March 19, 2025 • 22 mins
Cerebral Palsy: What is it, and how does it impact the lives of millions? What are the different types, and what causes this condition? In this episode, we explore the history of cerebral palsy, uncover its wide-ranging symptoms, and explore the specific areas of the brain that are affected. Tune in to learn more!
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Resources:
Rhiannon Clarke: https://www.instagram.com/rhiannonclarke_?igsh=YXh2amlia3F1N2x3
Catarina Guimaraes: https://www.instagram.com/catarinaguimaraes04?igsh=MXZpbzh3MWY5eDd0Mg==
Cerebral Palsy Foundation(US): https://www.yourcpf.org/
Ariana Rye Foundation (US): https://www.arianaryefoundation.com/
Cerebral Palsy Alliance (Aus): https://cerebralpalsy.org.au/
References:
https://www.cerebralpalsyguidance.com/cerebral-palsy/research/history/
https://www.yourcpf.org/blogs/history-origin-cerebral-palsy-sarah-kim/
https://www.cerebralpalsy.org/about-cerebral-palsy/history-and-origin
https://link.springer.com/chapter/10.1007/978-3-319-67858-0_1
https://www.sciencedirect.com/science/article/pii/S0387760412001179
https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999
https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925
https://www.cerebralpalsyguide.com/cerebral-palsy/types/
https://www.ncbi.nlm.nih.gov/books/NBK225769/
https://www.mayoclinic.org/diseases-conditions/premature-birth/symptoms-causes/syc-20376730
https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/diagnosis-treatment/drc-20354005
https://www.paralympic.org.au/imagine/rhiannon-clarke/
https://www.catarinaguimaraes.com/
https://www.teamusa.com/profiles/catarina-guimaraes-1153655
*This podcast is for entertainment purposes only. If you suspect you have a medical condition, please seek out an opinion of a medical professional.*
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
After returning home from your mother's group with your 10 month old daughter Lily
(00:03):
and settling her down for floor time, you noticed that she was dragging one of her legs
while crawling.
This was the first time you had truly observed her crawl and it looked quite different when
compared to the other children.
It struck you then just how much smaller she was than her peers and how she had been hitting
her developmental milestones at a slower pace.
Concerned about these observations, you decided to bring them up with her pediatrician.
(00:40):
Hello and Welcome to Anatomy Of Illness.
Today's episode is about cerebral palsy.
Before we get into the condition, we are going to start with the history.
So why do we know cerebral palsy exists?
We begin with the ancient Egyptians between the years 1196 and 1190 BC.
This is specifically with the rule of the pharaoh Siptah.
He is believed to be the first discovered case of cerebral palsy based on the medical
(01:01):
examination of his body.
This examination found a severely deformed foot.
Various other aspects of his examination, including his whole body, has led people to
claim that Siptah was the oldest physical evidence of cerebral palsy.
Moving from ancient Egypt into ancient Greece where we meet Hippocrates between 400 to 390
BC.
He wrote the text "8-month fetus".
(01:22):
In this he discussed how prematurity, congenital infections, and prenatal stress can cause
brain damage.
He referred to these children as having intrauterine disease and that they had an increased risk
of mortality.
Hippocrates was the first to say that "Women who gave birth to lame, blind children with
any other deficit had fetal distress during the eighth month of pregnancy."
He would also claim that “pregnant women who have fever or lost too much weight without
(01:46):
any obvious cause gave birth to their child with difficulty and dangerously, or they would
abort dangerously.”
Abort in this case meaning miscarry or have a still birth.
Cerebral palsy can be seen in another one of his texts.
In this time they believed in the four humours theory so this is in part suggested as the
cause.
“If the flow be slight and make its descent either into both veins or into one or another,
(02:09):
the child recovers but bears the mark of the disease, a distortion of the mouth, eye, hand
or neck, according to the part from which the minor vein filled with phlegm was mastered
and reduced.”
We are going to jump forward to 1812.
This is when we would have the first publications on brain lesions by Johann Christian Reil.
In 1827 Jean Baptiste Cazauvieilh found cerebral atrophy in those who had congenital paralysis.
(02:34):
He tried to distinguish between lesions in the developing brain and those that had theirs
caused by trauma.
The next year Charles Michel Billard would describe the pathological changes in the infant
brain.
Now we move to Dr William John Little in the year 1853.
He is considered to be the first modern person to study and define cerebral palsy.
(02:54):
Dr Little was an interesting character.
He had a club foot and several childhood illnesses, including polio.
Rather than seeing these as a setback, he decided to research his experiences as part
of a lifelong project to help others in a similar position.
He presented his research on the concept of cerebral palsy to the Obstetrical Society
of London.
He explained in this presentation that children with this condition have an injured nervous
(03:17):
system that in turn resulted in spasticity.
At this time cerebral palsy was known by other names, often being called Little's disease
or cerebral paralysis.
Dr Little would suggest that cerebral palsy could potentially be caused by a lack of oxygen
during a difficult birth.
Not long after this, British neurologist Sir William Gower would expand this by linking
it with paralysis in infants caused by difficult births.
(03:40):
Moving on to 1887, we meet Sir William Osler, a man who is often known as the father of
modern medicine.
He would research cerebral palsy further and write his own book titled The Cerebral Palsies
in Children.
This is where we get the name cerebral palsy from.
This book was a summary of many lectures on the condition that featured numerous case
studies and several suggestions for potential causes.
(04:01):
Now we move to between 1891 to 1897.
This is where Sigmund Freud would come in.
Yes, that Freud.
He wasn't just big in psychology.
He wrote several volumes about cerebral palsy.
