underlying problems do not worsen over time.<ref name="NINDS2013" />

<!-- Cause and Diagnosis -->
Cerebral palsy is caused by abnormal development or damage to the parts of the brain that control movement, balance, and posture.<ref name="NINDS2013" /><ref>{{cite web|title=Cerebral Palsy: Overview|url=https://www.nichd.nih.gov/health/topics/cerebral-palsy/Pages/default.aspx|website=[[National Institutes of Health]]|access-date=21 February 2017|url-status=dead|archive-url=https://web.archive.org/web/20170215072205/https://www.nichd.nih.gov/health/topics/cerebral-palsy/Pages/default.aspx|archive-date=15 February 2017}}</ref> Most often, the problems occur during pregnancy, but may occur during childbirth or shortly afterwards.<ref name="NINDS2013" /> Often, the cause is unknown.<ref name="NINDS2013" /> Risk factors include [[preterm birth]], being a [[twin]], certain infections or exposure to [[methylmercury]] during pregnancy, a difficult delivery, and head trauma during the first few years of life.<ref name="NINDS2013" /> About 2% of cases are believed to be due to an [[heredity|inherited genetic cause]].<ref name="omim" />

Sub-types are classified, based on the specific problems present.<ref name="NINDS2013" /> For example, those with stiff muscles have [[spastic cerebral palsy]], poor coordination in locomotion have [[ataxic cerebral palsy]], and writhing movements have [[athetoid cerebral palsy|dyskinetic cerebral palsy]].<ref>{{cite journal | vauthors = Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Dan B, Jacobsson B | title = A report: the definition and classification of cerebral palsy April 2006 | journal = Developmental Medicine and Child Neurology. Supplement | volume = 109 | pages = 8–14 | date = February 2007 | pmid = 17370477 | doi = 10.1111/j.1469-8749.2007.tb12610.x | s2cid = 24504486 | doi-access = free }}</ref> Diagnosis is based on the child's development.<ref name="NINDS2013" /> Blood tests and [[medical imaging]] may be used to rule out other possible causes.<ref name="NINDS2013" />

<!-- Prevention and treatment -->
Some causes of CP are preventable through immunization of the mother, and efforts to prevent head injuries in children such as improved safety. There is no known cure for CP, but supportive treatments, medication and surgery may help individuals.<ref name="NINDS2013" /> This may include [[physical therapy]], [[occupational therapy]] and [[speech therapy]].<ref name="NINDS2013" /> Mouse [[Nerve growth factor|NGF]] has been shown to improve outcomes<ref name=Huiling2019/><ref name=Zhao2015/> and has been available in China since 2003.<ref name=Zhao2015/> Medications such as [[diazepam]], [[baclofen]] and [[botulinum toxin]] may help relax stiff muscles.<ref name="NINDS2013" /><ref name=Farag2020/><ref name=Blumetti2019/> Surgery may include lengthening muscles and [[selective dorsal rhizotomy|cutting overly active nerves]].<ref name="NINDS2013" /> Often, [[brace (orthopaedic)|external braces]] and Lycra splints and other [[assistive technology]] are helpful with mobility.<ref>{{Cite journal |last1=Elliott |first1=Catherine M. |last2=Reid |first2=Siobhan L. |last3=Alderson |first3=Jacqueline A. |last4=Elliott |first4=Bruce C. |date=2011-02-01 |title=Lycra arm splints in conjunction with goal-directed training can improve movement in children with cerebral palsy |url=http://dx.doi.org/10.3233/nre-2011-0631 |journal=NeuroRehabilitation |volume=28 |issue=1 |pages=47–54 |doi=10.3233/nre-2011-0631 |pmid=21335677 |issn=1878-6448}}</ref><ref name="NINDS2013" /> Some affected children can achieve near normal adult lives with appropriate treatment.<ref name="NINDS2013" /> While [[alternative medicine]]s are frequently used, there is no evidence to support their use.<ref name="NINDS2013" /> Potential treatments are being examined, including [[stem cell therapy]].<ref name="NINDS2013" /> However, more research is required to determine if it is effective and safe.<ref name="NINDS2013" />

<!-- Epidemiology and history -->
Cerebral palsy is the most common movement disorder in children,<ref>{{cite web|title=How many people are affected?|url=http://www.nichd.nih.gov/health/topics/cerebral-palsy/conditioninfo/Pages/how-common.aspx|publisher=[[National Institutes of Health]]|access-date=4 March 2015|date=5 September 2014|url-status=dead|archive-url=https://web.archive.org/web/20150402134614/http://www.nichd.nih.gov/health/topics/cerebral-palsy/conditioninfo/Pages/how-common.aspx|archive-date=2 April 2015}}</ref> occurring in about 2.1 per 1,000 live births.<ref name="Osk2013" /> It has been documented throughout history, with the first known descriptions occurring in the work of [[Hippocrates]] in the 5th century BCE.<ref name="History2013" /> Extensive study began in the 19th century by [[William John Little]], after whom spastic diplegia was called "Little's disease".<ref name="History2013" /> [[William Osler]] first named it "cerebral palsy" from the German {{lang|de|zerebrale Kinderlähmung}} (cerebral child-paralysis).<ref>{{cite web |title=What is cerebral palsy? |url=http://cpapinfo.com/What_is_Cerebral_Palsy.php?menu=About%20Us |publisher=The Cerebral Palsied Association of the Philippines Inc. |url-status=dead |archive-url=https://web.archive.org/web/20161220051952/http://cpapinfo.com/What_is_Cerebral_Palsy.php?menu=About%20Us |archive-date=20 December 2016 |access-date=4 December 2016}}</ref>
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==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" />

==Causes==
[[File:Fetal thrombotic vasculopathy - intermed mag.jpg|thumb |alt=refer to caption |[[Micrograph]] showing a fetal ([[placenta]]l) vein thrombosis, in a case of [[fetal thrombotic vasculopathy]]. This is associated with cerebral palsy and is suggestive of a [[hypercoagulable state]] as the underlying cause.]]
Cerebral palsy is due to abnormal development or damage occurring to the developing brain.<ref name="Yar2013" /> This damage can occur during pregnancy, delivery, the first month of life, or less commonly in early childhood.<ref name="Yar2013" /> Structural problems in the brain are seen in 80% of cases, most commonly within the [[white matter]].<ref name="Yar2013" />
More than three-quarters of cases are believed to result from issues that occur during pregnancy.<ref name="Yar2013" /> Most children who are born with cerebral palsy have more than one risk factor associated with CP.<ref>{{cite journal| vauthors = Eunson P |title=Aetiology and epidemiology of cerebral palsy|journal=[[Paediatrics and Child Health]]|date=September 2016|volume=26|issue=9|pages=367–372|doi=10.1016/j.paed.2016.04.011}}</ref> Cerebral palsy is not contagious and cannot be contracted in adulthood. CP is almost always developed en utero, or prior to birth.<ref>{{Cite web |title=Medical Errors During Pregnancy can Result in Cerebral Palsy |url=https://birthinjurylawyer.com/cerebral-palsy-lawyer |access-date=2024-03-16 |website=birthinjury.com |language=en}}</ref>

While in certain cases there is no identifiable cause, typical causes include problems in intrauterine development (e.g. exposure to radiation, infection, [[Intrauterine growth restriction|fetal growth restriction]]), [[hypoxia (medical)|hypoxia]] of the brain (thrombotic events, [[placental insufficiency]], [[umbilical cord prolapse]]), birth trauma during labor and delivery, and complications around birth or during childhood.<ref name="CPBeuk" /><ref>{{cite journal | vauthors = Sayed Ahmed WA, Hamdy MA | title = Optimal management of umbilical cord prolapse | journal = International Journal of Women's Health | volume = 10 | pages = 459–465 | date = 2018-08-21 | pmid = 30174462 | pmc = 6109652 | doi = 10.2147/IJWH.S130879 | doi-access = free }}</ref><ref name="nejm915" />

In Africa [[birth asphyxia]], [[kernicterus|high bilirubin levels]], and infections in newborns of the central nervous system are main cause. Many cases of CP in Africa could be prevented with better resources available.<ref>{{cite journal | vauthors = Burton A | title = Fighting cerebral palsy in Africa | journal = The Lancet. Neurology | volume = 14 | issue = 9 | pages = 876–877 | date = September 2015 | pmid = 26293560 | doi = 10.1016/S1474-4422(15)00189-1 | doi-access = free }}</ref>

===Preterm birth===
Between 40% and 50% of all children who develop cerebral palsy were born prematurely.<ref name="dev_beh_peds_2009" /> Most of these cases (75–90%) are believed to be due to issues that occur around the time of birth, often just after birth.<ref name="Yar2013" /> Multiple-birth infants are also more likely than single-birth infants to have CP.<ref name="saunders_2011" /> They are also more likely to be born with a [[low birth weight]].<ref>{{Cite journal |last1=Demeši Drljan |first1=Čila |last2=Mikov |first2=Aleksandra |last3=Filipović |first3=Karmela |last4=Tomašević-Todorović |first4=Snežana |last5=Knežević |first5=Aleksandar |last6=Krasnik |first6=Rastislava |date=April 12, 2016 |title=Cerebral palsy in preterm infants |url=https://pubmed.ncbi.nlm.nih.gov/29308865/ |journal=National Library of Medicine |volume=73 |issue=4 |pages=343–348 |doi=10.2298/VSP140321019D |issn=0042-8450 |pmid=29308865}}</ref>

In those who are born with a weight between 1&nbsp;kg (2.2 lbs) and 1.5&nbsp;kg (3.3 lbs) CP occurs in 6%.<ref name="Osk2013" /> Among those born before 28&nbsp;weeks of [[gestation]] it occurs in 8%.<ref name="Osk2016">{{cite journal | vauthors =  | title = Erratum | journal = Developmental Medicine and Child Neurology | volume = 58 | issue = 3 | pages = 316 | date = March 2016 | pmid = 26890023 | doi = 10.1111/dmcn.12662 | s2cid = 221682193 | doi-access = free }}</ref>{{efn|Incorrectly stated as 11% in 2013 <ref name="Osk2013" />}} Genetic factors are believed to play an important role in prematurity and cerebral palsy generally.<ref name="hallman_2012" /> In those who are born between 34 and 37&nbsp;weeks the risk is 0.4% (three times normal).<ref name="poets_2012" />

===Term infants===
In babies who are born at term risk factors include problems with the placenta, [[birth defect]]s, low birth weight, [[meconium aspiration|breathing meconium into the lungs]], a delivery requiring either the use of instruments or an emergency [[Caesarean section]], birth asphyxia, [[seizure]]s just after birth, [[Infant respiratory distress syndrome|respiratory distress syndrome]], [[hypoglycaemia|low blood sugar]], and infections in the baby.<ref name="mcintyre_2013" />

{{as of |2013}}, it was unclear how much of a role birth asphyxia plays as a cause.<ref name="ellenberg_2013" /> It is unclear if the size of the placenta plays a role.<ref name="teng_2012" /> {{as of|2015}} it is evident that in advanced countries, most cases of cerebral palsy in term or near-term neonates have explanations other than asphyxia.<ref name="nejm915" />

===Genetics===
[[File:Autosomal recessive - en.svg|right|thumb|Autosomal recessive inheritance pattern]]
Cerebral palsy is not commonly considered a genetic disease. About 2% of all CP cases are expected to be inherited, with [[GAD1|glutamate decarboxylase-1]] being one of the possible enzymes involved.<ref name="omim" /> Most inherited cases are [[autosomal recessive]].<ref name="omim" /> However, the vast majority of CP cases are connected to brain damage during birth and in infancy. There is a small percentage of CP cases caused by brain damage that stemmed from the prenatal period, which is estimated to be less than 5% of CP cases overall.<ref name="cdc.gov">{{Cite web|url=https://www.cdc.gov/ncbddd/cp/causes.html|title = Causes and Risk Factors of Cerebral Palsy &#124; CDC|date = 15 December 2020}}</ref> Moreover, there is no one reason why some CP cases come from prenatal brain damage, and it is not known if those cases have a genetic basis.<ref name="cdc.gov"/>

[[Cerebellar hypoplasia]] is sometimes genetic<ref>{{cite journal | vauthors = Parolin Schnekenberg R, Perkins EM, Miller JW, Davies WI, D'Adamo MC, Pessia M, Fawcett KA, Sims D, Gillard E, Hudspith K, Skehel P, Williams J, O'Regan M, Jayawant S, Jefferson R, Hughes S, Lustenberger A, Ragoussis J, Jackson M, Tucker SJ, Németh AH | title = De novo point mutations in patients diagnosed with ataxic cerebral palsy | journal = Brain | volume = 138 | issue = Pt 7 | pages = 1817–1832 | date = July 2015 | pmid = 25981959 | pmc = 4572487 | doi = 10.1093/brain/awv117 | quote = [...]a putative new gene had been found in Case 7, which is currently under investigation and will be presented elsewhere. }}</ref> and can cause [[ataxic cerebral palsy]].<ref>{{cite journal | vauthors = Parolin Schnekenberg R, Perkins EM, Miller JW, Davies WI, D'Adamo MC, Pessia M, Fawcett KA, Sims D, Gillard E, Hudspith K, Skehel P, Williams J, O'Regan M, Jayawant S, Jefferson R, Hughes S, Lustenberger A, Ragoussis J, Jackson M, Tucker SJ, Németh AH | title = De novo point mutations in patients diagnosed with ataxic cerebral palsy | journal = Brain | volume = 138 | issue = Pt 7 | pages = 1817–1832 | date = July 2015 | pmid = 25981959 | pmc = 4572487 | doi = 10.1093/brain/awv117 | quote = Case 6 had cerebellar vermis hypoplasia and Case 7 had global cerebellar hypoplasia (vermis and cerebellar hemispheres), both these cases were clinically stable. }}</ref>

===Early childhood===
After birth, other causes include toxins, severe [[jaundice]],<ref name="cdccauses" /> [[lead poisoning]], physical brain injury, [[stroke]],<ref>{{cite web|title = Cerebral Palsy | work = Johns Hopkins Pediatric Neurosurgery|url = http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/pediatric_neurosurgery/conditions/cerebral_palsy.html|access-date = 18 September 2015| vauthors = Kieffer S |url-status = dead|archive-url = https://web.archive.org/web/20150930032633/http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/pediatric_neurosurgery/conditions/cerebral_palsy.html|archive-date = 30 September 2015}}</ref> [[abusive head trauma]], incidents involving hypoxia to the brain (such as [[near drowning]]), and [[encephalitis]] or [[meningitis]].<ref name="cdccauses" />

