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🧠 Cerebral Palsy (CP)

1. Definition

Cerebral palsy (CP) is a group of permanent, non-progressive motor disorders caused by abnormal brain development or brain injury occurring during the antenatal, perinatal, or early postnatal period <2 years of age.
It affects movement, posture, and coordination, and is often accompanied by sensory, cognitive, and communication impairments.

Antenatal (most common):
- Prematurity
- Intrauterine infections (e.g., TORCH)
- Genetic syndromes or brain malformations
- Placental insufficiency
Perinatal:
- Birth asphyxia
- Complicated or traumatic delivery
Postnatal:
- Neonatal sepsis or meningitis
- Intracranial hemorrhage
- Head injury

Type	Description
Spastic (most common)	Hypertonia and hyperreflexia; hemiplegia, diplegia, or quadriplegia
Dyskinetic	Involuntary movements (athetosis, dystonia)
Ataxic	Poor coordination, balance, and depth perception
Mixed	Combination of spasticity and dyskinesia

Injury or abnormal development of the immature brain affects motor control centers such as:
- Motor cortex
- Basal ganglia
- Cerebellum
Damage is non-progressive, but the clinical manifestations may evolve with age due to muscle contractures and secondary complications.

System	Complications
Musculoskeletal	Contractures, scoliosis, hip dislocation
Neurologic	Seizures, intellectual disability
Speech & Swallowing	Dysarthria, drooling, aspiration, feeding problems
Vision	Strabismus, cortical visual impairment
Hearing	Sensorineural hearing loss
GI	Constipation, GERD, malnutrition
Respiratory	Recurrent aspiration pneumonia
Psychosocial	Social isolation, caregiver stress

Test	Purpose
MRI brain	Identify structural or acquired lesions
Metabolic/genetic tests	If MRI is inconclusive or syndromic features
EEG	If seizures are present

Test	Purpose
Hearing and vision screening	Detect sensory impairments
Swallow study (VFSS)	For suspected aspiration/dysphagia
Orthopedic assessment	Contractures, scoliosis, hip monitoring
Speech and developmental assessments	Evaluate for therapy needs

No cure, but early intervention and therapy improve function and quality of life

Treatment	Complication	Monitoring	Expected Results
Baclofen	Drowsiness, hypotonia	Clinical monitoring, tone assessment	Minimal sedation, effective tone control
Diazepam	Sedation, dependence	Clinical observation	No oversedation
Antiepileptics	Liver dysfunction, drowsiness	LFTs, therapeutic drug monitoring	Normal liver function, therapeutic levels
Botox injections	Weakness, injection site pain	Functional assessment	Focal tone reduction
PEG feeding	Infection, dislodgement	Site care, nutritional follow-up	Adequate nutrition, weight gain

Domain	Frequency	What to Monitor
Growth & Nutrition	Every 3–6 months	Weight, feeding, signs of malnutrition
Musculoskeletal	Every 6–12 months	Contractures, scoliosis, hip subluxation
Neurology	As needed	Seizure control, cognitive progress
Developmental	Ongoing	PT, OT, speech therapy progress
Vision/Hearing	Yearly or as needed	Strabismus, hearing loss
Swallowing/Breathing	As needed	VFSS, respiratory assessment
Mental Health	As needed	Behavior, mood, caregiver stress

Support Group	Description	Contact/Link
Cerebral Palsy Malaysia (CPM)	Advocacy, therapy, and family support	Facebook: @cpmalaysia
NASOM (National Autism Society Malaysia)*	Useful if CP coexists with ASD traits	nasom.org.my
Hospital-Based Rehab Clinics	Available in tertiary centers (HKL, HUSM, Penang GH)	Via pediatrics or rehab department referral

*Note: Not all children with CP have autism, but some benefit from overlapping services.