He came up with a classification system that is still used today.
Antipartum, which is congenital, intrapartum, which is acquired during birth, and postpartum,
which is acquired after birth.
(04:23):
Freud would argue against the idea of Brissaud that diplegia was caused by developmental
arrest due to prematurity.
Broussard blamed the spine for cerebral palsy based on Charcot's work on ALS, which I
explained in episode 38.
After this, Freud would grow an interest in the field of psychology and move away from
cerebral palsy.
In the 1890s, there was a common confusion among the medical community and, well, everyone
(04:47):
between poliomyelitis and cerebral palsy due to ill-defined symptoms and a lack of complete
understanding of the origins for both.
No, this does not mean that they are the same thing.
They are different conditions.
Now we move to Otfrid Foerster.
In 1908, he created a type of surgical procedure originally called a lumbosacral dorsal rhizotomy.
(05:08):
He performed this surgery in 153 children, which he reported on in 1913.
In this, he found that those children had reduced spasticity in their legs.
This is a basis for one of the surgical procedures still used in cerebral palsy treatment to
this day.
In 1941, Winthrop Phelps would publish a paper titled "The Management of Cerebral Palsy."
(05:30):
He had been interested in cerebral palsy from the 1930s.
However, unlike most in the past, he was more interested in the orthopedic point rather
than the neurological aspects.
He created the basis for the categories we primarily use today, spasticity, athetosis,
rigidity, incoordination, and tremor.
Some of the names have changed a little.
(05:50):
In 1953, Virginia Apgar would create a score that was used as a way to assess newborns.
This would be known as the Apgar score.
What is cerebral palsy?
Cerebral palsy is actually a group of conditions that affect a person's movement and their
posture.
In some cases, it can also affect a person's development and various other skills that
we take for granted, like swallowing, chewing, and talking.
(06:10):
So what causes cerebral palsy?
Cerebral palsy is, at its simplest, caused by damage to a developing brain.
This is often before a child is even born.
It can also be caused by irregular brain development.
Some of the things that can cause this are genetic mutations.
These cause genetic conditions or differences in brain development.
Maternal infections.
Stroke.
(06:31):
This interrupts the blood supply to the developing brain. Bleeding into the brain.
This is another form of stroke known as a hemorrhagic stroke.
This also interrupts the blood supply to the developing brain either in the uterus or after
being born.
Infections in infancy.
If these cause swelling in or around the brain. Traumatic head injuries to infants.
This could be caused by a fall, physical trauma, or from a motor vehicle accident.
(06:54):
Lack of oxygen to the brain due to hard labor or delivery.
However, this is less common than originally believed.
What are the risk factors for cerebral palsy?
There are several kinds of risk factors that can increase the risk of an infant or fetus
developing cerebral palsy.
These include maternal health factors.
If the mother is exposed to various infections or substances during pregnancy, it can increase
the risk of the child developing cerebral palsy.
(07:16):
Some of the risk factors that come under this are, cytomegalovirus.
If during pregnancy, the mother has her first active infection, it can lead to birth defects.
This virus causes flu-like symptoms, so it may be mistaken for the flu or the common
cold.
Rubella.
This is also known as the German measles.
Herpes.
This virus can affect the placenta and uterus during pregnancy.
(07:36):
It is normally passed down from the mother to the child during pregnancy.
Syphilis.
This is a bacterial infection often spread through intercourse.
Toxoplasmosis.
This is a parasite found in infected cat feces, contaminated food, and soil.
This is why you may be advised to get someone else to change the kitty litter.
Zika virus.
This is an infection spread by mosquitoes, which can affect the development of the brain
(07:57):
of an unborn child.
Intrauterine infections.
Having an infection in the placenta, uterus, or fetal membranes.
Exposure to various toxins, like methylmercury.
This is the kind you get from eating a lot of contaminated fish.
There are also a few other conditions to do with the mother that can slightly increase
the risk of developing cerebral palsy.
These include seizures, thyroid issues, and preeclampsia.
(08:18):
If you want to learn more about preeclampsia, we covered it in episode 6.
Infant illness is another subtype of risk factor that increases the risk of developing cerebral
palsy.
Illnesses that can increase the risk of a newborn developing cerebral palsy include
bacterial meningitis.
This is a bacterial infection of the meninges, which are the protective layers surrounding
the brain and spinal cord.
This infection can cause swelling in the brain.
(08:38):
Viral encephalitis.
This is a viral infection that also causes swelling in the membranes that protect and
surround the brain and spinal cord.
Severe or untreated jaundice.
Jaundice is a yellowing of the skin and eyes.
This condition is caused by the by-products of old blood cells, specifically bilirubin.
This is when they are not filtered out of the bloodstream. Bleeding into the brain,
(08:58):
also known as a hemorrhagic stroke.
This can occur in the uterus or in early infancy.
Cerebral palsy also has risk factors relating to birth, however, these contribute less.
These risk factors are low birth weight.
Invent who weigh less than 2.5 kilograms or 5.5 pounds are considered to be at a higher
risk for cerebral palsy.
The risk of this increases with even lower birth weights.
(09:20):
Multiple babies.
The more infants occupying a uterus at the same time, the higher the risk for cerebral
palsy.
This also increases the risk for premature birth and low birth weight, thus further increasing
the risk of cerebral palsy.
This risk also increases if one or more of the babies die.
Premature birth.
Babies who are born prematurely are at an increased risk of cerebral palsy.
(09:41):
Premature babies are any babies that are born before the 37th week of gestation.
This risk increases the earlier the baby is born.
Delivery complications.
Difficulties during labor and delivery can increase the risk of cerebral palsy.
