bubble_chart Overview

Cerebral palsy in children, also known as infantile cerebral paralysis, cerebral paralysis, or childhood cerebral palsy, abbreviated as CP, is a syndrome caused by non-progressive brain injury during the period from before birth to the developmental stage of the brain after birth. It primarily manifests as central motor dysfunction and abnormal posture. {|###|}The disease originates in the brain, affects the limbs, and presents with diverse symptoms, which may include intellectual disability, seizures, hearing and visual impairments, behavioral abnormalities, and more. It is one of the leading causes of disability in children.

Clinical data show that the incidence is significantly higher in boys than in girls, and the occurrence rate of cerebral palsy is higher in twins and triplets than in single births. In China, the incidence ranges from 1.6 to 4 per 1,000 births. The mortality rate is 6%, and the spontaneous recovery rate is 10%. Currently, there are many children with cerebral palsy in China, and new cases emerge every year. With the implementation of family planning and the aging of society, pediatric cerebral palsy has become a disease that warrants renewed attention and understanding. Children with cerebral palsy impact family happiness, a child's development, and the improvement of national health standards. Therefore, pediatric cerebral palsy is both a medical issue and a social problem.

bubble_chart Etiology

1. Hypoxic asphyxia: including fetal hypoxia and asphyxia in the mother's uterus, neonatal hypoxia and asphyxia during childbirth, respiratory distress syndrome, systemic circulatory failure, and polycythemia.
2. Brain injury: such as infant brain injury during childbirth, neonatal craniocerebral injury or brain infection, cerebrovascular accident.
3. Premature labor and fetal dysplasia: intrauterine infection, intrauterine growth retardation, congenital malformation. Neonatal weight less than 2500 grams, the possibility of cerebral palsy greatly increases (about 40% of children with cerebral palsy weigh less than 2500 grams).
4. Certain genetic diseases and neonatal nuclear jaundice.
5. Maternal causes: including maternal abdominal trauma, threatened late abortion, prenatal hemorrhage, pregnancy toxemia, and placental causes (placental abruption, placenta previa, placental necrosis or placental dysfunction), as well as certain chronic diseases in pregnant women (hypertension, hepatitis, diabetes, drug abuse, drug overdose, etc.).

bubble_chart Diagnosis

The symptoms of cerebral palsy in children include:

1. Motor impairment: Poor self-control of movement, with severe cases involving inability to grasp objects with hands or walk with feet. Some may even be unable to turn over, sit up, stand, or chew and swallow normally.
2. Postural impairment: Abnormal postures with poor stability, such as inability to hold the head upright by 3 months, a tendency to tilt to one side, or swaying back and forth. The child may dislike bathing and have difficulty opening their fists when washing hands.
3. Intellectual disability: About 1/4 of children have normal intelligence, 1/2 have mild to moderate (grade I or II) intellectual disability, and 1/4 have severe (grade III) intellectual disability.
4. Speech impairment: Difficulty in verbal expression, unclear pronunciation, or stuttering.
5. Visual and auditory impairments, with esotropia and difficulty distinguishing sound rhythms being the most common.
6. Growth retardation, resulting in short stature.
7. Dental developmental issues, such as brittle and easily broken teeth. Orofacial dysfunction, including spasms or uncoordinated contractions of facial and tongue muscles, difficulty chewing and swallowing, inability to close the mouth properly, and drooling.
8. Emotional and behavioral disorders: Stubbornness, irritability, social withdrawal, mood swings, and sometimes compulsive, self-injurious, or aggressive behaviors.
9. About 39–50% of children with cerebral palsy develop epilepsy due to fixed brain lesions, especially those with severe (grade III) intellectual disability.

According to the 1956 classification method (revised) by the American Academy for Cerebral Palsy, it can be categorized into spastic, dyskinetic (athetoid), hypotonic (sometimes misdiagnosed as hypocalcemia), ataxic, tremorous, rigid, mixed, and unclassified types. By affected areas, it includes monoplegia, diplegia, triplegia, quadriplegia, paraplegia, hemiplegia, and double hemiplegia.