===Others===
Infections in the mother, even those not easily detected, can triple the risk of the child developing cerebral palsy.<ref name="ucpref_2004" /> Infection of the fetal membranes known as [[chorioamnionitis]] increases the risk.<ref name="bersani_2012" />

Intrauterine and neonatal insults (many of which are infectious) increase the risk.<ref name="mwaniki_2012" />

[[Rh disease|Rh blood type incompatibility]] can cause the mother's immune system to attack the baby's red blood cells.<ref name="NINDS2013" />

It has been hypothesised that some cases of cerebral palsy are caused by the death in very early pregnancy of an identical twin.<ref name="pmid16354495" />

==Diagnosis==
The diagnosis of cerebral palsy has historically rested on the person's history and physical examination and is generally assessed at a young age. A [[general movements assessment]], which involves measuring movements that occur spontaneously among those less than four months of age, appears most accurate.<ref name="McI2011" /><ref name="bosanquet_2013" /> Children who are more severely affected are more likely to be noticed and diagnosed earlier. Abnormal muscle tone, delayed motor development and persistence of [[primitive reflexes]] are the main early symptoms of CP.<ref name="oxfordnutritionchapter" /> Symptoms and diagnosis typically occur by the age of two,<ref name="research gaps 2016" /> although depending on factors like malformations and congenital issues,<ref name=":1">{{Cite web|title=Cerebral Palsy from Birth Injury|url=https://www.birthinjuryguide.org/birth-injury-types/cerebral-palsy/|access-date=2022-01-04|website=Birth Injury Guide|date=3 January 2022 |language=en-US}}</ref> persons with milder forms of cerebral palsy may be over the age of five, if not in adulthood, when finally diagnosed.<ref name="autogenerated1" /> 

Cognitive assessments and medical observations are also useful to help confirm a diagnosis. Additionally, evaluations of the child's mobility, speech and language, hearing, vision, gait, feeding and digestion are also useful to determine the extent of the disorder.<ref name=":1" /> Early diagnosis and intervention are seen as being a key part of managing cerebral palsy.<ref>{{cite journal | vauthors = Graham D, Paget SP, Wimalasundera N | title = Current thinking in the health care management of children with cerebral palsy | journal = The Medical Journal of Australia | volume = 210 | issue = 3 | pages = 129–135 | date = February 2019 | pmid = 30739332 | doi = 10.5694/mja2.12106 | s2cid = 73424991 }}</ref> Machine learning algorithms facilitate automatic early diagnosis, with methods such as deep neural network<ref>{{cite journal | vauthors = McCay KD, Ho ES, Shum HP, Fehringer G, Marcroft C, Embleton ND |title=Unifying Person and Vehicle Re-identification |journal=IEEE Access |volume=8 |issue=1 |page=2169-3536 |year=2020 |doi=10.1109/ACCESS.2020.2980269|s2cid=214623895 |doi-access=free }}</ref> and geometric feature fusion<ref>{{cite journal | vauthors = McCay KD, Hu P, Shum HP, Woo WL, Marcroft C, Embleton ND, Munteanu A, Ho ES | title = A Pose-Based Feature Fusion and Classification Framework for the Early Prediction of Cerebral Palsy in Infants | journal = IEEE Transactions on Neural Systems and Rehabilitation Engineering | volume = 30 | pages = 8–19 | year = 2022 | pmid = 34941512 | doi = 10.1109/TNSRE.2021.3138185 | s2cid = 245457921 | doi-access = free }}</ref> producing high accuracy in predicting cerebral palsy from short videos.  It is a [[developmental disability]].<ref name="McI2011" />

Once a person is diagnosed with cerebral palsy, further diagnostic tests are optional. [[Neuroimaging]] with [[CT scan|CT]] or [[MRI]] is warranted when the cause of a person's cerebral palsy has not been established. An MRI is preferred over CT, due to diagnostic yield and safety. When abnormal, evidence from neuroimaging may suggest the timing of the initial damage. The CT or MRI is also capable of revealing treatable conditions, such as [[hydrocephalus]], [[porencephaly]], [[arteriovenous malformation]], [[subdural hematoma]]s and [[subdural hygroma|hygromas]], and a vermian tumour<ref name="pmid2602010" /> (which a few studies suggest are present 5–22% of the time). Furthermore, abnormalities detected by neuroimaging may indicate a high likelihood of associated conditions, such as [[epilepsy]] and intellectual disability.<ref>{{cite journal | vauthors = Ashwal S, Russman BS, Blasco PA, Miller G, Sandler A, Shevell M, Stevenson R | title = Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society | journal = Neurology | volume = 62 | issue = 6 | pages = 851–863 | date = March 2004 | pmid = 15037681 | doi = 10.1212/01.WNL.0000117981.35364.1B | doi-access = free | collaboration = Quality Standards Subcommittee of the American Academy of Neurology; Practice Committee of the Child Neurology Society }}</ref> There is a small risk associated with sedating children to facilitate a clear MRI.<ref name="autogenerated1" />

<!-- timing and differential diagnosis -->
The age when CP is diagnosed is important, but medical professionals disagree over the best age to make the diagnosis.<ref name="bosanquet_2013" /> The earlier CP is diagnosed correctly, the better the opportunities are to provide the child with physical and educational help, but there might be a greater chance of confusing CP with another problem, especially if the child is 18 months of age or younger.<ref name="bosanquet_2013" /> Infants may have temporary problems with muscle tone or control that can be confused with CP, which is permanent.<ref name="bosanquet_2013" /> A metabolism disorder or tumors in the nervous system may appear to be CP; metabolic disorders, in particular, can produce brain problems that look like CP on an MRI.<ref name="NINDS2013" /> Disorders that deteriorate the [[white matter]] in the brain and problems that cause spasms and weakness in the legs, may be mistaken for CP if they first appear early in life.<ref name="bosanquet_2013" /> However, these disorders get worse over time, and CP does not<ref name="bosanquet_2013" /> (although it may change in character).<ref name="NINDS2013" /> In infancy it may not be possible to tell the difference between them.<ref name="bosanquet_2013" /> In the UK, not being able to sit independently by the age of 8 months is regarded as a clinical sign for further monitoring.<ref name="autogenerated1" /> [[Fragile X syndrome]] (a cause of autism and intellectual disability) and general intellectual disability must also be ruled out.<ref name="bosanquet_2013" /> Cerebral palsy specialist John McLaughlin recommends waiting until the child is 36 months of age before making a diagnosis because, by that age, motor capacity is easier to assess.<ref name="bosanquet_2013" />

===Classification===
CP is classified by the types of motor impairment of the limbs or organs, and by restrictions to the activities an affected person may perform.<ref name="rethlefsen_2010" /> The [[Gross Motor Function Classification System]]-Expanded and Revised and the [[Manual Ability Classification System]] are used to describe mobility and manual dexterity in people with cerebral palsy, and recently the [[Communication Function Classification System]], and the Eating and Drinking Ability Classification System have been proposed to describe those functions.<ref name="multidisciplinary455" /> There are three main CP classifications by motor impairment: spastic, ataxic, and dyskinetic. Additionally, there is a mixed type that shows a combination of features of the other types. These classifications reflect the areas of the brain that are damaged.<ref>{{cite book | vauthors = Ogoke C |title=Clinical Classification of Cerebral Palsy |date=2018 |url=https://www.researchgate.net/publication/329785522 |access-date=21 March 2021}}</ref>

Cerebral palsy is also classified according to the topographic distribution of muscle spasticity.<ref name="Becher" /> This method classifies children as [[spastic diplegia|diplegic]], (bilateral involvement with leg involvement greater than arm involvement), [[spastic hemiplegia|hemiplegic]] (unilateral involvement), or [[spastic quadriplegia|quadriplegic]] (bilateral involvement with arm involvement equal to or greater than leg involvement).<ref name="O'Shea" /><ref name="Becher" />

====Spastic====
{{main|Spastic cerebral palsy}}
Spastic cerebral palsy is the type of cerebral palsy characterized by [[spasticity]] or high muscle tone often resulting in stiff, jerky movements.<ref name=":0:" /> Itself an [[umbrella term]] encompassing [[spastic hemiplegia]], [[spastic diplegia]], [[spastic quadriplegia]] and – where solely one limb or one specific area of the body is affected – spastic monoplegia. Spastic cerebral palsy affects the [[motor cortex]]<ref name=":0:" /> of the brain, a specific portion of the [[cerebral cortex]] responsible for the planning and completion of voluntary movement.<ref>{{Cite web|url=https://nba.uth.tmc.edu/neuroscience/m/s3/chapter03.html|title=Chapter 3: The motor cortex| vauthors = Knierim J |date=2020|website=Neuroscience online: An electronic textbook of the neurosciences from the University of Texas at Houston|url-status=dead|archive-url=https://web.archive.org/web/20191217070517/https://nba.uth.tmc.edu/neuroscience/m/s3/chapter03.html|archive-date=17 December 2019|access-date=4 March 2020}}</ref>  Spastic CP is the most common type of overall cerebral palsy, representing about 80% of cases.<ref>{{Cite web|url=https://www.cdc.gov/ncbddd/cp/facts.html|title=What is Cerebral Palsy? {{!}} CDC|last=CDC|date=2018-04-18|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-05}}</ref> [[Botulinum toxin]] is effective in decreasing [[spasticity]].<ref name=Farag2020/> It can help increase range of motion which could help mitigate CPs effects on the growing bones of children.<ref name=Farag2020/> There may be an improvement in motor functions in the children and ability to walk. however, the main benefit derived from botulinum toxin A comes from its ability to reduce muscle tone and spasticity and thus prevent or delay the development of fixed muscle contractures.<ref name=Farag2020/><ref>{{cite journal | vauthors = Nolan KW, Cole LL, Liptak GS | title = Use of botulinum toxin type A in children with cerebral palsy | journal = Physical Therapy | volume = 86 | issue = 4 | pages = 573–584 | date = April 2006 | pmid = 16579673 | doi = 10.1093/ptj/86.4.573 | doi-access = free }}</ref>

====Ataxic====
{{main|Ataxic cerebral palsy}}
Ataxic cerebral palsy is observed in approximately 5–10% of all cases of cerebral palsy, making it the least frequent form of cerebral palsy.<ref>{{cite journal | vauthors = McHale DP, Jackson AP, Levene MI, Corry P, Woods CG, Lench NJ, Mueller RF, Markham AF | title = A gene for ataxic cerebral palsy maps to chromosome 9p12-q12 | journal = European Journal of Human Genetics | volume = 8 | issue = 4 | pages = 267–272 | date = April 2000 | pmid = 10854109 | doi = 10.1038/sj.ejhg.5200445 | doi-access = free }}</ref> Ataxic cerebral palsy is caused by damage to cerebellar structures.<ref>{{cite journal | vauthors = Cheney PD |title=Pathophysiology of the corticospinal system and basal ganglia in cerebral palsy |journal= Mental Retardation and Developmental Disabilities Research Reviews |volume=3 |pages=153–167 |year=1997 |doi=10.1002/(SICI)1098-2779(1997)3:2<153::AID-MRDD7>3.0.CO;2-S |issue=2}}</ref> Because of the damage to the [[cerebellum]], which is essential for coordinating muscle movements and balance, patients with ataxic cerebral palsy experience problems in coordination, specifically in their arms, legs, and trunk. Ataxic cerebral palsy is known to decrease muscle tone.<ref>{{cite journal | vauthors = Straub K, Obrzut JE |title=Effects of cerebral palsy on neurophsyological function |journal=Journal of Developmental and Physical Disabilities |volume=21 |pages=153–167 |year=2009 |doi=10.1007/s10882-009-9130-3 |issue=2|s2cid=144152618 }}</ref> The most common manifestation of ataxic cerebral palsy is intention (action) [[tremor]], which is especially apparent when carrying out precise movements, such as tying shoe laces or writing with a pencil. This symptom gets progressively worse as the movement persists, making the hand shake. As the hand gets closer to accomplishing the intended task, the trembling intensifies, which makes it even more difficult to complete.<ref name="O'Shea" />

====Dyskinetic====
{{main|Dyskinetic cerebral palsy}}
Dyskinetic cerebral palsy (sometimes abbreviated DCP) is primarily associated with damage to the [[basal ganglia]] and the [[substantia nigra]] in the form of [[lesions]] that occur during brain development due to [[bilirubin]] [[encephalopathy]] and hypoxic-ischemic [[brain]] injury.<ref name="Hou et al" /> DCP is characterized by both [[hypertonia]] and [[hypotonia]], due to the affected individual's inability to control muscle tone.<ref name="O'Shea" /> Clinical diagnosis of DCP typically occurs within 18 months of birth and is primarily based upon motor function and [[neuroimaging]] techniques.<ref name="ADCP" /><ref name="Mann" />
Dyskinetic cerebral palsy is an [[extrapyramidal system|extrapyramidal]] form of cerebral palsy.<ref name="Jones" /> Dyskinetic cerebral palsy can be divided into two different groups; [[choreoathetosis]] and [[dystonia]].<ref name="O'Shea" /> Choreo-athetotic CP is characterized by involuntary movements, whereas dystonic CP is characterized by slow, strong contractions, which may occur locally or encompass the whole body.<ref name="Becher" />

====Mixed====
Mixed cerebral palsy has symptoms of dyskinetic, ataxic and spastic CP appearing simultaneously, each to varying degrees, and both with and without symptoms of each. Mixed CP is the most difficult to treat as it is extremely heterogeneous and sometimes unpredictable in its symptoms and development over the lifespan.<ref>{{Cite news |date=2023-10-05 |title=World Cerebral Palsy Day 2023: What is it and how does it affect a person? |url=https://www.bbc.com/newsround/67018528 |access-date=2024-03-16 |work=BBC Newsround |language=en-GB}}</ref><ref>{{Cite journal |title=Multi-Organ Dysfunction in Cerebral Palsy |journal=NLM|date=2021 |pmc=8382237 |volume=9 |doi=10.3389/fped.2021.668544 |doi-access=free |pmid=34434904 | vauthors = Allen J, Zareen Z, Doyle S, Whitla L, Afzal Z, Stack M, Franklin O, Green A, James A, Leahy TR, Quinn S, Elnazir B, Russell J, Paran S, Kiely P, Roche EF, McDonnell C, Baker L, Hensey O, Gibson L, Kelly S, McDonald D, Molloy EJ }}</ref><ref>{{Cite web |last=Visco |first=Rory |date=2023-11-09 |title=Early detection, societal support needed to combat cerebral palsy in the PHL {{!}} Rory Visco |url=https://businessmirror.com.ph/2023/11/09/early-detection-societal-support-needed-to-combat-cerebral-palsy-in-the-phl/ |access-date=2024-03-16 |website=BusinessMirror |language=en-US}}</ref><ref>{{Cite web |title=Cerebral Palsy {{!}} National Institute of Neurological Disorders and Stroke |url=https://www.ninds.nih.gov/health-information/disorders/cerebral-palsy |access-date=2024-03-16 |website=www.ninds.nih.gov |language=en}}</ref>

=== Gait classification ===
[[File:Amsterdam Gait Classification gb.jpg|thumb|The [[Orthotics#Definition of the orthotic functions in cases of paralysis caused by cerebral palsy and traumatic brain injury|Amsterdam Gait Classification]] facilitates the assessment of the gait pattern in CP patients. It helps to facilitate communication in the interdisciplinary team between those affected, doctors, physiotherapists and orthotists.]]
In patients with spastic hemiplegia or diplegia, various gait patterns can be observed, the exact form of which can only be described with the help of complex gait analysis systems. In order to facilitate interdisciplinary communication in the interdisciplinary team between those affected, doctors, physiotherapists and orthotists, a simple description of the gait pattern is useful. J. Rodda and H. K. Graham already described in 2001 how gait patterns of CP patients can be more easily recognized and defined gait types which they compared in a classification. They also described that gait patterns can vary with age.<ref>{{cite journal | vauthors = Rodda J, Graham HK | title = Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm | journal = European Journal of Neurology | volume = 8 | issue = Suppl 5 | pages = 98–108 | date = November 2001 | pmid = 11851738 | doi = 10.1046/j.1468-1331.2001.00042.x | s2cid = 45860264 }}</ref> Building on this, the [[Orthotics#Definition of the orthotic functions in cases of paralysis caused by cerebral palsy and traumatic brain injury|Amsterdam Gait Classification]] was developed at the free university in Amsterdam, the VU medisch centrum. 