What are the types of cerebral palsy?
There are several kinds of cerebral palsy.
These include spastic cerebral palsy.
This is also known as hypotonic cerebral palsy or pyramidal cerebral palsy.
(10:03):
This is caused by damage to the muscle cortex (motor cortex) in the brain, so the symptoms will primarily
be from the motor region.
Examples of these being awkward reflexes, contractures, which are shortened areas of
muscles due to tightness, stiff muscles in one or more parts of the body, and difficulty
with walking and crawling.
The next kind is dyskinetic cerebral palsy, also known as athetoid cerebral palsy.
(10:24):
This type of cerebral palsy primarily affects the basal ganglia and/or the cerebellum.
Your basal ganglia is all about eye movement and voluntary motor function.
The cerebellum's purpose is controlling balance and coordination.
This form of cerebral palsy often causes feeding issues, limb floppiness, problems with posture,
and a stiff or rigid body.
Ataxic cerebral palsy.
(10:44):
This type of cerebral palsy is caused by damage to the cerebellum.
People with this form often experience ataxia, which is issues with voluntary movement, balance,
and coordination.
Some of the symptoms often seen with this kind of cerebral palsy include poor coordination,
spreading feet apart whilst walking, shakiness and tremors, speech difficulties, and issues
with depth perception.
(11:05):
Hypotonic cerebral palsy, also known as atonic cerebral palsy.
This is another type where the cerebellum is affected.
It causes instability and floppiness in the muscles.
Due to this, children with this type can often miss developmental milestones like walking,
standing, and crawling.
Some of the common symptoms experienced with this form include flexible joints and ligaments,
lack of head control, loose muscles, poor balance, and stability.
(11:27):
There is also mixed-type cerebral palsy.
This is where someone has damage in more than one area of the brain causing their cerebral
palsy symptoms.
The symptoms and type will depend on the specific person, however, the most common kind of mixed
cerebral palsy is spastic dyskinetic cerebral palsy.
Where does cerebral palsy affect?
This will depend on the specific case of cerebral palsy as it can affect any and all limbs.
(11:48):
There are terms we use to classify what area or limbs are being affected.
Speaking of limbs, if you want to wear clothes on those limbs of yours, you should check
out merchanatomy.com.
But anyway, back to the episode.
There are several different classifications surrounding which limbs are affected.
These include, Monoplegia.
This term means only one arm or leg is showing symptoms of a movement disorder.
This is rare.
(12:09):
Diplegia.
This term means two limbs are affected.
Most commonly meaning two legs.
In some cases, some people with diplegia will also have mild upper body movement issues.
Hemiplegia.
This occurs when one side is affected.
The left or the right side.
In these cases, the arm is generally more affected than the leg.
In some cases, this may be evident through a rigidly flexed wrist or elbow.
(12:30):
Triplegia.
This is where three out of the four limbs are affected.
This may be when someone has both legs and one arm affected.
Quadriplegia.
This is when all four limbs are affected.
In this form, generally the legs are more severely affected than the arms.
The muscle tone in the trunk can also be affected and there may also be limited control over
the facial muscles.
This may lead to difficulty with talking, eating and swallowing.
(12:51):
Double Hemiplegia.
All the limbs are affected, however, one side is more affected than the other.
By combining these terms with the types of cerebral palsy, we are better able to classify
the condition.
If you have been enjoying this episode and think someone else might find it useful, then
you should share it with them.
How do we test for cerebral palsy?
Well, when it comes to cerebral palsy, these symptoms often do not show until the first
few months or a year after birth.
(13:13):
In some milder cases, it can even take longer to be diagnosed.
To test for cerebral palsy, brain imaging tests can be done to reveal what areas of
the brain are affected.
This can be done through an MRI or a cranial ultrasound, which is an ultrasound on the
brain.
Depending on the symptoms, your child may have other tests.
An example of this is an electroencephalogram.
This measures the electrical activity in the brain and is done if the child is having seizures.
(13:36):
We will get right into symptoms and presentation right after this little break.
If you have been enjoying this episode, then don't forget to check us out on BuyMeACoffee.
What symptoms might your child have if they had cerebral palsy?
(13:58):
The symptoms of cerebral palsy can be broken down into several subgroups.
These subgroups and their symptoms include movement and coordination.
Some symptoms that may be included in movement and coordination are stiff muscles and exaggerated
reflexes.
This is what is known as spasticity.
This is what people mostly associate with cerebral palsy.
Variation in muscle tone, so they can either be very stiff or very floppy.
(14:19):
Stiff muscles with regular reflexes, this is known as rigidity.
Ataxia, this is a lack of balance and coordination.
Tremors, these are a jerky movement that are not able to be controlled. Slow writhing movements.
Favouring one side of the body.
You may see this as only reaching for things with one hand or in small children dragging
one of their legs whilst crawling.
(14:41):
Trouble walking.
People with cerebral palsy may have several changes to their walk in comparison to others.
These can include toe walking, crouching down when they walk or walking with a scissor-like
walk, which essentially means their knees cross when they take a step.
They may also have a wide gate or an unsteady walk.
They may also have trouble with various fine motor skills like buttoning a shirt or picking
(15:02):
up utensils.
Cerebral palsy can also affect speech and eating.
Symptoms that are affected in speech and eating include delays in speech development, having
trouble with speaking, trouble with sucking, chewing or eating, having trouble with swallowing
or drooling.
Cerebral palsy can also affect development.
Some of the symptoms related to development include delays in reaching motor skill milestones,
(15:22):
such as sitting up or crawling, having learning disabilities or intellectual disabilities
and delayed growth.
