Ottobock | Understanding Cerebral Palsy: A Comprehensive Guide

What is Cerebral Palsy?

Cerebral Palsy (CP) is a group of movement disorders that appear in early childhood, caused by a brain injury that develops before, during, or soon after birth. The symptoms of CP can vary greatly in each child but mainly affect mobility. For example, some children may find walking difficult, affecting their daily life. Therefore, it is important to support motor development as early as possible with mobility aids. Read on to find out how CP can affect children and how you can support your child's development in a targeted manner.

Causes and Risks.

What are the causes of Cerebral Palsy?

Finding out the exact cause behind CP in an individual child or determining the risk factors that may have played a role is often challenging for doctors. It is often not possible to determine what caused Cerebral Palsy, and there may have been several factors involved.

The causes of Cerebral Palsy in children are very diverse. Doctors usually classify the causes according to the time at which children acquire the brain injury:

Before birth (prenatal): more than 50 percent of children are affected during pregnancy, usually as a result of infection or lack of oxygen, for example when a blood clot (thrombosis) forms in a blood vessel in the brain and obstructs blood flow.
During birth (perinatal): for example as a result of lack of oxygen during birth due to complications.
After birth (postnatal): this can occur due to an infection such as meningitis

Cerebral palsy patient playing with his toys

In addition, there are a number of factors that may increase the risk of developing Cerebral Palsy in children. Some of these factors are:

Premature birth: Children born before 32 weeks are more likely to be affected by Cerebral Palsy.
Birth complications
A birth weight that is too high or too low
Maternal obesity during pregnancy
Infectious diseases such as toxoplasmosis or rubella, or those caused by cytomegalovirus or herpes simplex virus before or after birth

Cerebral palsy - Causes and risks - Image 2 (HQ)

Symptoms

How will Cerebral Palsy affect my child's development?

Depending on the severity of the resulting brain injury, different symptoms of cerebral palsy may appear. As Cerebral Palsy is a group of movement disorders, it mostly affects motor skills or mobility. In addition, there may be other accompanying symptoms such as pain or cognitive impairments. The symptoms of each child depend on the area of the brain that is affected, so not every child will experience the same symptoms or the same severity. The following signs of Cerebral Palsy occur alone or in combination.

Spasticity

Spasticity is an abnormal increase in muscle tone that is aggravated by sudden or quick movements. It means that certain muscles, for example in the legs or arms, appear stiff, making controlled movements difficult. Spasticity occurs in 75 to 87 percent of cases of Cerebral Palsy. If spasticity is left untreated, or unmanaged, this can lead to permanent shortening of the muscles affected, resulting in restricted mobility of joints. For example, spasticity in the hamstring muscles could lead to the inability to fully straighten the knee.

Graphic of a human head and brain in which the areas of the brain affected by spastic paralysis are highlighted in blue

Paralysis (Monoplegic, Hemiplegic, Diplegic, Quadraplegic)

Paralysis of varying severity is a common symptom of Cerebral Palsy. In the medical world, a distinction is made between paresis and paralysis. Individuals with paresis often have mobility, although limited, and reduced muscle strength. Individuals with paralysis, however, experience a complete loss of function in the affected area of the body or limb.

Doctors define paralysis according to where it occurs:

If only one limb (e.g. an arm) is affected, it is referred to as monoparesis or monoplegia.
In people with hemiparesis or hemiplegia, the left or the of the body is paralysed or has limited mobility
If both legs, or occasionally both arms are affected, this is called diparesis or diplegia.
In quadraparesis, or quadriplegia (previously also referred to as tetraparesis or tetraplegia) all four limbs (i.e., both arms and both legs) are affected.

Depending on how pronounced the paralysis is and where exactly it is located, movements such as sitting independently or walking may be difficult.