A special feature of this classification is that it makes different gait patterns very easy to recognize and can be used in CP patients in whom only one leg and both legs are affected. According to the Amsterdam Gait Classification, five gait types are described. To assess the gait pattern, the patient is viewed visually or via a video recording from the side of the leg to be assessed. At the point in time at which the leg to be viewed is in mid stance and the leg not to be viewed is in mid swing, the knee angle and the contact of the foot with the ground are assessed on the one hand.<ref name=":0">{{Cite journal| vauthors = Grunt S |title=Geh-Orthesen bei Kindern mit Cerebralparese|journal=Pediatrica|volume=18|pages=30–34}}</ref>

Classification of the gait pattern according to the Amsterdam Gait Classification: In gait type 1, the knee angle is normal and the foot contact is complete. In gait type 2, the knee angle is hyperextended and the foot contact is complete. In gait type 3, the knee angle is hyperextended and foot contact is incomplete (only on the forefoot). In gait type 4, the knee angle is bent and foot contact is incomplete (only on the forefoot). With gait type 5, the knee angle is bent and the foot contact is complete.<ref name=":0" />

Gait types 5 is also known as crouch gait.<ref>{{Cite journal |last=Armand |first=Stephan |date=Dec 2016 |title=Gait analysis in children with cerebral palsy |journal=Paediatrics and Child Health |language=English |volume=18 |issue=9 |pages=405–409 |doi=10.1016/j.paed.2008.05.013 |pmid=28698802 |pmc=5489760 |issn=1751-7222}}</ref>

==Prevention==
Because the causes of CP are varied, a broad range of preventive interventions have been investigated.<ref name="Shepherd et al 2016" />

[[Electronic fetal monitoring]] has not helped to prevent CP, and in 2014 the [[American College of Obstetricians and Gynecologists]], the [[Royal Australian and New Zealand College of Obstetricians and Gynaecologists]], and the [[Society of Obstetricians and Gynaecologists of Canada]] have acknowledged that there are no long-term benefits of electronic fetal monitoring.<ref name="nejm915" /> Before this, electronic fetal monitoring was widely used to prop up obstetric litigation.<ref name="Sartwelle" />

In those at risk of an early delivery, [[magnesium sulphate]] appears to decrease the risk of cerebral palsy.<ref>{{cite journal | vauthors = Crowther CA, Middleton PF, Voysey M, Askie L, Duley L, Pryde PG, Marret S, Doyle LW | title = Assessing the neuroprotective benefits for babies of antenatal magnesium sulphate: An individual participant data meta-analysis | journal = PLOS Medicine | volume = 14 | issue = 10 | pages = e1002398 | date = October 2017 | pmid = 28976987 | pmc = 5627896 | doi = 10.1371/journal.pmed.1002398 | doi-access = free }}</ref> It is unclear if it helps those who are born at term.<ref name="Ngu2013" /> In those at high risk of preterm labor a review found that moderate to severe CP was reduced by the administration of magnesium sulphate, and that adverse effects on the babies from the magnesium sulphate were not significant. Mothers who received magnesium sulphate could experience side effects such as [[respiratory depression]] and nausea.<ref>{{cite journal | vauthors = Zeng X, Xue Y, Tian Q, Sun R, An R | title = Effects and Safety of Magnesium Sulfate on Neuroprotection: A Meta-analysis Based on PRISMA Guidelines | journal = Medicine | volume = 95 | issue = 1 | pages = e2451 | date = January 2016 | pmid = 26735551 | pmc = 4706271 | doi = 10.1097/MD.0000000000002451 }}</ref> However, guidelines for the use of magnesium sulfate in mothers at risk of preterm labour are not strongly adhered to;<ref name="pmid29319155" /> in 2017 only 2 in 3 eligible women in the UK received the medication despite it being recommended by [[National Institute for Health and Care Excellence|NICE guidelines]].<ref>{{Cite journal |last1=Edwards |first1=Hannah B |last2=Redaniel |first2=Maria Theresa |last3=Sillero-Rejon |first3=Carlos |last4=Margelyte |first4=Ruta |last5=Peters |first5=Tim J |last6=Tilling |first6=Kate |last7=Hollingworth |first7=William |last8=McLeod |first8=Hugh |last9=Craggs |first9=Pippa |last10=Hill |first10=Elizabeth |last11=Redwood |first11=Sabi |last12=Donovan |first12=Jenny |last13=Treloar |first13=Emma |last14=Wetz |first14=Ellie |last15=Swinscoe |first15=Natasha |date=July 2023 |title=National PReCePT Programme: a before-and-after evaluation of the implementation of a national quality improvement programme to increase the uptake of magnesium sulfate in preterm deliveries |journal=Archives of Disease in Childhood - Fetal and Neonatal Edition |language=en |volume=108 |issue=4 |pages=342–347 |doi=10.1136/archdischild-2022-324579 |pmid=36617442 |pmc=10314002 |issn=1359-2998}}</ref> An [[National Health Service|NHS]] quality improvement programme increased its usage in England from 71% in 2018 to 83% in 2020.<ref>{{Cite journal |last1=Edwards |first1=Hannah B |last2=Redaniel |first2=Maria Theresa |last3=Sillero-Rejon |first3=Carlos |last4=Margelyte |first4=Ruta |last5=Peters |first5=Tim J |last6=Tilling |first6=Kate |last7=Hollingworth |first7=William |last8=McLeod |first8=Hugh |last9=Craggs |first9=Pippa |last10=Hill |first10=Elizabeth |last11=Redwood |first11=Sabi |last12=Donovan |first12=Jenny |last13=Treloar |first13=Emma |last14=Wetz |first14=Ellie |last15=Swinscoe |first15=Natasha |date=July 2023 |title=National PReCePT Programme: a before-and-after evaluation of the implementation of a national quality improvement programme to increase the uptake of magnesium sulfate in preterm deliveries |journal=Archives of Disease in Childhood - Fetal and Neonatal Edition |language=en |volume=108 |issue=4 |pages=342–347 |doi=10.1136/archdischild-2022-324579 |pmid=36617442 |pmc=10314002 |issn=1359-2998}}</ref><ref>{{Cite journal |date=30 May 2023 |title=NHS quality improvement programme reduces the risk of cerebral palsy in newborns |url=https://evidence.nihr.ac.uk/alert/nhs-quality-improvement-programme-reduces-risk-cerebral-palsy-newborns/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_58371 }}</ref>

[[Caffeine]] is used to treat [[apnea of prematurity]] and reduces the risk of cerebral palsy in premature babies, but there are also concerns of long term negative effects.<ref>{{cite journal | vauthors = Atik A, Harding R, De Matteo R, Kondos-Devcic D, Cheong J, Doyle LW, Tolcos M | title = Caffeine for apnea of prematurity: Effects on the developing brain | journal = Neurotoxicology | volume = 58 | pages = 94–102 | date = January 2017 | pmid = 27899304 | doi = 10.1016/j.neuro.2016.11.012 | s2cid = 46761491 }}</ref> A moderate quality level of evidence indicates that giving women [[antibiotic]]s during preterm labor before her membranes have ruptured (water is not yet not broken) may increase the risk of cerebral palsy for the child.<ref name="pmid28786098" /> Additionally, for preterm babies for whom there is a chance of fetal compromise, allowing the birth to proceed rather than trying to [[Tocolytic|delay the birth]] may lead to an increased risk of cerebral palsy in the child.<ref name="pmid28786098" /> [[Corticosteroids]] are sometimes taken by pregnant women expecting a preterm birth to provide neuroprotection to their baby.<ref>{{cite journal | vauthors = Chang E | title = Preterm birth and the role of neuroprotection | journal = BMJ | volume = 350 | pages = g6661 | date = January 2015 | pmid = 25646630 | doi = 10.1136/bmj.g6661 | s2cid = 46429378 }}</ref> Taking corticosteroids during pregnancy is shown to have no significant correlation with developing cerebral palsy in preterm births.<ref name="pmid28786098" />

Cooling high-risk full-term babies shortly after birth may reduce disability,<ref name="jacobs_2013" /> but this may only be useful for some forms of the brain damage that causes CP.<ref name="research gaps 2016" />

==Management==
[[File:Cerebral palsy.jpg|thumb|alt=A girl wearing leg braces walks towards a woman in a gym, with a treadmill visible in the background.| Researchers are developing an electrical stimulation device specifically for children with cerebral palsy, who have [[foot drop]], which causes tripping when walking.]]
{{Main|Management of cerebral palsy}}
Over time, the approach to CP management has shifted away from narrow attempts to fix individual physical problems {{endash}} such as spasticity in a particular limb {{endash}} to making such treatments part of a larger goal of maximizing the person's independence and community engagement.<ref name="novak_2013" />{{rp|886}}  However, the evidence base for the effectiveness of intervention programs reflecting the philosophy of independence has not yet caught up: effective interventions for body structures and functions have a strong evidence base, but evidence is lacking for effective interventions targeted toward participation, environment, or personal factors.<ref name="novak_2013" /> There is also no good evidence to show that an intervention that is effective at the body-specific level will result in an improvement at the activity level or vice versa.<ref name="novak_2013" /> Although such cross-over benefit might happen, not enough high-quality studies have been done to demonstrate it.<ref name="novak_2013" />

Because cerebral palsy has "varying severity and complexity" across the lifespan,<ref name="multidisciplinary455" /> it can be considered a collection of conditions for management purposes.<ref name="research gaps 2016" /> A [[multidisciplinary]] approach for cerebral palsy management is recommended,<ref name="multidisciplinary455" /> focusing on "maximising individual function, choice and independence" in line with the [[International Classification of Functioning, Disability and Health]]'s goals.<ref name="autogenerated1" /> The team may include a paediatrician, a [[health visitor]], a social worker, a physiotherapist, an orthotist, a speech and language therapist, an [[occupational therapist]], a teacher specialising in helping children with visual impairment, an educational psychologist, an [[orthopaedic surgeon]], a neurologist and a neurosurgeon.<ref>{{cite web|title=Cerebral palsy – Treatment|url=http://www.nhs.uk/Conditions/Cerebral-palsy/Pages/Treatment.aspx|website=www.nhs.uk|publisher=[[NHS Choices]]|access-date=6 February 2017|url-status=live|archive-url=https://web.archive.org/web/20170206185635/http://www.nhs.uk/Conditions/Cerebral-palsy/Pages/Treatment.aspx|archive-date=6 February 2017}}</ref>

Various forms of therapy are available to people living with cerebral palsy as well as caregivers and parents. Treatment may include one or more of the following: physical therapy; occupational therapy; speech therapy; water therapy; drugs to control seizures, alleviate pain, or relax muscle spasms (e.g. [[benzodiazepine]]s); surgery to correct anatomical abnormalities or release tight muscles; [[orthotics|braces and other orthotic devices]]; rolling walkers; and communication aids such as computers with attached voice synthesisers.<ref>{{Cite web |title=Cerebral Palsy {{!}} National Institute of Neurological Disorders and Stroke |url=https://www.ninds.nih.gov/health-information/disorders/cerebral-palsy |access-date=2024-03-16 |website=www.ninds.nih.gov |language=en}}</ref> Intensive rehabilitation is practiced in certain countries, but obtaining reliable data on its medium and long-term effectiveness is challenging.<ref>{{Cite journal |last1=Ravault |first1=Lucas |last2=Darbois |first2=Nelly |last3=Pinsault |first3=Nicolas |date=2020-07-03 |title=Methodological Considerations to Investigate Dosage Parameters of Intensive Upper Limb Rehabilitation in Children with Unilateral Spastic Cerebral Palsy: A Scoping Review of RCTs |url=https://www.tandfonline.com/doi/full/10.1080/17518423.2019.1687599 |journal=Developmental Neurorehabilitation |language=en |volume=23 |issue=5 |pages=309–320 |doi=10.1080/17518423.2019.1687599 |pmid=31710245 |s2cid=207966055 |issn=1751-8423}}</ref>

Surgical intervention in CP children may include various [[orthopaedic surgery|orthopaedic]] or [[neurosurgery|neurological surgeries]] to improve quality of life, such as tendon releases, hip rotation, [[spinal fusion]], ([[selective dorsal rhizotomy]]) or placement of an [[intrathecal]] baclofen pump.<ref name="Amen2018" /><ref name="novak_2013" /><ref>Hallman-Cooper JL, Rocha Cabrero F. Cerebral Palsy. [Updated 2022 Oct 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538147/</ref>

A Cochrane review published in 2004 found a trend toward the benefit of speech and language therapy for children with cerebral palsy but noted the need for high-quality research.<ref>{{cite journal | vauthors = Pennington L, Goldbart J, Marshall J | title = Speech and language therapy to improve the communication skills of children with cerebral palsy | journal = The Cochrane Database of Systematic Reviews | volume = 2004 | issue = 2 | pages = CD003466 | year = 2004 | pmid = 15106204 | pmc = 8407241 | doi = 10.1002/14651858.CD003466.pub2 }}</ref> A 2013 systematic review found that many of the therapies used to treat CP have no good evidence base; the treatments with the best evidence are medications ([[anticonvulsant]]s, [[botulinum toxin]], [[bisphosphonate]]s, [[diazepam]]), therapy (bimanual training, [[Orthopedic cast|casting]], [[constraint-induced movement therapy]], context-focused therapy, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care) and surgery. There is also research on whether the sleeping position might improve hip migration, but there are not yet high-quality evidence studies to support that theory.<ref>{{cite journal | vauthors = Blake SF, Logan S, Humphreys G, Matthews J, Rogers M, Thompson-Coon J, Wyatt K, Morris C | title = Sleep positioning systems for children with cerebral palsy | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 11 | pages = CD009257 | year = 2015 | pmid = 26524348 | pmc = 8761500 | doi = 10.1002/14651858.CD009257.pub2 }}</ref> Research papers also call for an agreed consensus on outcome measures which will allow researchers to cross-reference research. Also, the terminology used to describe orthoses<ref>{{cite journal | vauthors = Eddison N, Mulholland M, Chockalingam N | title = Do research papers provide enough information on design and material used in ankle foot orthoses for children with cerebral palsy? A systematic review | journal = Journal of Children's Orthopaedics | volume = 11 | issue = 4 | pages = 263–271 | date = August 2017 | pmid = 28904631 | pmc = 5584494 | doi = 10.1302/1863-2548.11.160256 }}</ref> needs to be standardised to ensure studies can be reproduced and readily compared and evaluated.

