The parts of the body affected by CP, the level of severity and combination of symptoms can differ for each person. For example, one person may have a weakness in one hand and find tasks like writing or tying shoelaces challenging. Another person may have little or no control over their movements or speech and require 24 hour assistance.
People with cerebral palsy may experience uncontrolled or unpredictable movements, muscles can be stiff, weak or tight and some people may have shaky movements or tremors. People with severe cerebral palsy may also have difficulties with swallowing, breathing, head and neck control, bladder and bowel control, eating and have dental and digestive problems.
1 in 3 children with cerebral palsy will be unable to walk. At greatest risk are those who have spastic quadriplegia, intellectual disability, epilepsy, vision impairment and an inability to sit independently at 2 years of age.
CP can affect a person’s ability to finely coordinate the muscles around the mouth and tongue that are needed for speech. The coordinated breathing that is needed to support speech can also be affected, e.g. some people may sound ‘breathy’ when they speak. Some people with CP may not be able to produce any sounds, others may be able to produce sounds but have difficulty controlling their movement enough to produce speech that is clear and understood by others.
Pain is often a result of the impairments that are associated with CP, e.g. contractures, abnormal postures, dystonia, skin breakdown, hip subluxation, gastro-oesophageal reflux and scoliosis. This pain can affect a person’s behaviour, their ability to do things for themselves, to sleep and their social relationships. People might avoid day-to-day tasks that are important for independence, such as attending school and social events. Pain can be relieved, so it is best to be guided by your medical practitioner.
CP can affect the muscles that open and close the mouth and move the lips and the tongue. Some people with CP may have difficulties in chewing and swallowing food and drink – a condition known as dysphagia. Because CP often impacts fine motor skills, many people are unable to easily use cutlery, hold a cup, or transfer food from a plate to their mouth using their hands. Others may suffer from gastroesophageal reflux – where acid from the stomach rises into the oesophagus – which makes eating uncomfortable or painful. This can sometimes be controlled by medication.
Because CP can affect the muscles around the mouth, some children with CP have saliva loss (also known as dribbling, drooling or sialorrhoea). The saliva loss may be more noticeable when they are concentrating on doing other tasks.
1 in 5 people have a moderate to severe intellectual disability.
Generally, the greater the level of a person’s physical impairment, the more likely it is that they will have an intellectual disability. However, there are people who have a profound level of physical impairment, who do not have an intellectual disability. And, there are others with a mild physical impairment who have an intellectual disability.
These may include a short attention span, motor planning difficulties (organisation and sequencing of movement), perceptual difficulties and language difficulties. These can impact on literacy, numeracy and other classroom skills and activities.
Learning may also be affected by difficulties in fine motor and gross motor coordination and communication. Students with CP need to put more effort into concentrating on their movements and sequence of actions than others, so they may tire more easily.
Vision impairment is not uncommon in people with CP. Children with the more severe forms of CP are more likely than others to experience myopia, absence of binocular fusion, dyskinetic strabismus (also known as ‘turned eye’ or ‘squint’), severe gaze dysfunction, and optic neuropathy or cerebral visual impairment.
At greatest risk are those with an intellectual disability, epilepsy, severe pain or a milder level of physical disability. Problem behaviours include dependency, being headstrong, hyperactive, anxious, or prone to conflict with their peer group, or exhibiting antisocial behaviours. Children with CP may also have emotional problems such as difficulties with their peer group and strong emotional responses to new challenges. Teenagers and adults with cerebral palsy may be more prone to depression and anxiety disorders.
When children have CP and an intellectual disability, the incidence of epilepsy is higher – 48%. Seizures can affect speech, intellectual and physical functioning. Medication is the most effective intervention for epilepsy and the child’s doctor or therapist may also recommend modifications to the student’s school supports and equipment. Some medications have side effects which cause drowsiness or irritability. Both epilepsy and the related medication can affect a person’s behaviour and attention span.
There are a range of contributing factors, including the muscle spasms associated with CP, other forms of musculoskeletal pain, and decreased ability to change body position during the night. Epilepsy is also known to disturb sleep and is likely to predispose to sleep disorders. Blindness or severe visual impairment can affect the timing and maintenance of sleep through their effect on melatonin secretion and the lack of light perception.
Abnormalities of the spine and hips are associated with CP and can make sitting, standing and walking difficult, and cause chronic pain. Children and adults who have a severe physical disability or those whose body is affected on both sides are at greater risk of hip problems. This means that people who use wheelchairs most of the time are more at risk of hip problems than those who walk with assistive devices or independently.
Continence and constipation are issues for many people with CP. Children with intellectual disability and/or a severe form of CP are most at risk. Lack of mobility and difficulty eating can predispose people with CP to constipation.
1 in 20 people with CP have some level of hearing impairment, while 1 in 25 are deaf.