Graphic representation of different forms of paralysis

Dyskinesia (for example Athetosis or Dystonia)

Dyskinesia is caused by damage to the basal ganglia in the brain, which is responsible for regulating voluntary movement. In people with Cerebral Palsy, dyskinesia is characterised by involuntary, twisting, and uncontrollable movements, which can be slow or sudden. For instance, children with dyskinesia tend to have difficulty controlling the movement in their hands. This makes it harder for them to hold or grasp items such as a cup or toy. Dyskinesia can increase when a child gets excited about something. For instance, children with dyskinetic cerebral palsy may over-extend and twist their neck due to limited body control. In these cases, an appropriately customised wheelchair with seating and positioning aids can provide support and increase stability Athetosis and Dystonia are the two main types of dyskinesia, which are described further on.

Graphic of a human head and brain in which the areas of the brain affected by Dyskinesia are highlighted in blue

Malpositions and contractures

One of the most common malpositions in children with Cerebral Palsy is an equinus deformity. Due to muscle spasticity, or weakness in the muscles that lift the foot, the foot points downwards. If this deformity is fixed, the sole of the foot cannot be placed flat on the ground. It is therefore often difficult to stand upright with a stable base of support. With physiotherapy and orthotics, this deformity can be managed and accommodated. It may even be possible to avoid or stretch out shortened muscles, tendons, and ligaments. If these soft tissue structures do shorten, this can lead to a permanently stiff joint, called a contracture.

Gait abnormalities

Children with Cerebral Palsy often have gait abnormalities. An example is a scissoring gait pattern, which is characterised by the knees and thighs being pressed together or legs crossing when walking as a result of weakness in the hip abductors, or spasticity in the hip adductors.

Weakness in the muscles that bend the knees and hips can make it difficult to clear the ground when swinging the leg through, in effect the legs are too long to clear the ground when walking. In order to move around, affected children must swing their legs out to the side when stepping forward, making their gait pattern appear choppy and stiff, this is known as circumducting.

A crouch gait is also a common gait abnormality in children with Cerebral Palsy. It is characterised by walking with bent knee and hip joints, which can be exhausting and stressful their joints. Walking with a crouch gait can also lead to shortening in the muscles and in the inability to straighten the knees and hips, even when lying down.

Orthotics and physiotherapy can help support the joints in a more appropriate position and improve the walking pattern of the child.

Based on the individual symptoms, doctors can distinguish between different types or classifications of Cerebral Palsy. The following overview shows the form of Cerebral Palsy behind the medical terms.

What is Athetoid Cerebral Palsy?

Athetoid Cerebral Palsy is derived from athetosis and is a subgroup of Dyskinetic CP. In people with Athetoid CP, involuntary movements occur. These, however, are usually slow and convulsive. If the individual with Athetoid Cerebral Palsy is under stress, the movement may increase. Tone in the muscles tends to fluctuate between low and high, meaning contractures are less common in this form of CP.

Definition

What is Cerebral Palsy?

Cerebral Palsy (CP) is defined as an injury to the brain that occurs before, during, or shortly after birth due to a variety of causes. It is usually accompanied by a number of movements and postural dysfunctions, which often limit mobility. In addition to these motor dysfunctions, other impairments may occur, such as disorders that affect communication or behaviour.

Cerebral palsy patient petting a horse together with his father

Early treatment of mobility

Cerebral Palsy does not progress, which means the brain injury will not get worse over time. However, Cerebral Palsy is not curable and your child may need lifetime support. Therefore, physiotherapy to promote movement is essential. How mild or severe the symptoms depend on the affected area of the brain and the level of injury.

The development of mobility can vary significantly in children with Cerebral Palsy. The movement disorder or postural issues are specific to each individual. Physiotherapy, orthotic devices, and mobility aids, such as wheelchairs, walkers, and standing frames, and therefore prescribed on an individual basis and are important in promoting mobility and independence.

What is Cerebral Palsy?

Cerebral Palsy (CP) is defined as an injury to the brain that occurs before, during, or shortly after birth due to a variety of causes. It is usually accompanied by a number of movements and postural dysfunctions, which often limit mobility. In addition to these motor dysfunctions, other impairments may occur, such as disorders that affect communication or behaviour.

Early treatment of mobility

Cerebral Palsy does not progress, which means the brain injury will not get worse over time. However, Cerebral Palsy is not curable and your child may need lifetime support. Therefore, physiotherapy to promote movement is essential. How mild or severe the symptoms depend on the affected area of the brain and the level of injury.