They may be smaller in stature than expected.
Cerebral palsy can also cause a variety of other symptoms.
These include seizures.
Some children with cerebral palsy do go on to get diagnosed with epilepsy.
If you want to learn more about epilepsy, we go through it in episode 19.
Cerebral palsy can also cause difficulty hearing, issues with vision as well as changes in the
(15:46):
eye movements, pain or trouble feeling, various sensations like touch, bladder and bowel issues.
This includes urinary incontinence and constipation.
There are multiple kinds of cerebral palsy, so each person will present differently as
the types of cerebral palsy governs how they are affected.
Just because you have two people with the condition does not mean they will present
the same.
What are some complications a doctor should be aware of when it comes to cerebral palsy?
(16:10):
Some complications a doctor should be aware of are contractures.
These are shortenings in the muscle tissue due to muscle tightness.
This can be caused by spasticity.
This in turn can cause a variety of issues, including slowed bone growth, bones bending,
changes in the joint, dislocations or partial dislocations.
These issues can include a variety of things like dislocated hips, curved spines and other
(16:31):
bone changes.
Osteoarthritis.
This is caused by the pressure on the joints or from misalignments from spasticity.
It is a common form of arthritis where the cushioning tissues in the joints wear down
causing pain and swelling.
Osteoporosis.
This is where there is a decrease in bone density, causing the bones to become weak
and brittle.
This leads to an increased risk of fractures.
(16:52):
Malnutrition.
Due to the issues surrounding swallowing and eating, some infants with cerebral palsy may
have issues with nutrition.
Some older children and adults may also have trouble and may require feeding tubes to help
with nutrition.
Malnutrition impairs growth and can lead to weakened bones.
Heart and Lung Diseases.
People with cerebral palsy may develop respiratory conditions, heart disease and lung disease.
(17:12):
Due to the difficulties with swallowing, in some people there is an increased risk for
aspiration pneumonia.
This happens when someone inhales their food, drink, saliva or even vomit into their lungs.
However each case will be different so some people will be high risk for this whereas
others will not be.
How do we treat cerebral palsy?
Well it will depend on the specific person as managing cerebral palsy will be different
in every individual.
(17:33):
One of the ways that cerebral palsy can be managed is through medications.
Some of the kinds of medications that are used in the management of cerebral palsy are
Muscle or nerve injections.
This is done to treat the tightening of specific muscles.
Things like Botox or other similar medications may be used to help with this.
Muscle Relaxants.
These are normally oral so taken by mouth and are used to relax muscles.
(17:53):
A few examples are baclofen and diazepam.
Therapies can also be done to help with some of the symptoms of cerebral palsy.
These therapies include
Physical Therapy.
A physical therapist can provide muscle training and exercises.
These can help with the strength, flexibility, balance, motor development and mobility.
Some physical therapists can also help with your child's at home needs like bathing
and feeding, helping provide safer instructions on how to do this better.
(18:17):
Occupational Therapy.
These kinds of therapists can help your child to gain independence in their daily activities.
They can also help with adaptive equipment.
Speech and Language Therapy.
Speech language pathologists can help to improve the ability to communicate and speak more
clearly.
They can also help with communication and other methods like sign language or various
communication devices like language boards or tablets with specific language apps included.
(18:40):
In some cases, surgery may be used as a way to help manage cerebral palsy symptoms.
Some of the surgeries that may be done include
Selective Dorsal Rhizotomy.
This is done in those who are having a hard time walking and are also in pain.
This is done if other treatments haven't worked.
This procedure cuts the nerves that are serving specific muscles.
I mentioned the originating procedure back in the history.
Orthopedic Surgeries.
(19:00):
This can be done to help with contractures.
Surgery may also be done to help with bones and joints that are not in the correct position.
These are only some of the management strategies as depending on the case, various other tools
and surgeries may be utilised to help with the management of cerebral palsy.
Are there any famous people with cerebral palsy?
There are several styles with cerebral palsy.
One of them being Rosie Jones.
(19:20):
She is a British comedian with ataxic cerebral palsy.
She has appeared in numerous shows, including Taskmaster and an episode of Call the Midwife.
She has also had her own shows, including a travel show, Trip Hazard.
Rosie uses comedy as a way to raise awareness about her disability and other important issues.
For any of you who are fans of the Paralympics, especially the Australian team, there is Rhiannon
(19:41):
Clarke.
She is a T-38 athlete with mild spastic diplegia who often breaks Australian records and has
won several medals in her track and field events.
Rhiannon is all about being proud of who you are and paving the way for others in the Paralympic
space.
I have linked her Instagram if you want to check out some of her incredible skill.
There is also the American Paralympic athlete, Catarina Guimaraes.
(20:02):
She is a track and field star.
She is also very talented at soccer/football and many other sports.
Like seriously, there's a massive list.
I am talented at none of those, probably should cut that out.
She is an advocate for disability sports and even an author.
Halfway through writing her fantasy series, the Death Garden series.
Catarina is an incredibly successful person and an elite athlete who shows a lot of behind
(20:24):
the scenes in her Instagram page, which I will also link.
If you would like to check out a book, there is My Left Foot by Christy Brown.
This book is a memoir written by Brown who was born with cerebral palsy and eventually
gained the ability to use his left foot to paint and write.
This book was turned into a movie in 1989.
If you want to check out a foundation for those in the US, there is the Cerebral Palsy
(20:45):
Foundation.
Their focus is research in cerebral palsy, they focus on interventions and accessibility,
as well as in the future, potential preventions for cerebral palsy development.
There is also the Ariana Rye Foundation.