== Orthotics in the concept of therapy ==
[[File:Cerebralparese Orthese orthotics.jpg|thumb|Child with cerebral palsy and [[orthotics]] with adjustable functional elements to improve safety when standing and walking]]
To improve the gait pattern, [[orthotics]] can be included in the therapy concept. An orthosis can support physiotherapeutic treatment in setting the right motor impulses in order to create new cerebral connections.<ref>{{Cite book| vauthors = Horst R |title=Motorisches Strategietraining und PNF|publisher=Renata Horst|year=2005|isbn=978-3-13-151351-9}}</ref> The orthosis must meet the requirements of the medical prescription. In addition, the orthosis must be designed by the orthotist in such a way that it achieves the effectiveness of the necessary levers, matching the gait pattern, in order to support the proprioceptive approaches of physiotherapy. The characteristics of the stiffness of the orthosis shells and the adjustable dynamics in the ankle joint are important elements of the orthosis to be considered.<ref>{{Cite book|url=https://musculoskeletalkey.com/orthoses-for-cerebral-palsy/|title=Orthoses for cerebral palsy|vauthors=Novacheck TF|publisher=John D. Hsu, John W. Michael, John R. Fisk|year=2008|isbn=978-0-323-03931-4|series=AAOS Atlas of Orthoses and Assistive Devices|location=Philadelphia|pages=487–500}}</ref> 

Due to these requirements, the development of orthoses has changed significantly in recent years, especially since around 2010. At about the same time, care concepts were developed that deal intensively with the orthotic treatment of the lower extremities in cerebral palsy.<ref>{{Cite journal|vauthors=Muñoz S|date=2018|title=The new generation of AFOs|url=https://www.opedge.com/Articles/ViewArticle/2018-11-01/the-new-generation-of-afos|journal=The O&P EDGE|volume=11|access-date=16 July 2021|archive-date=6 June 2021|archive-url=https://web.archive.org/web/20210606193110/https://www.opedge.com/Articles/ViewArticle/2018-11-01/the-new-generation-of-afos|url-status=dead}}</ref> Modern materials and new functional elements enable the rigidity to be specifically adapted to the requirements that fits to the gait pattern of the CP patient.<ref>{{cite journal | vauthors = Kerkum YL, Harlaar J, Buizer AI, van den Noort JC, Becher JG, Brehm MA | title = An individual approach for optimizing ankle-foot orthoses to improve mobility in children with spastic cerebral palsy walking with excessive knee flexion | journal = Gait & Posture | volume = 46 | pages = 104–111 | date = May 2016 | pmid = 27131186 | doi = 10.1016/j.gaitpost.2016.03.001 }}</ref> The adjustment of the stiffness has a decisive influence on the gait pattern and on the energy cost of walking.<ref>{{Cite journal|vauthors=Kerkum YL|date=2016|title=The effect of ankle foot orthosis stiffness on trunk movement and walking energy cost in cerebral palsy|url=http://dx.doi.org/10.1016/j.gaitpost.2016.07.070|journal=Gait & Posture|volume=49|pages=2|doi=10.1016/j.gaitpost.2016.07.070|issn=0966-6362}}</ref><ref>{{cite journal | vauthors = Meyns P, Kerkum YL, Brehm MA, Becher JG, Buizer AI, Harlaar J | title = Ankle foot orthoses in cerebral palsy: Effects of ankle stiffness on trunk kinematics, gait stability and energy cost of walking | journal = European Journal of Paediatric Neurology | volume = 26 | pages = 68–74 | date = May 2020 | pmid = 32147412 | doi = 10.1016/j.ejpn.2020.02.009 | s2cid = 212641072 | url = http://resolver.tudelft.nl/uuid:8042e419-4780-4ee8-9a7d-d2868ed15174 }}</ref><ref>{{cite journal | vauthors = Waterval NF, Nollet F, Harlaar J, Brehm MA | title = Modifying ankle foot orthosis stiffness in patients with calf muscle weakness: gait responses on group and individual level | journal = Journal of Neuroengineering and Rehabilitation | volume = 16 | issue = 1 | pages = 120 | date = October 2019 | pmid = 31623670 | pmc = 6798503 | doi = 10.1186/s12984-019-0600-2 | doi-access = free }}</ref> It is of great advantage if the stiffness of the orthosis can be adjusted separately from one another via resistances of the two functional elements in the two directions of movement, [[dorsiflexion]] and [[plantar flexion]].<ref name=":5">{{cite journal | vauthors = Ploeger HE, Waterval NF, Nollet F, Bus SA, Brehm MA | title = Stiffness modification of two ankle-foot orthosis types to optimize gait in individuals with non-spastic calf muscle weakness - a proof-of-concept study | language = German | journal = Journal of Foot and Ankle Research | volume = 12 | pages = 41 | year = 2019 | pmid = 31406508 | pmc = 6686412 | doi = 10.1186/s13047-019-0348-8 | doi-access = free }}</ref>

==Prognosis==
CP is not a [[neurodegenerative disorder|progressive disorder]] (meaning the brain damage does not worsen), but the symptoms can become more severe over time. A person with the disorder may improve somewhat during childhood if he or she receives extensive care, but once bones and musculature become more established, orthopedic surgery may be required. People with CP can have varying degrees of [[cognitive impairment]] or none whatsoever. The full intellectual potential of a child born with CP is often not known until the child starts school. People with CP are more likely to have [[learning disorders]] but have normal intelligence. Intellectual level among people with CP varies from [[genius]] to [[intellectually disabled]], as it does in the general population, and experts have stated that it is important not to underestimate the capabilities of a person with CP and to give them every opportunity to learn.<ref>{{cite journal | vauthors = Jenks KM, de Moor J, van Lieshout EC, Maathuis KG, Keus I, Gorter JW | title = The effect of cerebral palsy on arithmetic accuracy is mediated by working memory, intelligence, early numeracy, and instruction time | journal = Developmental Neuropsychology | volume = 32 | issue = 3 | pages = 861–879 | year = 2007 | pmid = 17956186 | doi = 10.1080/87565640701539758 | s2cid = 17795628 | hdl = 1871/34092 | url = https://research.vu.nl/en/publications/83a36ddf-a316-4c93-8cc3-35384117e688 | hdl-access = free }}</ref>

The ability to live independently with CP varies widely, depending partly on the severity of each person's impairment and partly on the capability of each person to self-manage the logistics of life. Some individuals with CP require personal assistant services for all [[activities of daily living]]. Others only need assistance with certain activities, and still others do not require any physical assistance. But regardless of the severity of a person's physical impairment, a person's ability to live independently often depends primarily on the person's capacity to manage the physical realities of his or her life autonomously. In some cases, people with CP recruit, hire, and manage a staff of [[personal care assistant]]s (PCAs). PCAs facilitate the independence of their employers by assisting them with their daily personal needs in a way that allows them to maintain control over their lives.{{citation needed|date=January 2021}}

Puberty in young adults with cerebral palsy may be [[Precocious puberty|precocious]] or [[Delayed puberty|delayed]]. Delayed puberty is thought to be a consequence of nutritional deficiencies.<ref name="Zaffuto-Sforza2005" /> There is currently no evidence that CP affects fertility, although some of the secondary symptoms have been shown to affect sexual desire and performance.<ref>{{cite journal | vauthors = Wiegerink D, Roebroeck M, Bender J, Stam H, Cohen-Kettenis P | title = Sexuality of Young Adults with Cerebral Palsy: Experienced Limitations and Needs | journal = Sexuality and Disability | volume = 29 | issue = 2 | pages = 119–128 | date = June 2011 | pmid = 21660090 | pmc = 3093545 | doi = 10.1007/s11195-010-9180-6 }}</ref> Adults with CP were less likely to get routine reproductive health screening as of 2005. [[Gynecological examination]]s may have to be performed under anesthesia due to spasticity, and equipment is often not accessible. [[Breast self-examination]] may be difficult, so partners or carers may have to perform it. Men with CP have higher levels of [[cryptorchidism]] at the age of 21.<ref name="Zaffuto-Sforza2005" />

CP can significantly reduce a person's life expectancy, depending on the severity of their condition and the quality of care they receive.<ref name="Yar2013" /><ref>{{cite journal | vauthors = Hutton JL | title = Cerebral palsy life expectancy | journal = Clinics in Perinatology | volume = 33 | issue = 2 | pages = 545–555 | date = June 2006 | pmid = 16765736 | doi = 10.1016/j.clp.2006.03.016 | author-link = Jane Hutton }}</ref> 5–10% of children with CP die in childhood, particularly where seizures and intellectual disability also affect the child.<ref name="multidisciplinary455" /> The ability to ambulate, roll, and self-feed has been associated with increased life expectancy.<ref name="strauss_2008" /> While there is a lot of variation in how CP affects people, it has been found that "independent gross motor functional ability is a very strong determinant of life expectancy".<ref>{{cite journal | vauthors = Day SM, Reynolds RJ, Kush SJ | title = Extrapolating published survival curves to obtain evidence-based estimates of life expectancy in cerebral palsy | journal = Developmental Medicine and Child Neurology | volume = 57 | issue = 12 | pages = 1105–1118 | date = December 2015 | pmid = 26174088 | doi = 10.1111/dmcn.12849 | s2cid = 8895402 | doi-access = free }}</ref> According to the [[Australian Bureau of Statistics]], in 2014, 104 [[Australian people|Australians]] died of cerebral palsy.<ref>{{Cite web |title=Australian Bureau of Statistics 2014, 3303.0 - Causes of Death, Australia - 1. Underlying causes of death (Australia), 2014, data cube: Excel spreadsheet |url=http://abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3303.02014?OpenDocument |work=abs.gov.au/AUSSTATS |access-date=14 August 2016 |archive-date=12 September 2016 |archive-url=https://web.archive.org/web/20160912150416/http://www.abs.gov.au/AUSSTATS/abs%40.nsf/DetailsPage/3303.02014?OpenDocument |url-status=dead }}</ref> The most common causes of death in CP are related to respiratory causes, but in middle age cardiovascular issues and [[neoplastic disorders]] become more prominent.<ref name="rehabilitation443" />

===Self-care===
For many children with CP, parents are heavily involved in self-care activities. Self-care activities, such as bathing, dressing, and grooming, can be difficult for children with CP, as self-care depends primarily on the use of the upper limbs.<ref name="vanzelst_2006" /> For those living with CP, impaired upper limb function affects almost 50% of children and is considered the main factor contributing to decreased activity and participation.<ref name="Nieuwenhuijsen_2009" /> As the hands are used for many self-care tasks, sensory and motor impairments of the hands make daily self-care more difficult.<ref name="Donkervoort2007" />{{Primary source inline|date=February 2014}}<ref name="arnould_2008" /> Motor impairments cause more problems than sensory impairments.<ref name="Donkervoort2007" /> The most common impairment is that of finger dexterity, which is the ability to manipulate small objects with the fingers.<ref name="Donkervoort2007" /> Compared to other disabilities, people with cerebral palsy generally need more help in performing daily tasks.<ref>{{Cite web |title= Therapy and equipment needs of people with cerebral palsy and like disabilities in Australia |work=Australian Institute of Health and Welfare AIHW |year=2006 |url=http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442455831 |archive-url=https://web.archive.org/web/20150330125338/http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442455831 |archive-date=30 March 2015}} Disability Series. Cat. no. DIS 49. Canberra: AIHW.</ref> Occupational therapists are healthcare professionals that help individuals with disabilities gain or regain their independence through the use of meaningful activities.<ref>{{Cite web|title=Patients & Clients: Learn About Occupational Therapy|url=https://www.aota.org/About-Occupational-Therapy/Patients-Clients.aspx|publisher=The American Occupational Therapy Association, Inc.|access-date=3 September 2019}}</ref>

===Productivity===
The effects of sensory, motor, and cognitive impairments affect self-care occupations in children with CP and productivity occupations. Productivity can include but is not limited to, school, work, household chores, or contributing to the community.<ref name="fedrizzi_2003" />

Play is included as a productive occupation as it is often the primary activity for children.<ref name="Blesedell CE 2003. p. 705-709" /> If play becomes difficult due to a disability, like CP, this can cause problems for the child.<ref name="Townsend E 2002. p. 34" /> These difficulties can affect a child's self-esteem.<ref name="Townsend E 2002. p. 34" /> In addition, the sensory and motor problems experienced by children with CP affect how the child interacts with their surroundings, including the environment and other people.<ref name="Townsend E 2002. p. 34" /> Not only do physical limitations affect a child's ability to play, the limitations perceived by the child's caregivers and playmates also affect the child's play activities.<ref name="parham_1997" /> Some children with disabilities spend more time playing by themselves.<ref name="miller_2003" /> When a disability prevents a child from playing, there may be social, emotional and psychological problems,<ref name="okimoto_2000" /> which can lead to increased dependence on others, less motivation, and poor social skills.<ref name="hestenes_2000" />