The development of mobility can vary significantly in children with Cerebral Palsy. The movement disorder or postural issues are specific to each individual. Physiotherapy, orthotic devices, and mobility aids, such as wheelchairs, walkers, and standing frames, and therefore prescribed on an individual basis and are important in promoting mobility and independence.

What is Cerebral Palsy?

Cerebral Palsy (CP) is defined as an injury to the brain that occurs before, during, or shortly after birth due to a variety of causes. It is usually accompanied by a number of movements and postural dysfunctions, which often limit mobility. In addition to these motor dysfunctions, other impairments may occur, such as disorders that affect communication or behaviour.

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Types & Symptoms.

Spastic CP (75% of cases) – Stiff muscles, exaggerated reflexes.
Hemiplegia (32% of cases) – One side of the body is affected, with the arm more impacted than the leg.
Diplegia (40% of cases) – Both legs are more affected than the arms.
Tetraplegia (2% of cases) – All limbs are impacted, often with significant developmental delays.
Bilateral Hemiplegia & Triplegia – Varying paralysis affecting multiple limbs.

Common complications include stiff joints, difficulty in sitting or walking, speech delays, and posture abnormalities.

GMFCS

What does the GMFCS level say about my child's mobility?

Based on the results of an examination of motor skills and mobility in everyday life, doctors can diagnose the level of severity of cerebral palsy. The “Gross Motor Function Classification System” (GMFCS) is often used for this purpose – not only by doctors but also by members of other professional groups, such as physiotherapists and occupational therapists. In many cases, you as parents are actively involved in this process: Questionnaires are used to include your perspective, which makes it easier to identify everyday problems and observations. The GMFCS consists of five levels or stages, into which mildly to severely affected children with cerebral palsy can be classified.

Determining the GMFCS level is about recording your child's current level of mobility – in other words, which movements are possible for your child in everyday life and where he or she encounters obstacles or difficulties. Each level refers to the movements that are possible. Since the ability to move depends on the age of your child, the GMFCS also distinguishes between different age levels (from 0–2, 2–4, 4–6, 6–12, and 12–18 years). Below you can find a general summary across all ages.

GMFCS 1

Your child can move around independently (with or without an orthosis, such as an arm or leg splint). Mobility is hardly restricted, and depending on age, activities such as walking, climbing stairs without using hands for support, running, and jumping are possible. Participating in sports is also possible in later childhood (6-12 years). At this age, speed, coordination, or balance restrictions may become apparent.

GMFCS 1

Your child can move around independently (with or without an orthosis, such as an arm or leg splint). Mobility is hardly restricted, and depending on age, activities such as walking, climbing stairs without using hands for support, running, and jumping are possible. Participating in sports is also possible in later childhood (6-12 years). At this age, speed, coordination, or balance restrictions may become apparent.

GMFCS 2

Your child can move around independently to a limited extent (with or without an orthosis, such as an arm or leg orthosis). Mobility is slightly restricted, and depending on age, your child can stand and walk on stable ground. However, uneven ground or outdoor environments may be more difficult. Climbing stairs is possible with handrails but running and jumping skills are limited. In older children (6-12 years), a mobility aid may be needed for sports.

GMFCS 3

Your child can move around independently with the use of a mobility aid such as a walker, crutches, or self-propelling wheelchair. For longer distances or on uneven ground your child may require assistance. Your child may be able to climb stairs with support from an adult or holding on to the railing. To participate in physical activity or sports in later childhood (6-12 years), your child may require a mobility aid such as a wheelchair.

GMFCS 4

Your child has limited ability to move around independently, and walking is very limited, even with the use of orthotic devices. Children that can walk will use a walker, and changes in direction and uneven ground can cause problems. Your child will tend to use a wheelchair most of the time, which may be self-propelling or electric. Participating in physical activity and sports require assistance from a second person or adapted mobility aids such as an electric wheelchair.

GMFCS 5

Your child is driven in a wheelchair or buggy, or they use an electric wheelchair. Conscious movements are severely restricted and your child's ability to hold their head up against gravity, or sit independently is not possible. Your child cannot walk independently by may be able to use an electric wheelchair. Adapted mobility aids such as an electric wheelchair are required for participation in sports.

