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| CEREBRAL PALSY |
Cerebral palsy, commonly called CP, is a lifelong condition that mainly affects movement, posture, balance and coordination.
It begins because of abnormal development of the brain or damage to the developing brain, usually before birth, around the time of birth or during early infancy.
Cerebral palsy is not contagious, and it is not something a child can pass to another person.
It is also important to understand that cerebral palsy does not automatically mean intellectual disability. Some people with CP have typical intelligence, while others may also have learning, communication or cognitive difficulties.
With appropriate healthcare, rehabilitation, education, assistive technology and family support, many people with cerebral palsy can study, work, build relationships and participate actively in their communities.
What Is Cerebral Palsy?
Cerebral palsy is a group of disorders affecting a person's ability to move, maintain posture and balance.
It is the most common motor disability beginning in childhood.
The word cerebral refers to the brain, while palsy refers to problems with movement or muscle control.
CP develops because the parts of the developing brain responsible for movement and posture have developed abnormally or have been injured.
The condition can affect people very differently.
One person may have only mild difficulty walking, while another may require substantial assistance with movement, communication, feeding and daily activities.
Is Cerebral Palsy Progressive?
Cerebral palsy is considered a non-progressive neurological condition.
This means that the original injury or abnormality in the brain does not continuously spread or deteriorate in the way some progressive neurological diseases do.
However, this does not mean that CP simply gets better with age.
A person's needs and symptoms can change throughout life.
For example, people with cerebral palsy may develop:
muscle tightness;
joint stiffness;
contractures;
hip problems;
chronic pain;
fatigue;
difficulties with mobility; or
other secondary health complications.
Some abilities may improve with therapy and development, while other difficulties can become more noticeable as the body grows or ages.
What Causes Cerebral Palsy?
Cerebral palsy results from abnormal brain development or damage to the developing brain.
The timing and reason for this can vary.
Before birth
Many cases begin before labour starts.
Possible contributing conditions include:
abnormal brain development;
genetic or developmental abnormalities;
certain infections during pregnancy;
reduced blood or oxygen supply affecting the developing brain;
fetal stroke; and
complications affecting the placenta.
Around the time of birth
In some cases, injury can occur around delivery.
Severe interruption of oxygen supply to the brain can cause cerebral palsy, although lack of oxygen during birth accounts for only a proportion of cases.
Complications associated with extreme prematurity and serious neonatal illness may also contribute.
After birth
Brain injury during infancy can also cause cerebral palsy.
Possible causes include:
meningitis or encephalitis;
stroke;
serious head injury;
severe untreated jaundice leading to kernicterus; and
other conditions causing significant injury to the developing brain.
In many children, however, one definite cause cannot be established.
Risk Factors for Cerebral Palsy
A risk factor increases the likelihood of cerebral palsy but does not mean a child will definitely develop it.
Important risk factors can include:
Premature birth
Babies born very prematurely have a higher risk because their brains are still developing and are more vulnerable to injury.
Low birth weight
Very low birth weight is associated with increased risk.
Multiple pregnancy
Twins, triplets and other multiple births may have increased risk, partly because of higher rates of premature delivery and low birth weight.
Certain infections during pregnancy
Some maternal infections can affect fetal brain development.
Severe newborn illness
Serious infections, stroke, severe jaundice and other neonatal complications can increase risk.
Problems affecting blood or oxygen supply to the brain
Certain pregnancy, delivery or newborn complications can affect the brain's blood and oxygen supply.
A risk factor should never automatically be interpreted as proof that a parent, mother or healthcare worker caused a child's cerebral palsy.
What Are the Early Signs of Cerebral Palsy?
Signs can vary according to age and severity.
In some babies, differences are recognised within the first few months of life. In others, they become clearer as expected developmental milestones are delayed.
Possible early signs include:
unusually stiff or unusually floppy muscles;
poor head control;
difficulty feeding;
unusual posture;
persistent use of one side of the body;
delayed rolling, sitting, crawling or walking;
abnormal or persistent reflexes;
difficulty controlling movements; and
unusual movement patterns.
Parents may also notice that a baby feels unusually stiff when being dressed or lifted or seems unusually floppy.
Developmental Signs That Need Assessment
Development varies between children, so a single delayed milestone does not automatically mean cerebral palsy.
However, concerns should be discussed with a healthcare professional.
Examples include a child who:
has difficulty controlling the head;
has persistent stiffness or floppiness;
does not use both hands or sides of the body similarly;
develops unusual movements;
appears to lose previously acquired abilities; or
shows significant delays in motor development.
Loss of abilities that a child had already developed is particularly important.
Cerebral palsy itself is non-progressive, so loss of previously acquired skills can suggest another neurological condition and requires medical assessment.
Can Cerebral Palsy Be Diagnosed Early?
Yes.
It is no longer considered necessary to wait until a child is two years old when there are clear risk factors or clinical signs.
Early identification allows appropriate intervention to begin sooner.
