Cerebral Palsy

Cerebral palsy (CP) is a group of permanent disorders of movement and posture caused by a non-progressive injury to, or difference in, the developing brain before, during or shortly after birth. It is the commonest physical disability of childhood, affecting about 2 in every 1,000 children.

The brain injury does not worsen, but its effects on muscles, bones and joints change as a child grows. CP cannot be cured. Treatment aims at function, comfort and participation through therapy, management of muscle tone and well-timed orthopaedic surgery, guided by goals the family and child set.

Symptoms

• Delayed milestones: not sitting by 8 months or not walking by 18 months
• Stiff, tight muscles (spasticity), sometimes with scissoring of the legs
• Floppiness in infancy that later becomes stiffness
• Showing a hand preference before 12 months, or using one side of the body less
• Toe walking or a crouched gait
• Involuntary twisting or writhing movements (dyskinetic type), or shaky unsteady movements (ataxic type)
• Difficulty with feeding, swallowing, drooling and speech
• Associated problems: epilepsy, learning difficulties, squint, vision and hearing impairment, pain, sleep disturbance and constipation

Causes and risk factors

Most cases originate before birth. The strongest risk factor is prematurity, particularly before 32 weeks, and low birthweight, through damage to white matter near the ventricles. Other causes include infection in pregnancy, stroke in the baby before or around birth, brain malformations, multiple pregnancy, shortage of oxygen during birth (which accounts for a minority, around 1 in 10), severe untreated newborn jaundice, and meningitis or head injury in the first 2 years. Genetic variants are found in up to a quarter of children, particularly when no other risk factor is present.

How it is diagnosed

• Clinical assessment and developmental history: Diagnosis is clinical. Early standardised tools, the General Movements Assessment and the Hammersmith Infant Neurological Examination, can identify high risk before 5 months of age.
• MRI of the brain: Shows the pattern and timing of injury in most children and helps exclude progressive conditions.
• Classification of function: GMFCS levels I to V describe walking ability and predict future needs; MACS and CFCS describe hand use and communication.
• Hip surveillance X-rays: Regular pelvic films from age 2, because the hips can dislocate silently, especially at GMFCS levels III to V.
• Genetic and metabolic tests: When MRI is normal, there is a family history, or the condition appears to worsen; this also excludes treatable mimics such as dopa-responsive dystonia.
• Gait analysis: Three-dimensional motion laboratory assessment before orthopaedic surgery in walking children.
• Vision, hearing, swallowing and EEG assessment: As indicated by the child's difficulties.

Treatment options

• Physiotherapy and occupational therapy: Goal-directed, task-specific training; constraint-induced and bimanual therapy for hemiplegia. Intensity and practice at home matter more than any branded method.
• Orthoses and equipment: Ankle-foot orthoses, standing frames, walkers, wheelchairs and supportive seating.
• Botulinum toxin injections: Reduce focal spasticity for 3 to 6 months, combined with casting and therapy.
• Oral and intrathecal baclofen: Tablets for generalised spasticity; an implanted pump for severe spasticity or dystonia, which needs refills every few months.
• Selective dorsal rhizotomy: Neurosurgical division of selected sensory nerve rootlets to reduce leg spasticity permanently, for carefully chosen children, typically aged 3 to 10 at GMFCS II or III, followed by many months of intensive physiotherapy.
• Single-event multilevel orthopaedic surgery: Tendon lengthening, transfers and bone realignment at several levels in one operation, usually between ages 7 and 12, with rehabilitation lasting up to a year. Hip reconstruction for displacement.
• Speech, feeding and communication support: Including communication devices, and gastrostomy when feeding is unsafe or growth is inadequate.
• Managing associated conditions: Epilepsy, reflux, constipation, drooling, sleep, pain and bone density.

When it is urgent

Seek emergency care locally for a seizure lasting over 5 minutes, breathing difficulty or a suspected chest infection after choking, persistent vomiting, or unexplained severe pain, which may indicate a hip dislocation or fracture. In a child with a baclofen pump, sudden high fever, rigidity, itching or drowsiness may mean withdrawal or overdose and is an emergency.

Travelling to Türkiye for treatment

CP is managed throughout childhood by a local team, and that cannot be replaced. A trip can sensibly cover a specific, planned intervention: gait analysis with a surgical opinion, multilevel orthopaedic surgery, selective dorsal rhizotomy, or a several-week intensive rehabilitation block. Each works only if months of follow-up therapy are already organised at home, so confirm that first. Stem cell and hyperbaric oxygen treatments marketed for CP have not shown meaningful benefit in controlled trials.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions