One of the common manifestations of HIE is cerebral palsy, a musculoskeletal condition that can cause physical disabilities. The disorder is non-progressive, meaning that it does not get worse over time. Cerebral palsy (abbreviated as CP) manifests itself as either the loss or impairment of motor control or function, but cerebral palsy is caused by underlying brain damage. This brain damage can be caused by brain injury (during birth or soon after the baby is born). In most cases, this brain damage is from hypoxic-ischemic encephalopathy (HIE).
Research suggests that a high percentage of cerebral palsy cases result from HIE occurring during pregnancy or during labor and delivery. There are numerous intersecting factors that can lead to cerebral palsy, including HIE, accidents, abuse, medical mistakes/negligence, and infections.
What Does Cerebral Palsy Look Like?
Cerebral palsy shows up first and foremost as a physical impairment, though the severity of the condition can vary dramatically. There are different levels of ‘involvement’ – some cerebral palsy cases are very mild while others are very severe. Mild cases might show impaired function in just one limb, while the most severe cases of cerebral palsy may cause patients to have impaired function in all of their limbs and their face.
This impaired function can show up as muscle weakness, contractures (tightness), stiffness and painful positioning. In some cases, contractions can cause tremors, shaking or writhing motions. Cerebral palsy can also impact balance, hand-eye coordination, or posture, as it may be harder for children with cerebral palsy to grasp objects or perform actions like brushing teeth or buttoning clothes, as these require fine motor coordination. CP can also manifest itself in a child having trouble swallowing, eating, or speaking, or having poor facial muscle tone as well. In an infant, this can look like a baby having trouble latching or sucking.
While cerebral palsy is a purely musculoskeletal disorder, it can also be accompanied by intellectual or developmental delays, seizures and other difficulties such as hearing or vision loss. This does not necessarily mean that every child with cerebral palsy will also have intellectual delays – the diagnosis’ severity is highly dependent on factors such as where the injury occurred, how long the child was oxygen-deprived, whether medical staff properly responded to fetal distress, and whether the child was properly treated with hypothermia therapy after the incident.
Signs and Symptoms of Cerebral Palsy
A sign is a clinically identifiable effect of a particular condition that a medical staffer uses to diagnose a patient. A symptom is an effect that a patient might identify or express to a physician but may be difficult to objectively verify. When a patient complains of symptoms, medical staff members can diagnose the patient using signs, clinical tests and exams.
Sometimes, a baby may show signs or symptoms of cerebral palsy in infancy, but in other cases, cerebral palsy is diagnosed once the child begins to miss developmental milestones around ages 3-5. These developmental delays are often caught by parents, who can observe that their child might not be rolling over, sitting up, crawling or walking properly at the right developmental stage. They may bring these concerns up with a medical practitioner, who can conduct tests to look for signs of CP, including abnormal muscle tone, poor posture, or abnormal reflexes.
In some cases, doctors may diagnose cerebral palsy very early if the baby had a traumatic or difficult birth and they suspect that multiple risk factors were at play. In other cases, the diagnosis might come late because CP tends to show up as the child’s brain continues growing. In some cases, cerebral palsy shows up when the child is at the developmental stage where they are developing higher-order brain processes but they fail to meet their milestones.
|Signs and Symptoms of Cerebral Palsy|
|Sign/Symptom||What does this look like?|
|Abnormal muscle tone||Limbs that are abnormally floppy, flaccid, stiff, or rigid
Involuntary muscle spasms
Joints that are fused together
Muscle spasms accompanied by rhythmic contractions
|Trouble with Movement, Coordination or Muscular Control||Spastic movements, ‘scissoring’ legs, writhing movements, trouble with balance or fine motor control, difficulty walking|
|Abnormal Reflexes||The presence of certain primitive reflexes that are normally expected to disappear (asymmetrical tonic reflex, spinal gallant reflexes, palmar grasp reflex, placing reflex, startle reflex)|
|Development of Early Hand Preference||Children usually start preferring one hand over another when they are about two years old; earlier preferences can indicate that something is wrong|
|Undeveloped or Late Postural Responses||
|Trouble Balancing||Inability to sit without using hands for support, swaying while standing, unsteady walking, abnormal gait, trouble making fast motions, and needing to use hands to support themselves for activities that need balance|
|Trouble with Gross Motor Function||Inability or delayed development of the ability to make large coordinating movements using multiple limbs and muscle groups (such as walking, running, jumping, balancing, or rolling, sitting up, crawling, standing, walking or balancing in a baby)|
|Trouble with Fine Motor Function||Intention tremors as children get closer to completing a task, difficulty with grasping small objects, holding objects between thumb and forefinger, or doing tasks like setting objects down gently, coloring, or turning a page|
|Oral Motor Function Difficulty||Trouble with using the lips, jaw or tongue, including difficulty with speaking, swallowing, feeding/chewing, and drooling|