Specialist teams may use a combination of:
developmental history;
neurological examination;
assessment of spontaneous infant movements;
standardised motor assessments; and
brain imaging such as MRI.
For high-risk babies younger than about five months corrected age, tools such as the General Movements Assessment, together with MRI where appropriate, can help identify CP early.
For older infants, structured neurological examinations such as the Hammersmith Infant Neurological Examination may contribute to assessment.
AACPDM guidance strongly supports early detection because delaying diagnosis can also delay useful intervention.
How Is Cerebral Palsy Diagnosed?
There is no single blood test that confirms cerebral palsy.
Diagnosis is clinical and usually involves assessing:
developmental history;
pregnancy and birth history;
movement patterns;
posture;
reflexes;
muscle tone;
coordination;
developmental milestones; and
neurological findings.
MRI may help identify abnormalities or injuries in the brain and can sometimes provide information about the likely cause.
Other investigations may be considered if the child's presentation is unusual or another neurological or genetic disorder is suspected.
What Are the Main Types of Cerebral Palsy?
Cerebral palsy is usually classified according to the predominant type of movement disorder.
The principal motor types are:
Spastic cerebral palsy
Dyskinetic cerebral palsy
Ataxic cerebral palsy
Mixed cerebral palsy
The old classification of "hypotonic cerebral palsy" as a separate major type is not generally used in modern CP classification.
Low muscle tone can occur, particularly early in life, but hypotonia may also suggest other neurological conditions and requires careful assessment.
Spastic Cerebral Palsy
Spastic cerebral palsy is the most common form.
Spasticity means that muscles have increased tone and can feel stiff or tight.
This can make movement more difficult and may affect walking, posture and use of the arms or hands.
The pattern can vary according to which parts of the body are affected.
Unilateral spastic cerebral palsy
One side of the body is predominantly affected.
The arm is often more affected than the leg, although this varies.
A child may begin using one hand much earlier than expected or have difficulty using one side.
This has historically been called spastic hemiplegia.
Bilateral spastic cerebral palsy
Both sides of the body are affected.
In some individuals, the legs are much more affected than the arms. This pattern has historically been called spastic diplegia.
In others, both arms and legs are substantially affected. Older terminology may describe this as spastic quadriplegia.
Modern descriptions increasingly focus on the person's functional abilities and which limbs are affected rather than relying only on older labels.
Dyskinetic Cerebral Palsy
Dyskinetic cerebral palsy involves involuntary movements that can interfere with posture and voluntary movement.
The movements may include:
Dystonia
Repeated or sustained muscle contractions can lead to twisting movements or abnormal postures.
Choreoathetosis
Movements may be irregular, unpredictable, slow or writhing.
Muscle tone may fluctuate between being too high and too low.
Dyskinetic CP can affect:
arms and legs;
trunk;
face;
tongue;
speech;
swallowing; and
posture.
A person's ability to understand language or think should never be judged simply from difficulty speaking or controlling movement.
Ataxic Cerebral Palsy
Ataxic cerebral palsy primarily affects balance and coordination.
A person may have:
an unsteady walk;
difficulty with precise movements;
tremor;
poor balance;
difficulty judging distance;
difficulty performing quick movements; or
speech difficulties.
Fine motor tasks such as writing, fastening clothing or reaching accurately for objects may also be affected.
Mixed Cerebral Palsy
Some people show features of more than one motor type.
For example, a person may have both spasticity and dystonia.
This is referred to as mixed cerebral palsy.
How Severe Can Cerebral Palsy Be?
Severity varies enormously.
Healthcare professionals often describe function rather than simply saying that someone has mild, moderate or severe CP.
One commonly used system is the Gross Motor Function Classification System, or GMFCS.
It groups gross motor function into five levels based on abilities such as sitting, walking and use of mobility equipment.
Other classification systems examine:
hand function;
communication;
eating and drinking ability; and
other aspects of everyday function.
These systems can help families and healthcare professionals plan support.
They are not measurements of a person's intelligence or worth.
Conditions That Can Occur Alongside Cerebral Palsy
Cerebral palsy mainly affects movement and posture, but some people have additional health or developmental conditions.
These may include:
Epilepsy
Seizures are more common among people with cerebral palsy than in the general population.
Communication difficulties
CP may affect the muscles involved in speech.
Some people communicate verbally, while others may use communication boards, symbols, eye-gaze technology or speech-generating devices.
Feeding and swallowing difficulties
Problems controlling the muscles involved in chewing and swallowing can affect nutrition and increase the risk of food or fluid entering the airway.
Vision problems
Some children have visual impairment or difficulties with how the brain processes visual information.
Hearing problems
Hearing impairment can occur and should be assessed when suspected.
Learning or intellectual disability
Some people with CP also have intellectual disability, while many do not.
Motor or speech impairment should not automatically be interpreted as reduced intelligence.
Pain
Pain can result from spasticity, joint problems, hip displacement, muscle contractures or other causes.
Sleep problems
Sleep disturbance can affect both children and families.