Treatment

Improving the mobility of children with Cerebral Palsy.

Treatment of Cerebral Palsy will depend on your child's symptoms and how they affect their daily life. The goal of physical therapy is to improve motor skills, and regular appointments are used to keep track of how mobile your child is and how they are developing. This will help health professionals to provide the best possible support and treatment plan for your child. Preventive measures also play a major role to prevent muscle, shortening, and contractures as well as malpositions in the first place.

Many different specialists will work together to promote the mobility of your child with Cerebral Palsy. Planning the necessary therapeutic measures is, however, mainly the responsibility of the treating doctor. For movement therapy, your child is primarily cared for by Physiotherapists, Occupational Therapists, and Orthotists. Speech and Language Therapists may also be part of the treatment team to provide support in achieving the best outcomes and quality of life for your child and your family.

Physiotherapy

Physiotherapy is about enhancing mobility and maintaining or improving, range of movement. It is adapted to the individual needs of your child; in general, Physiotherapists will teach you as parents how activity and movement promotion can be integrated into everyday life. You will be shown how to handle certain situations, such as getting your child in and out of a wheelchair safely. Parents will also learn special movement exercises that they can use with or on their child at home to improve and maintain range in the muscles and increase strength.

Orthotic Devices

In order to promote and maintain joint function and overall mobility in those with Cerebral Palsy, Orthotists will prescribe appropriate orthotic devices. These can improve or prevent the shortening of muscles by holding the joint, for example, the ankle in the most appropriate position. Lower limb orthotics are often necessary for walking to improve the position of the foot and ankle and subsequently your child's walking pattern. An orthosis might also be given to improve the range in a joint so that it becomes more mobile.

The scissor gait can be treated, for example with a hip abduction orthosis (such as the Ottobock Cosa Junior) with pads on the inner thighs makes it easier for children with CP to walk without their legs crossing over each other. The pads in the trousers function as spacers. The orthosis can also be combined with other mobility aids, such as a wheelchair or lower limb orthosis. The latter often is a dynamic ankle-foot orthosis (AFO), such as the Ottobock WalkOn Reaction Junior. It is used in case of drop foot symptoms. There are many different styles of WalkOn AFOs, each with different functional characteristics. All styles support children in walking - even at different speeds and loads. Another assistive device is the Exopulse Mollii Suit, which is designed to relax tense, spastic muscles and relieve pain. It can be used in combination with physiotherapy.

Medications

In some cases of spastic cerebral palsy, various medications (either orally or as injections) can be used as part of the physical therapy. The goal of drug therapy is to relieve spasticity and pain. Which medications are suitable and whether they are needed or not is decided by the doctors based on your child’s symptoms and under the benefit-risk assessment. As every case of cerebral palsy is different, this is decided on an individual basis.

Development

What does Cerebral Palsy mean for your child's future mobility?

Many parents of children with Cerebral Palsy often feel uncertain about their child's future. Questions about how the physical impairments will affect development, and therefore the prospect of independence and active life, are often the primary focus. Although CP cannot be cured, maintaining and improving mobility are the goals of treatment, and specific support can improve mobility. More than half of the children with Cerebral Palsy are able to walk independently, with or without the use of an orthotic device.

Cerebral Palsy patient wears Ottobock's Exopulse Molii Suit and is sitting on the stairs

Your child’s independence.

In addition, the clinical presentation of Cerebral Palsy is widely variable depending on the extent of the injury to your child's brain. As a result, some children only have very slight limitations, and having an independent life is indeed possible. If the CP is severe, it is possible that those affected will be dependent on support for the rest of their lives. However, even in these cases, there are many mobility aids to promote and shape your child's independence and participation.

Cerebral Palsy patient is outside in the park

Teen Years: Growing & Adapting

Navigating your Teenage years with CP.

Lot’s of things are changing. Including how you move! Your teenage years are a time of constant change. To your body, to what interests you and what’s important to you. You’re experiencing new feelings, looking for new kinds of friends, and starting a new part of your life.

But that can be tough when you have Cerebral Palsy, as it can have a big impact on every part of your body, and especially on how your body moves. Being able to move freely is more important than ever when you want to go new places, try new hobbies, and do lots more on your own.

Teenage years bring physical, emotional, and social challenges. For those with CP, mobility issues can affect independence, self-confidence, and participation in activities.

Key Challenges & Adaptations

Increased Spasticity & Joint Stiffness: Growth spurts may worsen muscle tightness.
Gait Abnormalities: Walking patterns may change, requiring updated orthotics or mobility aids.
Pain & Fatigue: Overuse of muscles can lead to chronic pain and exhaustion.
Social Inclusion: Teens with CP may feel different but can benefit from peer support and self-advocacy.

Maintaining Mobility & Independence

Physical & Occupational Therapy: Adjusting treatments to accommodate growth and new physical challenges.
Assistive Devices: Custom wheelchairs, orthotics, and adaptive technology for greater independence.
Mental Health Support: Addressing self-esteem, anxiety, and social concerns through counselling and peer groups.

Encouraging independence and confidence is key to helping teens transition into adulthood successfully.

Find out what to expect - from a teen just like you!

Grown ups and doctors have a lot of the answers you need when you have CP. But while they want what’s best for you, sometimes it just helps to hear it from someone your age. Someone who’s going through the same experiences and changes as you. So to share what it’s like being a teen with CP, we asked a real expert. Let’s meet her!

Our Special Guest

Meet Moya-May!

Moya-May is 14 years old and she’s from Dublin, Ireland. She loves music, musical theatre, and writing poetry. But most of all she loves making people laugh.

Like a lot of kids with CP, her condition has a big impact on the way her body moves. Let’s meet her and find out more!

Watch now

Cerebral Palsy patient walks with her walker

Moya-May’s Tips

How to take on life’s new challenges with CP.

Moya-May has a real passion for helping others with disabilities like her. She loves to share what she’s learned about growing up with CP, so we asked her for some real-life advice in this special video series.

Being a teen with CP: Learning as you grow.

Being a teen can be tough for anyone. But it’s even more challenging when you’re living with a disability like CP. You want to do more on your own. And you want to feel accepted as you are. In this video, Moya-May talks about how important that is for her too. CP doesn’t have to make you feel different, she says. It’s okay to be who you are and to share how you’re feeling as your body changes and grows.

What to expect and how to get ready.

Everyone’s teen years are different, but there are still a lot of things that just about everyone goes through. Like wanting to know that people love and understand you. Moya-May says that starts with being kind and patient when people ask questions about you and your CP. She loves to share how things are for her. It helps everyone understand, accept, and care for each other.

Ottobock user Ricky plays with his children wearing the exopulse suit.

CP in Adulthood: New Challenges

Adulthood: Long-Term Management.

While Cerebral Palsy (CP) is a non-progressive condition, its symptoms can evolve and present new challenges in adulthood due to aging, lifestyle factors, and the long-term impact of the condition on the body. Below are the most common symptoms experienced by adults with CP:

Motor and Mobility Issues

Increased Muscle Stiffness and Spasticity: Tightness in muscles can worsen over time, muscle tone imbalances may lead to contractures (permanent tightening of muscles) and reduced flexibility.
Reduced Mobility: Walking or maintaining balance can become difficult, leading to increased reliance on mobility aids such as a walker or wheelchair.
Joint and Muscle Pain: Is often caused by abnormal posture, overuse, or arthritis.
Fatigue: Increased energy expenditure for routine activities due to inefficient movement patterns.
Muscle Weakness: Gradual weakening of muscles, can impact daily functions.

Motor and Mobility Issues

Increased Muscle Stiffness and Spasticity: Tightness in muscles can worsen over time, muscle tone imbalances may lead to contractures (permanent tightening of muscles) and reduced flexibility.
Reduced Mobility: Walking or maintaining balance can become difficult, leading to increased reliance on mobility aids such as a walker or wheelchair.
Joint and Muscle Pain: Is often caused by abnormal posture, overuse, or arthritis.
Fatigue: Increased energy expenditure for routine activities due to inefficient movement patterns.
Muscle Weakness: Gradual weakening of muscles, can impact daily functions.

