Cerebral palsy (including spasticity)

What are cerebral palsy and spasticity?

Cerebral palsy (CP, or infantile encephalopathy) is a collective term. It is a combination of symptoms, the main feature of which is a postural and/or movement disorder. In other words, it is not an illness. It is linked to brain damage incurred in the first year of life, usually before or during birth. Other brain injuries (such as stroke) can also cause palsy. ⁴⁹³

Cerebral palsy can be broken down into:

• Hypertonic cerebral palsy: spasticity, in other words heightened or severe muscle tension. The muscles do not work together as they should. Spasticity may be unilateral ('hemiparesis' or 'hemiplegia' affecting one side of the body) or bilateral (a distinction can be made between diplegia, in which both legs are affected, or tetraparesis/quadriplegia, in which both arms and legs are affected).
• Hypotonic cerebral palsy: reduced muscle tension.
• Chorea/athetosis: strange, continuous and unexpectedly fast (chorea) or slow (athetosis) involuntary movements, making it difficult to adopt a fixed posture.
• Ataxia: uncoordinated motor abilities, making it difficult to move in a controlled way.

What are the complaints associated with cerebral palsy?

Spasticity can range from mild muscle stiffness to severe, painful and uncontrollable muscle cramps. Severe spasticity may place painful loads on the joints (contractures) or result in dislocation (luxation). Chronic pain is seen in 25%; activities of daily life are usually limited.

According to Dutch research, cerebral palsy is associated with: gastrointestinal disorders such as oesophagitis and constipation (in 50%), poor eyesight (a frequent complaint that is found in various degrees, from mild to very severe in cortical blindness), poor hearing, epilepsy (in 75% of children with tetraparesis, 50% of children with hemiparesis and 25% of children with a diplegia), under- and overweight (in 50%) and a growth disorder. ¹⁴⁴

Cognitive disabilities are common: 25% have normal intelligence, 50% have mild learning difficulties, 25% have intellectual disabilities. Beange has even claimed that 50% have an intellectual disability. ¹⁴⁵

A study of children with intellectual disabilities and spasticity found that almost 25% had severe challenging behaviour. Children with severe functional limitations had less challenging behaviour, and challenging behaviour was more common in children with severe pain. ¹⁴⁶

In adults also, chronic pain is associated with an increased risk of challenging behaviour. ⁴⁹⁴

Kobe found frequent challenging behaviour in non-outpatient adults with very severe intellectual disabilities. ¹⁴⁷

A Swedish study of 915 people found that people with cerebral palsy actually had problematic behaviour less often than people without cerebral palsy. ⁴⁹⁵

How common is cerebral palsy in the general population?

The prevalence of cerebral palsy is approximately 0.2% (2 per 1000 live births) and there is a rising trend, as indicated by a review of the Dutch literature for the years 1965 to 2004. ¹⁴⁴

Wichers found a prevalence in the Dutch population of 1.5%. ¹⁴⁸

How common is cerebral palsy in people with intellectual disabilities?

The European POMONA questionnaire survey of a random sample of 1269 adults with an intellectual disability found that 26% could not walk more than 200 m on a level surface and had motor problems. ¹⁴⁹

A Dutch review of international articles on health problems in children with intellectual disabilities showed that 19.8% of children with intellectual disabilities had cerebral palsy. ¹⁵⁰

In a large survey of 1020 children and adults with intellectual disabilities, 14.6% suffered from spasticity (only 0.8% were people with Down syndrome). ¹⁵¹

Cerebral palsy does not result in more externalising challenging behaviour. Indeed, severe functional limitations would appear to prevent people from engaging in such behaviour. However, severe pain as a result of cerebral palsy does result in more externalising challenging behaviour. ¹⁵³