In school, students are asked to complete many tasks and activities, many of which involve handwriting. Many children with CP have the capacity to learn and write in the school environment.<ref name="Missiuna" /> However, students with CP may find it difficult to keep up with the handwriting demands of school and their writing may be difficult to read.<ref name="Missiuna" /> In addition, writing may take longer and require greater effort on the student's part.<ref name="Missiuna" /> Factors linked to handwriting include postural stability, sensory and perceptual abilities of the hand, and writing tool pressure.<ref name="Missiuna" />

Speech impairments may be seen in children with CP depending on the severity of brain damage.<ref name="howard_1996" /> Communication in a school setting is important because communicating with peers and teachers is very much a part of the "school experience" and enhances social interaction. Problems with language or motor dysfunction can lead to underestimating a student's intelligence.<ref name="rigby_1999" /> In summary, children with CP may experience difficulties in school, such as difficulty with handwriting, carrying out school activities, communicating verbally, and interacting socially.{{citation needed|date=January 2021}}

===Leisure===
Leisure activities can have several positive effects on physical health, mental health, life satisfaction, and psychological growth for people with physical disabilities like CP.<ref name="smith_2009" /> Common benefits identified are stress reduction, development of coping skills, companionship, enjoyment, relaxation and a positive effect on life satisfaction.<ref name="ReferenceC" /> In addition, for children with CP, leisure appears to enhance adjustment to living with a disability.<ref name="ReferenceC" />

Leisure can be divided into structured (formal) and unstructured (informal) activities.<ref name="cassidy_1996" /> Children and teens with CP engage in less habitual [[physical activity]] than their peers.<ref>{{cite journal | vauthors = Carlon SL, Taylor NF, Dodd KJ, Shields N | title = Differences in habitual physical activity levels of young people with cerebral palsy and their typically developing peers: a systematic review | journal = Disability and Rehabilitation | volume = 35 | issue = 8 | pages = 647–655 | date = April 2013 | pmid = 23072296 | doi = 10.3109/09638288.2012.715721 | s2cid = 14115837 }}</ref> Children with CP primarily engage in physical activity through therapies aimed at managing their CP, or through [[organized sport]] for people with disabilities.<ref>{{cite journal | vauthors = Verschuren O, Peterson MD, Balemans AC, Hurvitz EA | title = Exercise and physical activity recommendations for people with cerebral palsy | journal = Developmental Medicine and Child Neurology | volume = 58 | issue = 8 | pages = 798–808 | date = August 2016 | pmid = 26853808 | pmc = 4942358 | doi = 10.1111/dmcn.13053 }}</ref> It is difficult to sustain behavioural change in terms of increasing physical activity of children with CP.<ref>{{cite journal | vauthors = Bloemen M, Van Wely L, Mollema J, Dallmeijer A, de Groot J | title = Evidence for increasing physical activity in children with physical disabilities: a systematic review | journal = Developmental Medicine and Child Neurology | volume = 59 | issue = 10 | pages = 1004–1010 | date = October 2017 | pmid = 28374442 | doi = 10.1111/dmcn.13422 | doi-access = free }} {{open access}}</ref> Gender, manual dexterity, the child's preferences, cognitive impairment and epilepsy were found to affect children's leisure activities, with manual dexterity associated with more leisure activity.<ref>{{cite journal | vauthors = Bult MK, Verschuren O, Jongmans MJ, Lindeman E, Ketelaar M | title = What influences participation in leisure activities of children and youth with physical disabilities? A systematic review | journal = Research in Developmental Disabilities | volume = 32 | issue = 5 | pages = 1521–1529 | date = September 2011 | pmid = 21388783 | doi = 10.1016/j.ridd.2011.01.045 }}</ref> Although leisure is important for children with CP, they may have difficulties carrying out leisure activities due to social and physical barriers.{{citation needed|date=January 2021}}

Children with cerebral palsy may face challenges when it comes to participating in sports. This comes with being discouraged from physical activity because of these perceived limitations imposed by their medical condition.<ref>{{cite journal | vauthors = Coleman N, Nemeth BA, LeBlanc CM | title = Increasing Wellness Through Physical Activity in Children With Chronic Disease and Disability | journal = Current Sports Medicine Reports | volume = 17 | issue = 12 | pages = 425–432 | date = December 2018 | pmid = 30531459 | doi = 10.1249/JSR.0000000000000548 | s2cid = 54473147 | doi-access = free }}</ref>

===Participation and barriers===
Participation is involvement in life situations and everyday activities.<ref name="King" /> Participation includes self-care, productivity, and leisure. In fact, communication, mobility, education, home life, leisure, and social relationships require participation, and indicate the extent to which children function in their environment.<ref name="King" /> Barriers can exist on three levels: micro, meso, and macro.<ref name="Aitchison" /> First, the barriers at the micro level involve the person.<ref name="Aitchison" /> Barriers at the micro level include the child's physical limitations (motor, sensory and cognitive impairments) or their subjective feelings regarding their ability to participate.<ref name="imms_2008" /> For example, the child may not participate in group activities due to lack of confidence. Second, barriers at the meso level include the family and community.<ref name="Aitchison" /> These may include negative attitudes of people toward disability or lack of support within the family or in the community.<ref name="Specht" /> 

One of the main reasons for this limited support appears to be the result of a lack of awareness and knowledge regarding the child's ability to engage in activities despite his or her disability.<ref name="Specht" /> Third, barriers at the macro level incorporate the systems and policies that are not in place or hinder children with CP. These may be environmental barriers to participation such as architectural barriers, lack of relevant assistive technology, and transportation difficulties due to limited wheelchair access or public transit that can accommodate children with CP.<ref name="Specht" /> For example, a building without an elevator can prevent the child from accessing higher floors.{{citation needed|date=August 2021}}

A 2013 review stated that outcomes for adults with cerebral palsy without intellectual disability in the 2000s were that "60–80% completed high school, 14–25% completed college, up to 61% were living independently in the community, 25–55% were competitively employed, and 14–28% were involved in long term relationships with partners or had established families".<ref>{{cite journal | vauthors = Frisch D, Msall ME | title = Health, functioning, and participation of adolescents and adults with cerebral palsy: a review of outcomes research | journal = Developmental Disabilities Research Reviews | volume = 18 | issue = 1 | pages = 84–94 | date = August 2013 | pmid = 23949832 | doi = 10.1002/ddrr.1131 }}</ref> Adults with cerebral palsy may not seek physical therapy due to transport issues, financial restrictions and practitioners not feeling like they know enough about cerebral palsy to take people with CP on as clients.<ref name="Lawrence2016" />

===Aging===
Children with CP may not successfully transition into using adult services because they are not referred to one upon turning 18, and may decrease their use of services.<ref name="rehabilitation443" /> Quality of life outcomes tend to decline for adults with cerebral palsy.<ref>{{cite journal | vauthors = Alves-Nogueira AC, Silva N, McConachie H, Carona C | title = A systematic review on quality of life assessment in adults with cerebral palsy: Challenging issues and a call for research | journal = Research in Developmental Disabilities | volume = 96 | pages = 103514 | date = January 2020 | pmid = 31706133 | doi = 10.1016/j.ridd.2019.103514 | s2cid = 207936522 }}</ref>  Because children with cerebral palsy are often told that it is a non-progressive disease, they may be unprepared for the greater effects of the [[aging]] process as they head into their 30s.<ref>{{cite report | veditors = Turk MA, Overeynder JC, Janicki MP | date= 1995 | url = http://www.rrtcadd.org/resources/Resources/Topics-of-Interest/CP/future.pdf | title = Uncertain Future – Aging and Cerebral Palsy: Clinical Concerns | location = Albany | publisher = New York State Developmental Disabilities Planning Council | archive-url = https://web.archive.org/web/20160803114950/http://www.rrtcadd.org/resources/Resources/Topics-of-Interest/CP/future.pdf | archive-date=3 August 2016}}</ref> Young adults with cerebral palsy experience problems with aging that non-disabled adults experience "much later in life".<ref name="Kerkovich, D 2009, pp. 41-53" />{{rp|42}} 25% or more adults with cerebral palsy who can walk experience increasing difficulties walking with age.<ref>{{cite journal | vauthors = Morgan P, McGinley J | title = Gait function and decline in adults with cerebral palsy: a systematic review | journal = Disability and Rehabilitation | volume = 36 | issue = 1 | pages = 1–9 | date = 17 April 2013 | pmid = 23594053 | doi = 10.3109/09638288.2013.775359 | s2cid = 9709075 }}</ref> Hand function does not seem to have similar declines.<ref name="The epidemiology of cerebral palsy" />  Chronic disease risk, such as [[obesity]], is also higher among adults with cerebral palsy than the general population.<ref>{{cite journal | vauthors = Peterson MD, Gordon PM, Hurvitz EA | title = Chronic disease risk among adults with cerebral palsy: the role of premature sarcopoenia, obesity and sedentary behaviour | journal = Obesity Reviews | volume = 14 | issue = 2 | pages = 171–182 | date = February 2013 | pmid = 23094988 | doi = 10.1111/j.1467-789X.2012.01052.x | hdl-access = free | s2cid = 26998110 | hdl = 2027.42/96337 }}</ref> Common problems include increased pain, reduced flexibility, increased spasms and contractures, [[post-impairment syndrome]]<ref>{{cite web|title=CP and ageing|url=http://www.scope.org.uk/support/disabled-people/old-age/cp|archive-url=https://web.archive.org/web/20160506052736/http://www.scope.org.uk/Support/Parents-and-Carers/Landing/Cerebral-palsy/Ageing|archive-date=6 May 2016 |website=[[Scope (charity)|Scope]]|access-date=24 December 2016}}</ref> and increasing problems with balance.<ref name="hirsch_2013" /> Increased [[fatigue (medical)|fatigue]] is also a problem.<ref name="Developmental Medicine 2011" /> When adulthood and cerebral palsy is discussed, {{as of|2011|lc=y}}, it is not discussed in terms of the different stages of adulthood.<ref name="Developmental Medicine 2011" /> About half of people with CP report some loss of function as of their 40s.<ref>{{cite journal |last1=Kumar |first1=Devina S. |last2=Perez |first2=Gabriel |last3=Friel |first3=Kathleen M. |title=Adults with Cerebral Palsy: Navigating the Complexities of Aging |journal=[[Brain Sciences]] |date=September 2023 |volume=13 |issue=9 |pages=1296 |doi=10.3390/brainsci13091296 |pmid=37759897 |pmc=10526900 |language=en |issn=2076-3425 |doi-access=free }}</ref>

Like they did in childhood, adults with cerebral palsy experience psychosocial issues related to their CP, chiefly the need for social support, self-acceptance, and acceptance by others. Workplace accommodations may be needed to enhance continued employment for adults with CP as they age. Rehabilitation or social programs that include [[salutogenesis]] may improve the coping potential of adults with CP as they age.<ref>{{cite journal | vauthors = Horsman M, Suto M, Dudgeon B, Harris SR | title = Ageing with cerebral palsy: psychosocial issues | journal = Age and Ageing | volume = 39 | issue = 3 | pages = 294–299 | date = May 2010 | pmid = 20178997 | doi = 10.1093/ageing/afq018 | doi-access = free }}</ref>

==Epidemiology==
Cerebral palsy occurs in about 2.1 per 1000 live births.<ref name="Osk2013" /> In those born at term rates are lower at 1 per 1000 live births.<ref name="Yar2013" /> Within a population it may occur more often in poorer people.<ref>{{cite journal | vauthors = Odding E, Roebroeck ME, Stam HJ | title = The epidemiology of cerebral palsy: incidence, impairments and risk factors | journal = Disability and Rehabilitation | volume = 28 | issue = 4 | pages = 183–191 | date = February 2006 | pmid = 16467053 | doi = 10.1080/09638280500158422 | s2cid = 45640254 }}</ref> The rate is higher in males than in females; in Europe it is 1.3 times more common in males.<ref name="JohnsonPrevalence" />

There was a "moderate, but significant" rise in the prevalence of CP between the 1970s and 1990s. This is thought to be due to a rise in [[low birth weight]] of infants and the increased survival rate of these infants. The increased survival rate of infants with CP in the 1970s and 80s may be indirectly due to the [[disability rights movement]] challenging perspectives around the worth of infants with a disability, as well as the [[Baby Doe Law]].<ref>{{cite journal | vauthors = Dalembert G, Brosco JP | title = Do politics affect prevalence? An overview and the case of cerebral palsy | journal = Journal of Developmental and Behavioral Pediatrics | volume = 34 | issue = 5 | pages = 369–374 | date = June 2013 | pmid = 23751888 | doi = 10.1097/DBP.0b013e31829455d8 | s2cid = 41883040 }}</ref>  Between 1990 and 2003, rates of cerebral palsy remained the same.<ref>{{cite journal |last1=Paul |first1=Sudip |last2=Nahar |first2=Anjuman |last3=Bhagawati |first3=Mrinalini |last4=Kunwar |first4=Ajaya Jang |title=A Review on Recent Advances of Cerebral Palsy |journal=[[Oxidative Medicine and Cellular Longevity]] |date=30 July 2022 |volume=2022 |pages=e2622310 |doi=10.1155/2022/2622310 |pmid=35941906 |pmc=9356840 |language=en |issn=1942-0900 |doi-access=free }}</ref>

As of 2005, advances in the care of pregnant mothers and their babies did not result in a noticeable decrease in CP. This is generally attributed to medical advances in areas related to the care of premature babies (which results in a greater survival rate). Only the introduction of quality medical care to locations with less-than-adequate medical care has shown any decreases. The incidence of CP increases with premature or very low-weight babies regardless of the quality of care.<ref name="bax_2005" /> {{as of|2016}}, there is a suggestion that both incidence and severity are slightly decreasing – more research is needed to find out if this is significant, and if so, which interventions are effective.<ref name="Shepherd et al 2016" />  It has been found that high-income countries have lower rates of children born with cerebral palsy than low or middle-income countries.<ref>{{cite journal | vauthors = McIntyre S, Goldsmith S, Webb A, Ehlinger V, Hollung SJ, McConnell K, Arnaud C, Smithers-Sheedy H, Oskoui M, Khandaker G, Himmelmann K | title = Global prevalence of cerebral palsy: A systematic analysis | journal = Developmental Medicine and Child Neurology | volume = 64 | issue = 12 | pages = 1494–1506 | date = December 2022 | pmid = 35952356 | doi = 10.1111/dmcn.15346 | pmc = 9804547 | s2cid = 251516376 }}</ref>