They are a foundation that helps families that have children with disabilities to get
the medical equipment they need.
This was after their personal experience with their own daughter, Ariana Rye, who had cerebral
(21:05):
palsy.
This foundation is partially funded by their own microbrewery, Nevada Brew Works.
So if you are ever in Las Vegas and feel like a nice beer, you should go crack a cold one
for a good cause.
Plus, their food looks really good.
And there is for those in Australia, the Cerebral Palsy Alliance.
They provide services and strategies for those diagnosed with cerebral palsy and they also
assist with research into cerebral palsy and help with technology to improve quality of
(21:29):
life.
If you want to check out the sources, social media links or any other links, you can head
to anatomyofillness.com.
If you enjoyed this episode and would like to hear more, subscribe to be notified about
our latest episodes.
If you would like to join our community, then you can join us over on Discord or Instagram.
If you want to see more great content, then check out our YouTube page.
Otherwise, stick around for the next episode.
(21:59):
What happens when your brain sees a friend across the street?
It gives a brainwave.
After returning home from your mother's group with your 10 month old daughter Lily
(00:03):
and settling her down for floor time, you noticed that she was dragging one of her legs
while crawling.
This was the first time you had truly observed her crawl and it looked quite different when
compared to the other children.
It struck you then just how much smaller she was than her peers and how she had been hitting
her developmental milestones at a slower pace.
Concerned about these observations, you decided to bring them up with her pediatrician.
(00:40):
Hello and Welcome to Anatomy Of Illness.
Today's episode is about cerebral palsy.
Before we get into the condition, we are going to start with the history.
So why do we know cerebral palsy exists?
We begin with the ancient Egyptians between the years 1196 and 1190 BC.
This is specifically with the rule of the pharaoh Siptah.
He is believed to be the first discovered case of cerebral palsy based on the medical
(01:01):
examination of his body.
This examination found a severely deformed foot.
Various other aspects of his examination, including his whole body, has led people to
claim that Siptah was the oldest physical evidence of cerebral palsy.
Moving from ancient Egypt into ancient Greece where we meet Hippocrates between 400 to 390
BC.
He wrote the text "8-month fetus".
(01:22):
In this he discussed how prematurity, congenital infections, and prenatal stress can cause
brain damage.
He referred to these children as having intrauterine disease and that they had an increased risk
of mortality.
Hippocrates was the first to say that "Women who gave birth to lame, blind children with
any other deficit had fetal distress during the eighth month of pregnancy."
He would also claim that “pregnant women who have fever or lost too much weight without
(01:46):
any obvious cause gave birth to their child with difficulty and dangerously, or they would
abort dangerously.”
Abort in this case meaning miscarry or have a still birth.
Cerebral palsy can be seen in another one of his texts.
In this time they believed in the four humours theory so this is in part suggested as the
cause.
“If the flow be slight and make its descent either into both veins or into one or another,
(02:09):
the child recovers but bears the mark of the disease, a distortion of the mouth, eye, hand
or neck, according to the part from which the minor vein filled with phlegm was mastered
and reduced.”
We are going to jump forward to 1812.
This is when we would have the first publications on brain lesions by Johann Christian Reil.
In 1827 Jean Baptiste Cazauvieilh found cerebral atrophy in those who had congenital paralysis.
(02:34):
He tried to distinguish between lesions in the developing brain and those that had theirs
caused by trauma.
The next year Charles Michel Billard would describe the pathological changes in the infant
brain.
Now we move to Dr William John Little in the year 1853.
He is considered to be the first modern person to study and define cerebral palsy.
(02:54):
Dr Little was an interesting character.
He had a club foot and several childhood illnesses, including polio.
Rather than seeing these as a setback, he decided to research his experiences as part
of a lifelong project to help others in a similar position.
He presented his research on the concept of cerebral palsy to the Obstetrical Society
of London.
He explained in this presentation that children with this condition have an injured nervous
(03:17):
system that in turn resulted in spasticity.
At this time cerebral palsy was known by other names, often being called Little's disease
or cerebral paralysis.
Dr Little would suggest that cerebral palsy could potentially be caused by a lack of oxygen
during a difficult birth.
Not long after this, British neurologist Sir William Gower would expand this by linking
it with paralysis in infants caused by difficult births.
(03:40):
Moving on to 1887, we meet Sir William Osler, a man who is often known as the father of
modern medicine.
He would research cerebral palsy further and write his own book titled The Cerebral Palsies
in Children.
This is where we get the name cerebral palsy from.
This book was a summary of many lectures on the condition that featured numerous case
studies and several suggestions for potential causes.
(04:01):
Now we move to between 1891 to 1897.
This is where Sigmund Freud would come in.
Yes, that Freud.
He wasn't just big in psychology.
He wrote several volumes about cerebral palsy.
He came up with a classification system that is still used today.
Antipartum, which is congenital, intrapartum, which is acquired during birth, and postpartum,
which is acquired after birth.
(04:23):
Freud would argue against the idea of Brissaud that diplegia was caused by developmental
arrest due to prematurity.
Broussard blamed the spine for cerebral palsy based on Charcot's work on ALS, which I
explained in episode 38.
After this, Freud would grow an interest in the field of psychology and move away from
cerebral palsy.
In the 1890s, there was a common confusion among the medical community and, well, everyone
(04:47):
between poliomyelitis and cerebral palsy due to ill-defined symptoms and a lack of complete
understanding of the origins for both.
No, this does not mean that they are the same thing.
They are different conditions.
Now we move to Otfrid Foerster.
In 1908, he created a type of surgical procedure originally called a lumbosacral dorsal rhizotomy.
