Cerebral Palsy in Children: Causes, Early Signs and Rehabilitation in Hyderabad

Cerebral palsy (CP) is a group of permanent but non-progressive motor disorders caused by damage to or abnormal development of the developing brain — occurring before, during, or shortly after birth. It is the most common cause of childhood physical disability globally, and with modern rehabilitation approaches, outcomes have improved substantially over the past two decades.

Causes of Cerebral Palsy

Prenatal causes (before birth): Infections during pregnancy (CMV, rubella, toxoplasmosis); stroke in the foetus; brain malformations; severe jaundice affecting the foetal brain (kernicterus); genetic conditions.

Perinatal causes (around birth): Birth asphyxia — the brain deprived of oxygen during a prolonged, complicated delivery; premature birth (the immature brain is highly vulnerable to periventricular leukomalacia — white matter damage around the ventricles); intracranial haemorrhage in premature infants.

Postnatal causes (after birth): Meningitis or encephalitis in infancy; severe hypoglycaemia (low blood sugar) in newborns; head trauma; near-drowning.

In many cases, the exact cause is never identified despite thorough investigation.

Types and Their Presentation

Spastic CP (most common, ~80%): Increased muscle tone, stiff movements, brisk reflexes. Affects one side of the body (hemiplegia) or both legs (diplegia — common in premature infants) or all four limbs (quadriplegia).

Dyskinetic CP: Involuntary, uncontrolled movements — fluctuating between stiffness and floppiness. Often associated with birth asphyxia or kernicterus.

Ataxic CP: Balance and coordination problems, wide-based gait, tremor.

Early Signs — What to Watch For

• Persistent floppiness (hypotonia) after 3–4 months without improvement
• Strong hand preference before 12 months (normal infants use both hands equally)
• Not reaching with one hand; curling the affected hand into a fist
• Leg scissoring when held upright (spastic diplegia)
• Persistent primitive reflexes (Moro, Asymmetric Tonic Neck Reflex) after they should have disappeared
• Delayed motor milestones: not sitting by 9 months, not standing by 14 months

Early Intervention — The Earlier the Better

The brain's neuroplasticity is highest in the first 3 years of life. Physiotherapy, occupational therapy, and speech therapy started in infancy produce significantly better functional outcomes than the same therapies started at school age. Early intervention optimises the use of the critical developmental window.

Associated conditions requiring management: epilepsy (30–50% of CP), intellectual disability, visual impairment, hearing impairment, speech and communication difficulties, feeding difficulties, and pain.

For cerebral palsy assessment and rehabilitation: Sri Anand CNC (physiotherapy with Dr. Harisha), Chanda Nagar, Hyderabad. Call +91 90633 66983.