Prevalence of cerebral palsy is best calculated around the school entry age of about six years; the prevalence in the U.S. is estimated to be 2.4 out of 1000 children.<ref name="pmid17261678" />

==History==
Cerebral palsy has affected humans since antiquity.<!-- <ref name="History2013" /> --> A decorated grave marker dating from around the 15th to 14th century BCE shows a figure with one small leg and using a crutch, possibly due to cerebral palsy.<!-- <ref name="History2013" /> --> The oldest likely physical evidence of the condition comes from the mummy of [[Siptah]], an Egyptian [[Pharaoh]] who ruled from about 1196 to 1190&nbsp;BCE and died at about 20 years of age.<!-- <ref name="History2013" /> --> The presence of cerebral palsy has been suspected due to his deformed foot and hands.<ref name="History2013" />

The medical literature of the [[Ancient Greece|ancient Greeks]] discusses paralysis and weakness of the arms and legs; the modern word ''palsy'' comes from the [[Ancient Greek]] words ''παράλυση'' or ''πάρεση'', meaning paralysis or paresis respectively.<!-- <ref name="History2013" /> --> The [[Hippocratic Corpus|works of the school of Hippocrates]] (460{{endash}}c. 370&nbsp;BCE), and the manuscript ''On the Sacred Disease'' in particular, describe a group of problems that matches up very well with the modern understanding of cerebral palsy.<!-- <ref name="History2013" /> --> The Roman Emperor [[Claudius]] (10 BCE{{endash}}54 CE) is suspected of having CP, as historical records describe him as having several physical problems in line with the condition. Medical historians have begun to suspect and find depictions of CP in much later art.<!-- <ref name="History2013" /> --> Several paintings from the 16th century and later show individuals with problems consistent with it, such as [[Jusepe de Ribera]]'s 1642 painting ''[[The Clubfoot]]''.<ref name="History2013" />

The modern understanding of CP as resulting from problems within the brain began in the early decades of the 1800s with a number of publications on brain abnormalities by [[Johann Christian Reil]], [[Claude François Lallemand]] and [[Philippe Pinel]].<!-- <ref name="History2013" /> --> Later physicians used this research to connect problems in the brain with specific symptoms.<!-- <ref name="History2013" /> --> The English surgeon [[William John Little]] (1810{{endash}}1894) was the first person to study CP extensively.<!-- <ref name="History2013" /> --> In his doctoral thesis he stated that CP was a result of a problem around the time of birth.<!-- <ref name="History2013" /> --> He later identified a difficult delivery, a [[preterm birth]] and [[perinatal asphyxia]] in particular as risk factors.<!-- <ref name="History2013" /> --> The [[spastic diplegia]] form of CP came to be known as Little's disease.<ref name="History2013" /> At around this time, a German surgeon was also working on cerebral palsy, and distinguished it from polio.<ref>{{cite journal|title=The Definition and Classification of Cerebral Palsy|journal=[[Developmental Medicine & Child Neurology]]|date=28 June 2008|volume=49|pages=1–44|doi=10.1111/j.1469-8749.2007.00201.x|s2cid=221645066|doi-access=free}}</ref> In the 1880s British neurologist [[William Gowers (neurologist)|William Gowers]] built on Little's work by linking paralysis in newborns to difficult births.<!-- <ref name=History2013/ --> He named the problem "birth palsy" and classified birth palsies into two types: peripheral and cerebral.<ref name="History2013" />

Working in the US in the 1880s, Canadian-born physician [[William Osler]] (1849{{endash}}1919) reviewed dozens of CP cases to further classify the disorders by the site of the problems on the body and by the underlying cause.<!-- <ref name="History2013" /> --> Osler made further observations tying problems around the time of delivery with CP, and concluded that problems causing bleeding inside the brain were likely the root cause.<!-- <ref name="History2013" /> --> Osler also suspected polioencephalitis as an infectious cause.<!-- <ref name="History2013" /> --> Through the 1890s, scientists commonly confused CP with [[Poliomyelitis|polio]].<ref name="History2013" />

Before moving to psychiatry, Austrian neurologist [[Sigmund Freud]] (1856{{endash}}1939) made further refinements to the classification of the disorder. He produced the system still being used today.<!-- <ref name="History2013" /> --> Freud's system divides the causes of the disorder into problems present at birth, problems that develop during birth, and problems after birth.<!-- <ref name="History2013" /> --> Freud also made a rough correlation between the location of the problem inside the brain and the location of the affected limbs on the body and documented the many kinds of movement disorders.<ref name="History2013" />

In the early 20th century, the attention of the medical community generally turned away from CP until orthopedic surgeon Winthrop Phelps became the first physician to treat the disorder.<!-- <ref name="History2013" /> --> He viewed CP from a [[musculoskeletal system|musculoskeletal]] perspective instead of a neurological one.<!-- <ref name="History2013" /> --> Phelps developed surgical techniques for operating on the muscles to address issues such as spasticity and muscle rigidity.<!-- <ref name="History2013" /> --> Hungarian [[physical rehabilitation]] practitioner [[András Pető]] developed a system to teach children with CP how to walk and perform other basic movements.<!-- <ref name="History2013" /> --> Pető's system became the foundation for [[conductive education]], widely used for children with CP today.<!-- <ref name=History2013/ --> Through the remaining decades, physical therapy for CP has evolved, and has become a core component of the CP management program.<ref name="History2013" />

In 1997, Robert Palisano ''et al.'' introduced the [[Gross Motor Function Classification System]] (GMFCS) as an improvement over the previous rough assessment of limitation as either mild, moderate, or severe.<ref name="rethlefsen_2010" /> The GMFCS grades limitation based on observed proficiency in specific basic mobility skills such as sitting, standing, and walking, and takes into account the level of dependency on aids such as wheelchairs or walkers. The GMFCS was further revised and expanded in 2007.<ref name="rethlefsen_2010" />

==Society and culture==

===Economic impact===
It is difficult to directly compare the cost and cost-effectiveness of interventions to prevent cerebral palsy or the cost of interventions to manage CP.<ref name="pmid29319155" /> Access Economics has released a report on the economic impact of cerebral palsy in Australia. The report found that, in 2007, the financial cost of cerebral palsy (CP) in Australia was A$1.47&nbsp;billion or 0.14% of GDP.<ref name="spasticcentre" /> Of this:
* A$1.03 billion (69.9%) was productivity lost due to lower employment, absenteeism, and premature death of Australians with CP
* A$141 million (9.6%) was the DWL from transfers including welfare payments and taxation forgone
* A$131 million (9.0%) was other indirect costs such as direct program services, aides and home modifications, and the bringing-forward of funeral costs
* A$129 million (8.8%) was the value of the informal care for people with CP
* A$40 million (2.8%) was direct health system expenditure

The value of lost well-being (disability and premature death) was a further A$2.4&nbsp;billion.{{citation needed|date=July 2021}}

In per capita terms, this amounts to a financial cost of A$43,431 per person with CP per annum. Including the value of lost well-being, the cost is over $115,000 per person per annum.{{citation needed|date=July 2021}}

Individuals with CP bear 37% of the financial costs, and their families and friends bear a further 6%. The federal government bears around one-third (33%) of the financial costs (mainly through taxation revenues forgone and welfare payments). State governments bear under 1% of the costs, while employers bear 5% and the rest of society bears the remaining 19%. If the burden of disease (lost well-being) is included, individuals bear 76% of the costs.{{citation needed|date=July 2021}}

The average lifetime cost for people with CP in the US is US$921,000 per individual, including lost income.<ref name="pmid14749614" />

In the United States, many states allow [[Medicaid]] beneficiaries to use their Medicaid funds to hire their own PCAs, instead of forcing them to use institutional or managed care.<ref name="medicaid" />

In India, the government-sponsored program called "NIRAMAYA" for the medical care of children with neurological and muscular deformities has proved to be an ameliorating economic measure for persons with such disabilities.<ref>{{cite web|title=NIRAMAYA Ministry of Social Justice and Empowerment (MSJE)|url=http://thenationaltrust.gov.in/content/scheme/niramaya.php|website=thenationaltrust.gov.in|access-date=27 February 2017|archive-url=https://web.archive.org/web/20170227150225/http://thenationaltrust.gov.in/content/scheme/niramaya.php|archive-date=27 February 2017|url-status=dead}}</ref> It has shown that persons with mental or physically debilitating congenital disabilities can lead better lives if they have financial independence.<ref>{{cite news| vauthors = Siva M, Nalinakanthi V |title=The Big Story. Financially able |url=http://www.thehindubusinessline.com/portfolio/financially-able/article7930167.ece|work=The Hindu Business Line|date=29 November 2015}}</ref>

===Use of the term===
"Cerebral" means "of, or pertaining to, the cerebrum or the brain"<ref>{{cite web | url=https://www.medicinenet.com/cerebral/definition.htm | title=Definition of Cerebral |date=2021}}</ref> and "palsy" means "paralysis, generally partial, whereby a local body area is incapable of voluntary movement".<ref>{{cite web | url=https://www.medicinenet.com/facial_nerve_problems/article.htm | title=Bell's Palsy & Other Facial Nerve Problems |date=2020}}</ref>  It has been proposed to change the name to "cerebral palsy spectrum disorder" to reflect the diversity of presentations of CP.<ref>{{cite journal | vauthors = Shevell M | title = Cerebral palsy to cerebral palsy spectrum disorder: Time for a name change? | journal = Neurology | pages = 233–235 | date = December 2018 | volume = 92 | issue = 5 | pmid = 30568002 | doi = 10.1212/WNL.0000000000006747 | s2cid = 58605985 }}</ref>

Many people would rather be referred to as a person with a disability ([[people-first language]]) instead of as "handicapped".<ref name="Guardian20020522" /><ref>{{Cite web |title=Guidelines: How To Write About People with Disabilities (9th edition) |url=https://rtcil.org/guidelines |access-date=2024-04-04 |website=rtcil.org |language=en}}</ref> "Cerebral Palsy: A Guide for Care" at the [[University of Delaware]] offers the following guidelines:

{{blockquote|Impairment is the correct term to use to define a deviation from normal, such as not being able to make a muscle move or not being able to control an unwanted movement. Disability is the term used to define a restriction in the ability to perform a normal activity of daily living which someone of the same age can perform. For example, a three-year-old child who is not able to walk has a disability because a normal three-year-old can walk independently. A handicapped child or adult is one who, because of the disability, is unable to achieve the normal role in society commensurate with his age and socio-cultural milieu. As an example, a sixteen-year-old who is unable to prepare his own meal or care for his own toilet or hygiene needs is handicapped. On the other hand, a sixteen-year-old who can walk only with the assistance of crutches but who attends a regular school and is fully independent in activities of daily living is disabled but not handicapped. All disabled people are impaired, and all handicapped people are disabled, but a person can be impaired and not necessarily be disabled, and a person can be disabled without being handicapped.<ref name="udel" />}}

The term "[[spastic (word)|spastic]]" denotes the attribute of spasticity in types of spastic CP. In 1952 a UK charity called [[The Spastics Society]] was formed.<ref name="Guardian20020522" /> The term "spastics" was used by the charity as a term for people with CP. The word "spastic" has since been used extensively as a general insult to disabled people, which some see as extremely offensive. They are also frequently used to insult non-disabled people when they seem overly uncoordinated, anxious, or unskilled in sports. The charity changed its name to [[Scope (charity)|Scope]] in 1994.<ref name="Guardian20020522" /> In the United States the word spaz has the same usage as an insult but is not generally associated with CP.<ref name="zimmer" />

===Media===
{{See also|Category:Works about cerebral palsy and other paralytic syndromes}}

Maverick documentary filmmaker [[Kazuo Hara]] criticises the mores and customs of Japanese society in an unsentimental portrait of adults with cerebral palsy in his 1972 film ''Goodbye CP'' (Sayonara CP). Focusing on how people with cerebral palsy are generally ignored or disregarded in Japan, Hara challenges his society's taboos about physical handicaps. Using a deliberately harsh style, with grainy black-and-white photography and out-of-sync sound, Hara brings a stark realism to his subject.<ref name="dvdtalk" />

''Spandan'' (2012), a film by Vegitha Reddy and Aman Tripathi, delves into the dilemma of parents whose child has cerebral palsy. While films made with children with special needs as central characters have been attempted before, the predicament of parents dealing with the stigma associated with the condition and beyond is dealt in ''Spandan''. In one of the songs of ''Spandan'' "Chal chaal chaal tu bala" more than 50 CP kids have acted. The famous classical singer [[Devaki Pandit]] has given her voice to the song penned by Prof. Jayant Dhupkar and composed by [[National Film Awards]] winner Isaac Thomas Kottukapally.<ref name="hindu" /><ref name="hindu2" /><ref name="newsleaks" /><ref name="deccan" />

''[[My Left Foot (film)|My Left Foot]]'' (1989) is a drama film directed by [[Jim Sheridan]] and starring [[Daniel Day-Lewis]]. It tells the true story of [[Christy Brown]], an Irishman born with cerebral palsy, who could control only his left foot. Christy Brown grew up in a poor, working-class family, and became a writer and artist. It won the [[Academy Award]] for Best Actor (Daniel Day-Lewis) and Best Actress in a Supporting Role (Brenda Fricker). It was also nominated for Best Director, Best Picture and Best Writing, Screenplay Based on Material from Another Medium. It also won the [[New York Film Critics Circle Award for Best Film]] for 1989.<ref name="latimes" />

''[[Call the Midwife]]'' (2012–) has featured two episodes with actor Colin Young, who himself has cerebral palsy, playing a character with the same disability. His storylines have focused on the segregation of those with disabilities in the UK in the 1950s, and also romantic relationships between people with disabilities.<ref>{{cite web|url=http://blog.scope.org.uk/2014/02/16/being-on-call-the-midwife-gave-me-the-sense-of-being-an-actor-in-my-own-right/ |title=Being on ''Call the Midwife'' gave me the sense of being an actor in my own right|access-date=12 August 2015|url-status=dead|archive-url=https://web.archive.org/web/20150905210353/http://blog.scope.org.uk/2014/02/16/being-on-call-the-midwife-gave-me-the-sense-of-being-an-actor-in-my-own-right/|archive-date=5 September 2015|date=2014-02-16}}</ref>

[[Micah Fowler]], an American actor with CP, stars in the [[American Broadcasting Company|ABC]] sitcom ''[[Speechless (TV series)|Speechless]]'' (2016–2019), which explores both the serious and humorous challenges a family faces with a teenager with CP.<ref>{{cite news|url=https://www.ew.com/article/2016/09/20/speechless-micah-fowler-breakout-star| vauthors = Rovenstine D |title=Micah Fowler is the breakout star of Speechless|publisher=EntertainmentWeekly|date=20 September 2016|access-date=3 October 2016|url-status=live|archive-url=https://web.archive.org/web/20160924061830/http://www.ew.com/article/2016/09/20/speechless-micah-fowler-breakout-star|archive-date=24 September 2016}}</ref>

[[9-1-1 (TV series)|''9-1-1'']] (2018–) is a procedural drama series on [[Fox Broadcasting Company|Fox]]. From season 2 onwards, it features Gavin McHugh (who himself has cerebral palsy) in the recurring role as Christopher Diaz – a young child who has cerebral palsy.