(05:08):
He performed this surgery in 153 children, which he reported on in 1913.
In this, he found that those children had reduced spasticity in their legs.
This is a basis for one of the surgical procedures still used in cerebral palsy treatment to
this day.
In 1941, Winthrop Phelps would publish a paper titled "The Management of Cerebral Palsy."
(05:30):
He had been interested in cerebral palsy from the 1930s.
However, unlike most in the past, he was more interested in the orthopedic point rather
than the neurological aspects.
He created the basis for the categories we primarily use today, spasticity, athetosis,
rigidity, incoordination, and tremor.
Some of the names have changed a little.
(05:50):
In 1953, Virginia Apgar would create a score that was used as a way to assess newborns.
This would be known as the Apgar score.
What is cerebral palsy?
Cerebral palsy is actually a group of conditions that affect a person's movement and their
posture.
In some cases, it can also affect a person's development and various other skills that
we take for granted, like swallowing, chewing, and talking.
(06:10):
So what causes cerebral palsy?
Cerebral palsy is, at its simplest, caused by damage to a developing brain.
This is often before a child is even born.
It can also be caused by irregular brain development.
Some of the things that can cause this are genetic mutations.
These cause genetic conditions or differences in brain development.
Maternal infections.
Stroke.
(06:31):
This interrupts the blood supply to the developing brain. Bleeding into the brain.
This is another form of stroke known as a hemorrhagic stroke.
This also interrupts the blood supply to the developing brain either in the uterus or after
being born.
Infections in infancy.
If these cause swelling in or around the brain. Traumatic head injuries to infants.
This could be caused by a fall, physical trauma, or from a motor vehicle accident.
(06:54):
Lack of oxygen to the brain due to hard labor or delivery.
However, this is less common than originally believed.
What are the risk factors for cerebral palsy?
There are several kinds of risk factors that can increase the risk of an infant or fetus
developing cerebral palsy.
These include maternal health factors.
If the mother is exposed to various infections or substances during pregnancy, it can increase
the risk of the child developing cerebral palsy.
(07:16):
Some of the risk factors that come under this are, cytomegalovirus.
If during pregnancy, the mother has her first active infection, it can lead to birth defects.
This virus causes flu-like symptoms, so it may be mistaken for the flu or the common
cold.
Rubella.
This is also known as the German measles.
Herpes.
This virus can affect the placenta and uterus during pregnancy.
(07:36):
It is normally passed down from the mother to the child during pregnancy.
Syphilis.
This is a bacterial infection often spread through intercourse.
Toxoplasmosis.
This is a parasite found in infected cat feces, contaminated food, and soil.
This is why you may be advised to get someone else to change the kitty litter.
Zika virus.
This is an infection spread by mosquitoes, which can affect the development of the brain
(07:57):
of an unborn child.
Intrauterine infections.
Having an infection in the placenta, uterus, or fetal membranes.
Exposure to various toxins, like methylmercury.
This is the kind you get from eating a lot of contaminated fish.
There are also a few other conditions to do with the mother that can slightly increase
the risk of developing cerebral palsy.
These include seizures, thyroid issues, and preeclampsia.
(08:18):
If you want to learn more about preeclampsia, we covered it in episode 6.
Infant illness is another subtype of risk factor that increases the risk of developing cerebral
palsy.
Illnesses that can increase the risk of a newborn developing cerebral palsy include
bacterial meningitis.
This is a bacterial infection of the meninges, which are the protective layers surrounding
the brain and spinal cord.
This infection can cause swelling in the brain.
(08:38):
Viral encephalitis.
This is a viral infection that also causes swelling in the membranes that protect and
surround the brain and spinal cord.
Severe or untreated jaundice.
Jaundice is a yellowing of the skin and eyes.
This condition is caused by the by-products of old blood cells, specifically bilirubin.
This is when they are not filtered out of the bloodstream. Bleeding into the brain,
(08:58):
also known as a hemorrhagic stroke.
This can occur in the uterus or in early infancy.
Cerebral palsy also has risk factors relating to birth, however, these contribute less.
These risk factors are low birth weight.
Invent who weigh less than 2.5 kilograms or 5.5 pounds are considered to be at a higher
risk for cerebral palsy.
The risk of this increases with even lower birth weights.
(09:20):
Multiple babies.
The more infants occupying a uterus at the same time, the higher the risk for cerebral
palsy.
This also increases the risk for premature birth and low birth weight, thus further increasing
the risk of cerebral palsy.
This risk also increases if one or more of the babies die.
Premature birth.
Babies who are born prematurely are at an increased risk of cerebral palsy.
(09:41):
Premature babies are any babies that are born before the 37th week of gestation.
This risk increases the earlier the baby is born.
Delivery complications.
Difficulties during labor and delivery can increase the risk of cerebral palsy.
What are the types of cerebral palsy?
There are several kinds of cerebral palsy.
These include spastic cerebral palsy.
This is also known as hypotonic cerebral palsy or pyramidal cerebral palsy.
(10:03):
This is caused by damage to the muscle cortex (motor cortex) in the brain, so the symptoms will primarily
be from the motor region.
Examples of these being awkward reflexes, contractures, which are shortened areas of
muscles due to tightness, stiff muscles in one or more parts of the body, and difficulty
with walking and crawling.
The next kind is dyskinetic cerebral palsy, also known as athetoid cerebral palsy.
(10:24):
This type of cerebral palsy primarily affects the basal ganglia and/or the cerebellum.
Your basal ganglia is all about eye movement and voluntary motor function.
The cerebellum's purpose is controlling balance and coordination.