Early diagnosis

1. First, abnormal movement. Normal infants follow a developmental pattern: "lifting the head at 2–3 months, rolling over at 4–5 months, sitting at 7 months, crawling at 8 months, and walking at 12 months." If a child's movement does not align with their age—such as inability to hold the head upright by 3–4 months, sit independently by 6–9 months, stand by 9–12 months, or walk by 12–18 months—it should raise concern.
2. Second, abnormal posture. This includes abnormally high or low muscle tone in the limbs, such as difficulty spreading the legs during diaper changes, scissoring of legs when held upright, toe-walking with heels not touching the ground, or clumsy hand movements with thumbs often clenched. Some may exhibit unusual facial movements like tongue protrusion, drooling, or unclear speech.
3. Third, a history of perinatal asphyxia, birth trauma, premature labor, or low birth weight significantly increases the risk of cerebral palsy.

Once these signs appear, immediate medical evaluation is necessary to avoid missing the optimal treatment window and causing lifelong delays. Based on our experience, the following situations warrant special attention: weak sucking, difficulty swallowing, frequent choking or vomiting during feeding; by 3 months, the head cannot be held in a neutral position, and movements of the head, hands, or legs are rigid, making the child difficult to hold. As they grow, standing with legs tightly together, walking on tiptoes, or even crossing legs; delayed motor skills with noticeable asymmetry in lower limb movements; after 4 months, inability to bring hands to the mouth, hand tremors when grasping objects, poor head control when lying prone, or inability to turn the head sideways or free hands trapped under the chest or abdomen. In such cases, parents should take the child to a pediatric neurology specialist for evaluation and early intervention.

bubble_chart Treatment Measures

The ideal age for cerebral palsy treatment and rehabilitation is to start within 6 months after birth. However, clinically, most children miss the golden period of rehabilitation due to family-related reasons. For example, when parents notice their child cannot perform certain movements or has abnormal postures, they often assume the child is still too young and will naturally improve with age. Due to such passive waiting, the child loses the optimal treatment window.

**Treatment Principles and Methods:**

1. 1. **Comprehensive Rehabilitation Therapy**: - **Physical (Exercise) Therapy**: Includes gross motor skills, fine motor skills, balance, and coordination training, such as crawling, targeted pointing (nose, ears, etc.), grasping and holding objects, sitting up, rocking, assisted walking (back against the wall, facing the wall), in-place exercises (bending to pick up objects, leg lifts, standing on one foot, jumping in place), walking, and running. - **Physical Therapy**: Includes neuroelectrical stimulation, thermotherapy, and hydrotherapy. - **Occupational Therapy (Ability Training)**: Specialized hospitals or clinics are now available in cities, and families with better financial conditions may opt for them, though the efficacy is generally moderate.
2. 2. **Pharmacotherapy**: - Oral or injectable medications: brain neurotrophic drugs, muscle relaxants, blood-activating drugs, etc. - Drugs that build and repair brain tissue (cells), such as lecithin (containing phosphatidylcholine, cephalin, sphingomyelin, etc.), 0.1g/tablet, three times daily, can repair brain cell membrane damage caused by trauma, hemorrhage, or hypoxia, protect neurons, accelerate nerve impulse conduction, and improve learning and memory. - Drugs that promote brain cell DNA synthesis, enhance oxygen utilization, improve brain cell energy metabolism, boost brain function, supply amino acids for brain tissue repair, and regulate neural activity, such as Gulixi (brain enzyme hydrolysate tablets), 1-2 tablets, three times daily; spirulina tablets (capsules), 1-2 tablets, three times daily. - Supplementation with multivitamins, such as 21-Gold-Vita, 1 tablet, 1-2 times daily. - For hospitals with resources, injectable alternatives (with similar effects to tablets) include Cerebrolysin, brain polypeptides, acetylglutamine, citicoline, etc.
3. 3. **Selective Posterior Rhizotomy (SPR Surgery)**: - A highly effective method for treating spastic cerebral palsy, pioneered by an Italian surgeon in 1978 and widely adopted globally. - Due to upper motor neuron injury in the cerebral cortex, lower motor neuron activity becomes uncontrolled. Certain nerve fibers are the primary cause of increased muscle tone. SPR surgery uses modern electrophysiology and microsurgery to identify and sever these fibers, stabilizing hyperactive reflex arcs and alleviating spasticity. Success rates range from 50-80%. Post-surgery, rehabilitation and muscle balance/coordination training are required. - Indications: Age 5-7, pure spastic cerebral palsy, near-normal intelligence, muscle tone ≥ grade 3, some motor control ability, and absence of hypotonia, athetosis, ataxia, or muscle contractures.
4. 4. **Traditional Chinese Medicine (TCM) Therapy**: - Includes acupuncture (caution for high muscle tone), tuina (massage), and herbal medicine.
5. 5. **Persistent Home Rehabilitation Training**.