''[[Special (TV series)|Special]]'' (2019) is a [[Television comedy|comedy series]] that premiered on [[Netflix]] on 12 April 2019. It was written, produced and stars [[Ryan O'Connell]] as a young [[gay]] man with mild cerebral palsy. It is based on O'Connell's book ''I'm Special: And Other Lies We Tell Ourselves''.<ref>{{cite news |url=https://www.nbcnews.com/feature/nbc-out/special-groundbreaking-new-netflix-series-stars-gay-man-cerebral-palsy-n994001 |title='Special': Groundbreaking new Netflix series stars gay man with cerebral palsy | vauthors = Kacala A |work=[[NBC News]] |date=12 April 2019 |access-date=22 April 2019}}</ref>

Australian drama serial ''[[The Heights (Australian TV series)|The Heights]]'' (2019–) features a character with mild cerebral palsy, teenage girl Sabine Rosso, depicted by an actor who herself has mild cerebral palsy, Bridie McKim.<ref>{{cite news|url=https://www.smh.com.au/entertainment/tv-and-radio/i-dont-think-ive-ever-seen-a-disabled-character-written-like-that-before-20190212-h1b5d2.html| vauthors = Houston M |title='I don't think I've ever seen a disabled character written like that before'|publisher=Sydney Morning Herald|date=12 February 2019|access-date=17 October 2020|url-status=live|archive-url=https://web.archive.org/web/20201016235219/https://www.smh.com.au/entertainment/tv-and-radio/i-dont-think-ive-ever-seen-a-disabled-character-written-like-that-before-20190212-h1b5d2.html|archive-date=16 October 2020}}</ref>

''6,000 Waiting'' (2021) is a documentary by [[Michael Joseph McDonald]]. It is the first film to depict a person with cerebral palsy parachuting. It tells the story of three men with cerebral palsy seeking to live in their communities instead of institutions.<ref>{{Cite web |title=6,000 Waiting |url=https://reelabilities.org/film/6000-waiting/ |access-date=2023-05-25 |website=ReelAbilities International |language=en-US}}</ref> Upon seeing the film, American politician [[Stacey Abrams]] interviewed one of the film's protagonists and publicly stated that her top priority was deinstitutionalization through Medicaid expansion.<ref>{{Cite web |title=VOICES: Southern legislatures must dismantle poverty traps for disabled people {{!}} Facing South |url=https://www.facingsouth.org/2023/01/southern-legislatures-must-dismantle-poverty-traps-for-disabled-people |access-date=2023-05-25 |website=www.facingsouth.org}}</ref>

===Notable cases===
{{category see also|People with cerebral palsy}}
<!-- To show notability, please ensure the subject has a Wikipedia article to link to. To ensure verifiability a reference is needed. -->
* [[Christy Brown]] was the basis for the Academy Award-winning film, ''[[My Left Foot]]''.
* Two sons of Canadian rock musician [[Neil Young]], Zeke and Ben.<ref>{{Cite web|url=https://www.biography.com/musician/neil-young|title=Neil Young|website=Biography|language=en-us|access-date=17 October 2019}}</ref> In 1986, Young helped found the [[Bridge School (California)|Bridge School]], an educational organization for children with severe verbal and physical disabilities, and its annual supporting [[Bridge School Benefit]] concerts, together with his wife Pegi.<ref>{{Cite magazine|url=https://www.rollingstone.com/music/music-news/neil-young-files-for-divorce-from-pegi-young-wife-of-36-years-62872/|title=Neil Young Files for Divorce From Pegi Young|date=26 August 2014|magazine=Rolling Stone|language=en-US|access-date=17 October 2019}}</ref><ref>{{Cite news|url=https://www.theguardian.com/music/2014/aug/27/neil-young-divorce-pegi|title=Neil Young files for divorce from Pegi, his wife of 36 years| vauthors = Michaels S |date=27 August 2014|work=The Guardian|access-date=17 October 2019|language=en-GB|issn=0261-3077}}</ref>
* [[Nicolas Hamilton]], a British racing driver competing in [[BTCC]]. He is the half-brother of [[Formula 1]] driver [[Lewis Hamilton]].<ref>{{Cite web|url=https://www.nicolashamilton.com/the-driver/|title=The Driver - Nicolas Hamilton|website=nicolashamilton|language=en-GB|access-date=3 June 2020|archive-date=3 June 2020|archive-url=https://web.archive.org/web/20200603155647/https://www.nicolashamilton.com/the-driver/|url-status=dead}}</ref>
[[File:Keynote speaker Geri Jewell.jpg|thumb|right|[[Geri Jewell]] in 2009]]
* [[Geri Jewell]], who had a regular role in the prime-time series ''[[The Facts of Life (TV series)|The Facts of Life]]''.<ref name="gerijewell" />
* [[Josh Blue]], winner of the fourth season of NBC's ''Last Comic Standing'', whose act revolves around his CP.<ref name="joshblue" /> Blue was also on the 2004 U.S. Paralympic soccer team.<ref name="joshblue2" />
* [[Jason Benetti]], play-by-play broadcaster for ESPN, Fox Sports, Westwood One, and Time Warner covering football, baseball, lacrosse, hockey, and basketball. From 2016 until 2023, he was the television play-by-play announcer for Chicago White Sox home games. Since 2024, Benetti has been the play-by-play announcer for the Detroit Tigers.<ref>{{cite web |url=http://www.aolnews.com/2010/11/23/jason-benetti-is-voice-of-hope-in-face-of-cerebral-palsy/|title=Jason Benetti Is Voice of Hope in Face of Cerebral Palsy|archive-url=https://web.archive.org/web/20130317010345/http://www.aolnews.com/2010/11/23/jason-benetti-is-voice-of-hope-in-face-of-cerebral-palsy/ |archive-date=17 March 2013}}</ref>
* [[Jack Carroll (comedian)|Jack Carroll]], British comedian and runner-up in the seventh season of ''[[Britain's Got Talent (series 7)|Britain's Got Talent]]''.<ref name="jackcarroll" />
* [[Abbey Curran]], an American beauty queen who represented Iowa at [[Miss USA 2008]] and was the first contestant with a disability to compete.<ref name="curran" />
* [[Robert Griswold]], swimmer
* [[Francesca Martinez]], British stand-up comedian and actress.<ref name="martinez" />
* [[Evan O'Hanlon]], Australian Paralympian, the fastest athlete with cerebral palsy in the world.<ref name="ohanlon" />
* [[Arun Shourie]]'s son Aditya, about whom he has written a [[Arun Shourie#Publications|book]] ''Does He Know a Mother's Heart''<ref name="shourie" />
* [[Maysoon Zayid]], the self-described "Palestinian Muslim virgin with cerebral palsy, from New Jersey", who is an actress, stand-up comedian, and activist.<ref name="franks" /> Zayid has been a resident of [[Cliffside Park, New Jersey]].<ref name="heydarpour" /> She is considered one of America's first Muslim women comedians and the first person ever to perform standup in Palestine and Jordan.<ref name="imeu" />
[[Image:RJ Mitte by Gage Skidmore.jpg|thumb|upright=0.7|right|[[RJ Mitte]] at the 2018 [[San Diego Comic-Con]]]]
* [[RJ Mitte]], an American actor best known for his role as [[Walter White Jr.]] in ''[[Breaking Bad]]''. He is also a celebrity ambassador for [[United Cerebral Palsy]].<ref>{{cite web|url=http://ucp.org/about/celebrity-ambassadors/|title=Celebrity Ambassadors|access-date=18 June 2015|url-status=dead|archive-url=https://web.archive.org/web/20150609225117/http://ucp.org/about/celebrity-ambassadors/|archive-date=9 June 2015}}</ref>
* [[Zach Anner]], an American comedian, actor, and writer. He had a television series on [[Oprah Winfrey]]'s [[Oprah Winfrey Network (U.S. TV channel)|OWN]] called ''Rollin' With Zach'' and is the author of ''If at Birth You Don't Succeed.''<ref name="anner" />
* Kaine, a member of the American hip-hop duo [[The Ying Yang Twins]], has a mild form of cerebral palsy that causes him to limp.<ref>{{cite news |author=ABS Staff |url=http://atlantablackstar.com/2014/06/04/10-celebrities-physical-deformities-may-never-noticed/5/ |title=10 Celebrities With Physical Deformities You May Have Never Noticed |publisher=Atlanta Black Star |date=4 June 2014 |access-date=8 December 2016 |url-status=dead |archive-url=https://web.archive.org/web/20161221001053/http://atlantablackstar.com/2014/06/04/10-celebrities-physical-deformities-may-never-noticed/5/ |archive-date=21 December 2016 }}</ref>{{unreliable source?|date=December 2016}}
* [[Hannah Cockroft]], is a British [[Wheelchair racing|wheelchair athlete]] specialising in sprint distances in the [[T34 (classification)|T34&nbsp;classification]]. She holds the [[Paralympic Games|Paralympic]] and [[world record]]s for the [[100 metres]], [[200 metres]] and [[400 metres]] in her classification.<ref>{{cite web|title=IPC Athletics Records|url=https://www.paralympic.org/Results/world-records/Athletics|publisher=www.paralympic.org|access-date=10 September 2012|url-status=live|archive-url=https://web.archive.org/web/20120910071204/http://www.paralympic.org/Results/world-records/Athletics|archive-date=10 September 2012}}</ref><ref>{{cite news|title=Paralympics 2012: Cockroft wins first GB track gold|url=https://www.bbc.co.uk/sport/0/disability-sport/19437634|work=BBC Sport|access-date=1 September 2012|date=31 August 2012|url-status=live|archive-url=https://web.archive.org/web/20120901002544/http://www.bbc.co.uk/sport/0/disability-sport/19437634|archive-date=1 September 2012}}</ref><ref>{{cite news|url=https://www.bbc.co.uk/sport/0/disability-sport/19511011|title=Paralympics 2012: Hannah Cockroft wins second sprint gold|work=BBC Sport|access-date=6 September 2012|date=6 September 2012|url-status=live|archive-url=https://web.archive.org/web/20120908173939/http://www.bbc.co.uk/sport/0/disability-sport/19511011|archive-date=8 September 2012}}</ref>
* [[Keah Brown]], American [[disability rights]] activist, author and journalist.<ref>{{Cite web|url=https://www.libraryjournal.com/?detailStory=perspectives-on-disabiity|title=Perspectives on Disability |website=Library Journal|access-date=2020-04-29}}</ref>
* [[Kuli Kohli]], Indian-British writer, poet, activist.<ref>{{Cite news|date=2020-08-29|title='They wanted to drown me at birth - now I'm a poet'|language=en-GB|work=BBC News|url=https://www.bbc.com/news/stories-53749629|access-date=2020-11-04}}</ref>
* [[Simon James Stevens]], a British disability issues consultant and activist, who starred in ''[[I'm Spazticus]]'' and founded [[Wheelies]] virtual nightclub <ref>{{cite web |url=http://www.simonstevens.com |title=Lord of Glencoe Simon Stevens |website=simonstevens.com |access-date=1 July 2021 |url-status=live|archive-url=https://web.archive.org/web/20010519205627/http://www.simonstevens.com:80/ |archive-date=19 May 2001 }}</ref>
* The [[Roman Empire|Roman]] Emperor [[Claudius]] is hypothesized to have had cerebral palsy on the basis of his reported symptoms.<ref>Leon, E.F. (1948). "The Imbecillitas of the Emperor Claudius", ''Transactions and Proceedings of the American Philological Association'', '''79'''  79–86.{{JSTOR|283354}}</ref>
* [[Rosie Jones (comedian)|Rosie Jones]], a British comedian and actress, is incorporating her cerebral palsy into her comedic style.
* [[Christopher Nolan (author)|Christopher Nolan]], an Irish Poet and Author, he wrote Damn-Burst of Dreams, The Banyan Tree, and Under The Eye Of The Clock.  He passed away in 2009.
* [[Lost Voice Guy]] British Comedian

===Litigation===
Because of the perception that cerebral palsy is mostly caused by trauma during birth, as of 2005, 60% of obstetric [[litigation]] was about cerebral palsy, which [[Alastair MacLennan (medicine)|Alastair MacLennan]], Professor of Obstetrics and Gynaecology at the [[University of Adelaide]], regards as causing an exodus from the profession.<ref>{{cite news|title=Cerebral Palsy Litigation|url=http://www.abc.net.au/radionational/programs/healthreport/cerebral-palsy-litigation/3370924#transcript|access-date=21 February 2017|work=[[Radio National]]|date=10 October 2005|url-status=live|archive-url=https://web.archive.org/web/20170222061659/http://www.abc.net.au/radionational/programs/healthreport/cerebral-palsy-litigation/3370924#transcript|archive-date=22 February 2017}}</ref> In the latter half of the 20th century, obstetric litigation about the cause of cerebral palsy became more common, leading to the practice of [[defensive medicine]].<ref name="Sartwelle" />

== See also ==
* [[Cerebral palsy sport classification]] – describes the [[disability sport classification]] for cerebral palsy.
* [[Inclusive recreation]]
* [[World Cerebral Palsy Day]]