This form of cerebral palsy often causes feeding issues, limb floppiness, problems with posture,
and a stiff or rigid body.
Ataxic cerebral palsy.
(10:44):
This type of cerebral palsy is caused by damage to the cerebellum.
People with this form often experience ataxia, which is issues with voluntary movement, balance,
and coordination.
Some of the symptoms often seen with this kind of cerebral palsy include poor coordination,
spreading feet apart whilst walking, shakiness and tremors, speech difficulties, and issues
with depth perception.
(11:05):
Hypotonic cerebral palsy, also known as atonic cerebral palsy.
This is another type where the cerebellum is affected.
It causes instability and floppiness in the muscles.
Due to this, children with this type can often miss developmental milestones like walking,
standing, and crawling.
Some of the common symptoms experienced with this form include flexible joints and ligaments,
lack of head control, loose muscles, poor balance, and stability.
(11:27):
There is also mixed-type cerebral palsy.
This is where someone has damage in more than one area of the brain causing their cerebral
palsy symptoms.
The symptoms and type will depend on the specific person, however, the most common kind of mixed
cerebral palsy is spastic dyskinetic cerebral palsy.
Where does cerebral palsy affect?
This will depend on the specific case of cerebral palsy as it can affect any and all limbs.
(11:48):
There are terms we use to classify what area or limbs are being affected.
Speaking of limbs, if you want to wear clothes on those limbs of yours, you should check
out merchanatomy.com.
But anyway, back to the episode.
There are several different classifications surrounding which limbs are affected.
These include, Monoplegia.
This term means only one arm or leg is showing symptoms of a movement disorder.
This is rare.
(12:09):
Diplegia.
This term means two limbs are affected.
Most commonly meaning two legs.
In some cases, some people with diplegia will also have mild upper body movement issues.
Hemiplegia.
This occurs when one side is affected.
The left or the right side.
In these cases, the arm is generally more affected than the leg.
In some cases, this may be evident through a rigidly flexed wrist or elbow.
(12:30):
Triplegia.
This is where three out of the four limbs are affected.
This may be when someone has both legs and one arm affected.
Quadriplegia.
This is when all four limbs are affected.
In this form, generally the legs are more severely affected than the arms.
The muscle tone in the trunk can also be affected and there may also be limited control over
the facial muscles.
This may lead to difficulty with talking, eating and swallowing.
(12:51):
Double Hemiplegia.
All the limbs are affected, however, one side is more affected than the other.
By combining these terms with the types of cerebral palsy, we are better able to classify
the condition.
If you have been enjoying this episode and think someone else might find it useful, then
you should share it with them.
How do we test for cerebral palsy?
Well, when it comes to cerebral palsy, these symptoms often do not show until the first
few months or a year after birth.
(13:13):
In some milder cases, it can even take longer to be diagnosed.
To test for cerebral palsy, brain imaging tests can be done to reveal what areas of
the brain are affected.
This can be done through an MRI or a cranial ultrasound, which is an ultrasound on the
brain.
Depending on the symptoms, your child may have other tests.
An example of this is an electroencephalogram.
This measures the electrical activity in the brain and is done if the child is having seizures.
(13:36):
We will get right into symptoms and presentation right after this little break.
If you have been enjoying this episode, then don't forget to check us out on BuyMeACoffee.
What symptoms might your child have if they had cerebral palsy?
(13:58):
The symptoms of cerebral palsy can be broken down into several subgroups.
These subgroups and their symptoms include movement and coordination.
Some symptoms that may be included in movement and coordination are stiff muscles and exaggerated
reflexes.
This is what is known as spasticity.
This is what people mostly associate with cerebral palsy.
Variation in muscle tone, so they can either be very stiff or very floppy.
(14:19):
Stiff muscles with regular reflexes, this is known as rigidity.
Ataxia, this is a lack of balance and coordination.
Tremors, these are a jerky movement that are not able to be controlled. Slow writhing movements.
Favouring one side of the body.
You may see this as only reaching for things with one hand or in small children dragging
one of their legs whilst crawling.
(14:41):
Trouble walking.
People with cerebral palsy may have several changes to their walk in comparison to others.
These can include toe walking, crouching down when they walk or walking with a scissor-like
walk, which essentially means their knees cross when they take a step.
They may also have a wide gate or an unsteady walk.
They may also have trouble with various fine motor skills like buttoning a shirt or picking
(15:02):
up utensils.
Cerebral palsy can also affect speech and eating.
Symptoms that are affected in speech and eating include delays in speech development, having
trouble with speaking, trouble with sucking, chewing or eating, having trouble with swallowing
or drooling.
Cerebral palsy can also affect development.
Some of the symptoms related to development include delays in reaching motor skill milestones,
(15:22):
such as sitting up or crawling, having learning disabilities or intellectual disabilities
and delayed growth.
They may be smaller in stature than expected.
Cerebral palsy can also cause a variety of other symptoms.
These include seizures.
Some children with cerebral palsy do go on to get diagnosed with epilepsy.
If you want to learn more about epilepsy, we go through it in episode 19.
Cerebral palsy can also cause difficulty hearing, issues with vision as well as changes in the
(15:46):
eye movements, pain or trouble feeling, various sensations like touch, bladder and bowel issues.
This includes urinary incontinence and constipation.
There are multiple kinds of cerebral palsy, so each person will present differently as
the types of cerebral palsy governs how they are affected.
Just because you have two people with the condition does not mean they will present
the same.
What are some complications a doctor should be aware of when it comes to cerebral palsy?
(16:10):
Some complications a doctor should be aware of are contractures.