Postural Changes

Joint Deformities: Development of contractures or scoliosis.
Poor Posture: Difficulty maintaining proper posture while sitting or standing.

Speech and Swallowing Problems

Dysarthria: Slurred or slow speech patterns.
Swallowing Difficulties (Dysphagia): Increased risk of choking or aspiration.

Chronic Pain

Pain in the muscles, joints, and nerves, is often due to years of abnormal muscle use and misalignment.

Cognitive and Mental Health Challenges

Cognitive Decline: Some adults may experience memory or concentration difficulties.
Mental Health Concerns: Higher risk of depression, anxiety, and emotional distress.
Social Isolation: Challenges in social integration and maintaining relationships.

Secondary Health Issues

Arthritis: Accelerated joint wear and tear.
Osteoporosis: Increased risk of bone fractures.
Incontinence: Bladder or bowel control issues.
Seizures: Some adults may continue to experience epileptic episodes.

Fatigue and Reduced Endurance & Post-Impairment Syndrome

Daily activities may become increasingly exhausting due to the extra effort required for movement and posture control.
Post-impairment syndrome is a common condition that occurs when you max out your body's energy repeatedly. If you have CP, you may use all your energy doing certain everyday tasks, such as climbing small flights of stairs or sweeping the floor.

Premature Aging

Adults with CP may experience physical aging earlier than the general population due to the strain on their muscles and joints over time.

The Future with CP

Although CP is lifelong, many individuals achieve independence and lead fulfilling lives with the right support. Early interventions, adaptive strategies, and a strong support network can help people with CP thrive at every stage of life.

Male person in the Ottobock Exopulse suit hugs a female person with a smile

Treatment Options for Cerebral Palsy.

While there is no cure, various treatments can help manage symptoms and improve quality of life. These include physiotherapy, occupational therapy, speech therapy, medications, assistive devices, and, in some cases, surgery. Early intervention and a personalised treatment plan are key to addressing the unique needs of each individual. Explore our site to learn more about CP, available treatment options, and resources for support and care.

Product Solutions

Product Solutions, Orthotic aids, and Mobility Aids.

Julius uses L300 Go and is a happy child

Functional Electrical Stimulation

Functional Electrical Stimulation (FES) systems are designed to lift your foot as you walk, improving your gait pattern, and make it smoother and safer.

Learn More

Support

Where to find support.

Your doctor is your first point of contact. Later, allied health professionals such as Physiotherapists, Orthotists, Occupational Therapists, and Speech and Language Therapists will be available to assist you if you need advice.

In addition to discussing cerebral palsy within your own family and circle of friends, networking with others in a similar situation can also be helpful.

Here are some organisations that can provide more information and support for Cerebral Palsy:

Scope - Advice, and support for young people
Action Cerebral Palsy - Raising awareness for children and young people with Cerebral Palsy
Brainwave - Helping children with disabilities reach their potential
Brain & Spine Foundation - Support for those affected by neurological problems

Cerebral Palsy: An Overview

Living with cerebral palsy

What is Cerebral Palsy?

What are the causes of Cerebral Palsy?

How will Cerebral Palsy affect my child's development?

Based on the individual symptoms, doctors can distinguish between different types or classifications of Cerebral Palsy. The following overview shows the form of Cerebral Palsy behind the medical terms.

What is Cerebral Palsy?

Early treatment of mobility

What is Cerebral Palsy?

Early treatment of mobility

What is Cerebral Palsy?

Types & Symptoms.

What does the GMFCS level say about my child's mobility?

Improving the mobility of children with Cerebral Palsy.

What does Cerebral Palsy mean for your child's future mobility?

Your child’s independence.

Navigating your Teenage years with CP.

Find out what to expect - from a teen just like you!

Meet Moya-May!

Meet Moya-May!

How to take on life’s new challenges with CP.

Being a teen with CP: Learning as you grow.

What to expect and how to get ready.

Adulthood: Long-Term Management.

The Future with CP

The Future with CP

Treatment Options for Cerebral Palsy.

Product Solutions, Orthotic aids, and Mobility Aids.

Where to find support.

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