==Notes==
{{notelist}}

== References ==
{{reflist|1=30em|refs=
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<ref name="elsobky2017">{{cite journal | vauthors = El-Sobky TA, Fayyad TA, Kotb AM, Kaldas B | title = Bony reconstruction of hip in cerebral palsy children Gross Motor Function Classification System levels III to V: a systematic review | journal = Journal of Pediatric Orthopedics. Part B | volume = 27 | issue = 3 | pages = 221–230 | date = May 2018 | pmid = 28953164 | doi = 10.1097/BPB.0000000000000503 | s2cid = 4204446 }}</ref>
<ref name="argawal&verma2012">{{cite journal | vauthors = Agarwal A, Verma I | title = Cerebral palsy in children: An overview | journal = Journal of Clinical Orthopaedics and Trauma | volume = 3 | issue = 2 | pages = 77–81 | date = December 2012 | pmid = 26403442 | pmc = 3872805 | doi = 10.1016/j.jcot.2012.09.001 }}</ref>
<ref name="Amen2018">{{cite journal | vauthors = Amen J, ElGebeily M, El-Mikkawy DM, Yousry AH, El-Sobky TA |title=Single-event multilevel surgery for crouching cerebral palsy children: Correlations with quality of life and functional mobility |journal=Journal of Musculoskeletal Surgery and Research |date=2018 |volume=2 |issue=4 |pages=148 |doi=10.4103/jmsr.jmsr_48_18|s2cid=81725776 |doi-access=free }}</ref>
<ref name="auto">{{cite journal | vauthors = Sewell MD, Eastwood DM, Wimalasundera N | title = Managing common symptoms of cerebral palsy in children | journal = BMJ | volume = 349 | issue = sep25 7 | pages = g5474 | date = September 2014 | pmid = 25255910 | doi = 10.1136/bmj.g5474 | s2cid = 45300547 }}</ref>
<ref name="Kerkovich, D 2009, pp. 41-53">Kerkovich, D, & Aisen, M 2009, 'Chapter 4: Cerebral Palsy', Medical Management of Adults with Neurologic Disabilities pp. 41–53 n.p.: [[Demos Medical Publishing]], LLC. {{ISBN|9781933864457}}</ref>
<ref name="Mughal2014">{{cite journal | vauthors = Mughal MZ | title = Fractures in children with cerebral palsy | journal = Current Osteoporosis Reports | volume = 12 | issue = 3 | pages = 313–318 | date = September 2014 | pmid = 24964775 | doi = 10.1007/s11914-014-0224-1 | s2cid = 32791951 }}</ref>
<ref name="shore2010">{{cite journal | vauthors = Shore BJ, White N, Kerr Graham H | title = Surgical correction of equinus deformity in children with cerebral palsy: a systematic review | journal = Journal of Children's Orthopaedics | volume = 4 | issue = 4 | pages = 277–290 | date = August 2010 | pmid = 21804889 | pmc = 2908346 | doi = 10.1007/s11832-010-0268-4 }}</ref>
<ref name="Cloake2016">{{cite journal | vauthors = Cloake T, Gardner A | title = The management of scoliosis in children with cerebral palsy: a review | journal = Journal of Spine Surgery | volume = 2 | issue = 4 | pages = 299–309 | date = December 2016 | pmid = 28097247 | pmc = 5233861 | doi = 10.21037/jss.2016.09.05 | doi-access = free }}</ref>
<ref name="oxfordnutritionchapter">{{cite book| vauthors = Meyers RC, Bachrach SJ, Stallings VA | veditors = Ekvall SW, Ekvall VK |title=Pediatric and Adult Nutrition in Chronic Diseases, Developmental Disabilities, and Hereditary Metabolic Disorders: Prevention, Assessment, and Treatment|date=2017|publisher=Oxford Scholarship Online|isbn=978-0-19-939891-1|chapter=Cerebral Palsy| pages = 86–90 |doi=10.1093/acprof:oso/9780199398911.003.0009}}</ref>
<ref name="Myrdenetal2014">{{cite journal | vauthors = Myrden A, Schudlo L, Weyand S, Zeyl T, Chau T | title = Trends in communicative access solutions for children with cerebral palsy | journal = Journal of Child Neurology | volume = 29 | issue = 8 | pages = 1108–1118 | date = August 2014 | pmid = 24820337 | doi = 10.1177/0883073814534320 | s2cid = 28508184 }}</ref>
<ref name="CPBeuk">{{Cite book | vauthors = Beukelman DR, Mirenda P |title=Augmentative and Alternative Communication: Management of severe communication disorders in children and adults |publisher=Paul H Brookes Publishing Co |location=Baltimore |year=1999 |edition=2nd |pages=246–249 |isbn=978-1-55766-333-7 |doi=10.1080/07434619912331278735}}</ref>
<ref name="The epidemiology of cerebral palsy">{{cite journal | vauthors = van Gorp M, Hilberink SR, Noten S, Benner JL, Stam HJ, van der Slot WM, Roebroeck ME | title = Epidemiology of Cerebral Palsy in Adulthood: A Systematic Review and Meta-analysis of the Most Frequently Studied Outcomes | journal = Archives of Physical Medicine and Rehabilitation | volume = 101 | issue = 6 | pages = 1041–1052 | date = June 2020 | pmid = 32059945 | doi = 10.1016/j.apmr.2020.01.009 | hdl-access = free | s2cid = 211122403 | hdl = 1765/126053 | url = https://pure.eur.nl/en/publications/5c073052-1ce9-4d4c-b059-96b920f9e534 }}</ref>
<ref name="nejm915">{{cite journal | vauthors = Nelson KB, Blair E | title = Prenatal Factors in Singletons with Cerebral Palsy Born at or near Term | journal = The New England Journal of Medicine | volume = 373 | issue = 10 | pages = 946–953 | date = September 2015 | pmid = 26332549 | doi = 10.1056/NEJMra1505261 }}<!--|access-date=9 September 2015--></ref>
<ref name="cdccauses">{{Cite news|url=https://www.cdc.gov/ncbddd/cp/causes.html|title=Cerebral Palsy {{!}} NCBDDD {{!}} CDC|work=Cerebral Palsy Home {{!}} NCBDDD {{!}} CDC|access-date=20 April 2017|url-status=live|archive-url=https://web.archive.org/web/20170421093040/https://www.cdc.gov/ncbddd/cp/causes.html|archive-date=21 April 2017}}</ref>
<ref name="research gaps 2016">{{cite journal | vauthors = Lungu C, Hirtz D, Damiano D, Gross P, Mink JW | title = Report of a workshop on research gaps in the treatment of cerebral palsy | journal = Neurology | volume = 87 | issue = 12 | pages = 1293–1298 | date = September 2016 | pmid = 27558377 | pmc = 5035982 | doi = 10.1212/WNL.0000000000003116 | author-link3 = Diane Damiano }}</ref>
<ref name="multidisciplinary455">{{cite journal | vauthors = Trabacca A, Vespino T, Di Liddo A, Russo L | title = Multidisciplinary rehabilitation for patients with cerebral palsy: improving long-term care | journal = Journal of Multidisciplinary Healthcare | volume = 9 | pages = 455–462 | date = September 2016 | pmid = 27703369 | pmc = 5036581 | doi = 10.2147/JMDH.S88782 | doi-access = free }}</ref>
<ref name="Becher">{{cite journal| vauthors = Becher JG |year=2002|title=Pediatric rehabilitation in children with cerebral palsy: general management, classification of motor disorders|url=http://www.oandp.org/jpo/library/2002_04_143.asp|url-status=live|journal= Journal of Prosthetics and Orthotics |volume=14|issue=4|pages=143–149|doi=10.1097/00008526-200212000-00004|s2cid=71684103|url-access=subscription|archive-url=https://web.archive.org/web/20170202051557/http://www.oandp.org/jpo/library/2002_04_143.asp|archive-date=2 February 2017|access-date=29 January 2017|doi-access=free}}</ref>
<ref name=":0:">{{Cite web|url=https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/what-is-cerebral-palsy/types-of-cerebral-palsy/spastic-cerebral-palsy/|title=Spastic cerebral palsy|date=18 November 2015|website=Cerebral Palsy Alliance|access-date=4 March 2020}}</ref>
<ref name="O'Shea">{{cite journal | vauthors = O'Shea TM | title = Diagnosis, treatment, and prevention of cerebral palsy | journal = Clinical Obstetrics and Gynecology | volume = 51 | issue = 4 | pages = 816–828 | date = December 2008 | pmid = 18981805 | pmc = 3051278 | doi = 10.1097/GRF.0b013e3181870ba7 }}</ref>
<ref name="pmid29319155">{{cite journal | vauthors = Shih ST, Tonmukayakul U, Imms C, Reddihough D, Graham HK, Cox L, Carter R | title = Economic evaluation and cost of interventions for cerebral palsy: a systematic review | journal = Developmental Medicine and Child Neurology | volume = 60 | issue = 6 | pages = 543–558 | date = June 2018 | pmid = 29319155 | doi = 10.1111/dmcn.13653 | doi-access = free | hdl = 11343/283488 | hdl-access = free }}</ref>
<ref name="pmid28786098">{{cite journal | vauthors = Shepherd E, Salam RA, Middleton P, Makrides M, McIntyre S, Badawi N, Crowther CA | title = Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 8 | pages = CD012077 | date = August 2017 | pmid = 28786098 | pmc = 6483544 | doi = 10.1002/14651858.CD012077.pub2 | author6-link = Nadia Badawi }}</ref>
<ref name="autogenerated1">{{cite book|author1=National Guideline Alliance (UK)|title=Cerebral Palsy in Under 25s: Assessment and Management|date=January 2017|publisher=[[National Institute for Health and Care Excellence]] (UK)|location=London|isbn=978-1-4731-2272-7|url=https://www.ncbi.nlm.nih.gov/books/NBK419326/pdf/Bookshelf_NBK419326.pdf|access-date=5 February 2017|url-status=live|archive-url=https://web.archive.org/web/20170910181620/https://www.ncbi.nlm.nih.gov/books/NBK419326/pdf/Bookshelf_NBK419326.pdf|archive-date=10 September 2017}}</ref>
<ref name="Zaffuto-Sforza2005">{{cite journal | vauthors = Zaffuto-Sforza CD | title = Aging with cerebral palsy | journal = Physical Medicine and Rehabilitation Clinics of North America | volume = 16 | issue = 1 | pages = 235–249 | date = February 2005 | pmid = 15561553 | doi = 10.1016/j.pmr.2004.06.014 }}</ref>
<ref name="rehabilitation443">{{cite book| vauthors = Kent RM | veditors = Barnes M, Good D |title=Neurological Rehabilitation Handbook of Clinical Neurology.|date=2012|publisher=[[Elsevier Science]]|location=Oxford|isbn=978-0-444-59584-3|pages=443–459|chapter=Cerebral palsy}}</ref>
<ref name="Developmental Medicine 2011">{{cite journal | vauthors = Kembhavi G, Darrah J, Payne K, Plesuk D | title = Adults with a diagnosis of cerebral palsy: a mapping review of long-term outcomes | journal = Developmental Medicine and Child Neurology | volume = 53 | issue = 7 | pages = 610–614 | date = July 2011 | pmid = 21418196 | doi = 10.1111/j.1469-8749.2011.03914.x | s2cid = 36859403 | doi-access = free }}</ref>
<ref name="Sartwelle">{{cite journal | vauthors = Sartwelle TP, Johnston JC | title = Cerebral palsy litigation: change course or abandon ship | journal = Journal of Child Neurology | volume = 30 | issue = 7 | pages = 828–841 | date = June 2015 | pmid = 25183322 | pmc = 4431995 | doi = 10.1177/0883073814543306 }}</ref>
<ref name=Zhao2015>{{Cite journal |last1=Zhao |first1=Meng |last2=Li |first2=Xiao-yan |last3=Xu |first3=Chun-ying |last4=Zou |first4=Li-ping |date=2015 |title=Effcacy and safety of nerve growth factor for the treatment of neurological diseases: a meta-analysis of 64 randomized controlled trials involving 6,297 patients |journal=Neural Regeneration Research |language=en |volume=10 |issue=5 |pages=819–828 |doi=10.4103/1673-5374.156989 |doi-access=free |issn=1673-5374 |pmc=4468778 |pmid=26109961}}</ref>
<ref name=Huiling2019>{{Cite journal |last1=赵会玲 |last2=冯欢欢 |last3=李晓捷 |last4=庞伟 |date=2019-08-20 |title=注射用鼠神经生长因子联合康复训练治疗脑性瘫痪患儿的临床疗效 |trans-title=Therapeutic effect of injectable mouse nerve growth factor combined with rehabilitation training on cerebral palsy in children
 |url=https://rs.yiigle.com/cmaid/1161373 |journal=中华实用儿科临床杂志 |language=zh |volume=34 |issue=16 |pages=1237–1240 |doi=10.3760/cma.j.issn.2095-428X.2019.16.011 |issn=2095-428X}}</ref>
<ref name=Farag2020>{{cite journal | vauthors = Farag SM, Mohammed MO, El-Sobky TA, ElKadery NA, ElZohiery AK | title = Botulinum Toxin A Injection in Treatment of Upper Limb Spasticity in Children with Cerebral Palsy: A Systematic Review of Randomized Controlled Trials | journal = JBJS Reviews | volume = 8 | issue = 3 | pages = e0119 | date = March 2020 | pmid = 32224633 | pmc = 7161716 | doi = 10.2106/JBJS.RVW.19.00119 | doi-access = free }}</ref>
<ref name=Blumetti2019>{{cite journal | vauthors = Blumetti FC, Belloti JC, Tamaoki MJ, Pinto JA | title = Botulinum toxin type A in the treatment of lower limb spasticity in children with cerebral palsy | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 10 | pages = CD001408 | date = October 2019 | pmid = 31591703 | pmc = 6779591 | doi = 10.1002/14651858.CD001408.pub2 }}</ref>
}} 

== External links ==
{{Commons category|Cerebral palsy}}
{{Wiktionary}}
{{Offline|med}}
{{Library resources box
|by=no
|onlinebooks=no
|others=no
|about=yes
|label=Cerebral palsy}}
* {{Curlie|Health/Conditions_and_Diseases/Neurological_Disorders/Cerebral_Palsy/}}
* [https://www.ninds.nih.gov/health-information/disorders/cerebral-palsy Cerebral Palsy Information Page] at [[NINDS]]

{{Medical condition classification and resources
| DiseasesDB     = 2232
| ICD10          = {{ICD10|G|80||g|80}}
| ICD9           = {{ICD9|343}}
| ICDO           =
| OMIM           = 603513
| OMIM_mult      = {{OMIM|605388||none}}
| MedlinePlus    = 000716
| eMedicineSubj  = neuro
| eMedicineTopic = 533
| eMedicine_mult = {{eMedicine2|pmr|24}}
| MeshID         = D002547}}
{{Cerebral palsy}}
{{Authority control}}

{{DEFAULTSORT:Cerebral Palsy}}
[[Category:Cerebral palsy and other paralytic syndromes| ]]
[[Category:Cerebral palsy types| ]]
[[Category:Congenital disorders of nervous system]]
[[Category:Disorders causing seizures]]
[[Category:Neurological disorders in children]]
[[Category:Neurotrauma]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Developmental disabilities]]
[[Category:Communication disorders]]