These are shortenings in the muscle tissue due to muscle tightness.
This can be caused by spasticity.
This in turn can cause a variety of issues, including slowed bone growth, bones bending,
changes in the joint, dislocations or partial dislocations.
These issues can include a variety of things like dislocated hips, curved spines and other
(16:31):
bone changes.
Osteoarthritis.
This is caused by the pressure on the joints or from misalignments from spasticity.
It is a common form of arthritis where the cushioning tissues in the joints wear down
causing pain and swelling.
Osteoporosis.
This is where there is a decrease in bone density, causing the bones to become weak
and brittle.
This leads to an increased risk of fractures.
(16:52):
Malnutrition.
Due to the issues surrounding swallowing and eating, some infants with cerebral palsy may
have issues with nutrition.
Some older children and adults may also have trouble and may require feeding tubes to help
with nutrition.
Malnutrition impairs growth and can lead to weakened bones.
Heart and Lung Diseases.
People with cerebral palsy may develop respiratory conditions, heart disease and lung disease.
(17:12):
Due to the difficulties with swallowing, in some people there is an increased risk for
aspiration pneumonia.
This happens when someone inhales their food, drink, saliva or even vomit into their lungs.
However each case will be different so some people will be high risk for this whereas
others will not be.
How do we treat cerebral palsy?
Well it will depend on the specific person as managing cerebral palsy will be different
in every individual.
(17:33):
One of the ways that cerebral palsy can be managed is through medications.
Some of the kinds of medications that are used in the management of cerebral palsy are
Muscle or nerve injections.
This is done to treat the tightening of specific muscles.
Things like Botox or other similar medications may be used to help with this.
Muscle Relaxants.
These are normally oral so taken by mouth and are used to relax muscles.
(17:53):
A few examples are baclofen and diazepam.
Therapies can also be done to help with some of the symptoms of cerebral palsy.
These therapies include
Physical Therapy.
A physical therapist can provide muscle training and exercises.
These can help with the strength, flexibility, balance, motor development and mobility.
Some physical therapists can also help with your child's at home needs like bathing
and feeding, helping provide safer instructions on how to do this better.
(18:17):
Occupational Therapy.
These kinds of therapists can help your child to gain independence in their daily activities.
They can also help with adaptive equipment.
Speech and Language Therapy.
Speech language pathologists can help to improve the ability to communicate and speak more
clearly.
They can also help with communication and other methods like sign language or various
communication devices like language boards or tablets with specific language apps included.
(18:40):
In some cases, surgery may be used as a way to help manage cerebral palsy symptoms.
Some of the surgeries that may be done include
Selective Dorsal Rhizotomy.
This is done in those who are having a hard time walking and are also in pain.
This is done if other treatments haven't worked.
This procedure cuts the nerves that are serving specific muscles.
I mentioned the originating procedure back in the history.
Orthopedic Surgeries.
(19:00):
This can be done to help with contractures.
Surgery may also be done to help with bones and joints that are not in the correct position.
These are only some of the management strategies as depending on the case, various other tools
and surgeries may be utilised to help with the management of cerebral palsy.
Are there any famous people with cerebral palsy?
There are several styles with cerebral palsy.
One of them being Rosie Jones.
(19:20):
She is a British comedian with ataxic cerebral palsy.
She has appeared in numerous shows, including Taskmaster and an episode of Call the Midwife.
She has also had her own shows, including a travel show, Trip Hazard.
Rosie uses comedy as a way to raise awareness about her disability and other important issues.
For any of you who are fans of the Paralympics, especially the Australian team, there is Rhiannon
(19:41):
Clarke.
She is a T-38 athlete with mild spastic diplegia who often breaks Australian records and has
won several medals in her track and field events.
Rhiannon is all about being proud of who you are and paving the way for others in the Paralympic
space.
I have linked her Instagram if you want to check out some of her incredible skill.
There is also the American Paralympic athlete, Catarina Guimaraes.
(20:02):
She is a track and field star.
She is also very talented at soccer/football and many other sports.
Like seriously, there's a massive list.
I am talented at none of those, probably should cut that out.
She is an advocate for disability sports and even an author.
Halfway through writing her fantasy series, the Death Garden series.
Catarina is an incredibly successful person and an elite athlete who shows a lot of behind
(20:24):
the scenes in her Instagram page, which I will also link.
If you would like to check out a book, there is My Left Foot by Christy Brown.
This book is a memoir written by Brown who was born with cerebral palsy and eventually
gained the ability to use his left foot to paint and write.
This book was turned into a movie in 1989.
If you want to check out a foundation for those in the US, there is the Cerebral Palsy
(20:45):
Foundation.
Their focus is research in cerebral palsy, they focus on interventions and accessibility,
as well as in the future, potential preventions for cerebral palsy development.
There is also the Ariana Rye Foundation.
They are a foundation that helps families that have children with disabilities to get
the medical equipment they need.
This was after their personal experience with their own daughter, Ariana Rye, who had cerebral
(21:05):
palsy.
This foundation is partially funded by their own microbrewery, Nevada Brew Works.
So if you are ever in Las Vegas and feel like a nice beer, you should go crack a cold one
for a good cause.
Plus, their food looks really good.
And there is for those in Australia, the Cerebral Palsy Alliance.
They provide services and strategies for those diagnosed with cerebral palsy and they also
assist with research into cerebral palsy and help with technology to improve quality of
(21:29):
life.
If you want to check out the sources, social media links or any other links, you can head
to anatomyofillness.com.
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Otherwise, stick around for the next episode.
(21:59):
What happens when your brain sees a friend across the street?
It gives a brainwave.
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