Bladder and bowel problems
Constipation and urinary difficulties may occur.
Mental-health and emotional difficulties
Children, adolescents and adults with CP can experience anxiety, depression and other emotional difficulties just like anyone else.
Mental-health needs should form part of comprehensive care.
Cerebral Palsy and Breathing Problems
Some people with more severe cerebral palsy are at increased risk of respiratory problems.
Swallowing difficulties can allow food, drinks or saliva to enter the airway, a process called aspiration.
This can contribute to recurrent chest infections or pneumonia.
Persistent coughing during meals, choking or recurrent pneumonia should therefore be assessed.
Is Cerebral Palsy an Intellectual Disability?
Not necessarily.
Cerebral palsy primarily affects movement and posture.
A person may have completely typical intellectual ability while experiencing substantial difficulty controlling muscles or speaking.
Other people may have both cerebral palsy and an intellectual or learning disability.
It is therefore important not to judge someone's intelligence based on their walking pattern, facial movements, speech or need for a wheelchair.
Can People With Cerebral Palsy Walk?
Many can.
Some people walk independently.
Others may walk with:
braces;
crutches;
walking frames; or
other mobility aids.
Some people primarily use wheelchairs.
The goal should not always be walking at any cost.
The more important goals are safe mobility, independence, participation, comfort and quality of life.
For some people, a wheelchair greatly increases independence rather than representing a failure of treatment.
Is There a Cure for Cerebral Palsy?
There is currently no treatment that reverses the original brain abnormality responsible for cerebral palsy.
However, this does not mean there is nothing that can be done.
A wide range of interventions can improve:
movement;
comfort;
communication;
independence;
nutrition;
participation;
learning; and
quality of life.
Treatment should be based on the individual's goals and needs.
How Is Cerebral Palsy Treated and Managed?
Cerebral palsy usually requires multidisciplinary care.
The care team may involve:
paediatricians;
neurologists;
rehabilitation specialists;
physiotherapists;
occupational therapists;
speech and language therapists;
dietitians;
psychologists;
orthopaedic specialists;
nurses;
educators; and
social-care professionals.
Not every person needs every service.
Physiotherapy
Physiotherapy can help with:
movement;
strength;
balance;
positioning;
mobility;
maintaining range of motion; and
participation in everyday activities.
Modern rehabilitation should be linked to meaningful goals rather than simply repeating exercises without a clear purpose.
Occupational Therapy
Occupational therapy can help a child or adult participate more independently in everyday tasks such as:
dressing;
feeding;
writing;
playing;
school activities;
work; and
personal care.
Therapists may also recommend adaptive equipment or changes to the person's environment.
Speech and Language Therapy
Speech and language therapists can assess and support:
speech;
language;
communication;
feeding; and
swallowing.
Some people benefit from augmentative and alternative communication, including communication boards, tablets or eye-gaze technology.
Being unable to speak clearly does not mean a person has nothing to communicate.
Medicines for Spasticity and Dystonia
Medication may be considered when increased muscle tone causes pain, interferes with function or contributes to complications.
Options depend on the person's needs and can include medicines such as:
baclofen;
diazepam;
botulinum toxin injections in selected muscles; and
other specialist treatments.
Medication should be prescribed and monitored by clinicians familiar with cerebral palsy because benefits and side effects vary.
The old approach of listing medicines such as gabapentin, topiramate, antidepressants and anti-inflammatory drugs as routine "cerebral palsy medications" is misleading.
These drugs may sometimes be used for specific associated conditions such as epilepsy, neuropathic pain or mental-health conditions, but they do not generally treat cerebral palsy itself.
Treatment of Epilepsy
If a person with CP also has epilepsy, antiseizure medication may be prescribed according to the type of seizures and individual medical circumstances.
Cerebral palsy alone is not an indication for taking an anticonvulsant.
Orthotics and Assistive Equipment
Depending on the person's needs, equipment may include:
ankle-foot orthoses;
adapted seating;
standing equipment;
walkers;
crutches;
wheelchairs;
positioning equipment; and
communication devices.
Appropriate assistive technology can improve independence and participation.
Surgery
Some people may benefit from surgery when muscle or skeletal problems significantly affect function, comfort or health.
Examples can include:
orthopaedic surgery for contractures or deformities;
surgery for hip problems; and
selective dorsal rhizotomy for carefully selected people with significant spasticity.
Surgery is not appropriate for everyone and should form part of an individual multidisciplinary treatment plan.
Hip Surveillance
Children with cerebral palsy can be at increased risk of gradual displacement of the hip, particularly those with more limited mobility.
Regular hip surveillance may therefore be recommended according to the child's age and functional classification.
Identifying hip displacement early can allow treatment before severe pain or dislocation develops.
Feeding and Nutrition
Some children with CP have difficulty chewing, swallowing or maintaining adequate nutrition.
Assessment may involve speech and language therapists, dietitians and medical specialists.
Interventions can include:
safer food textures;
changes in feeding position;
nutritional supplementation; or
tube feeding in selected circumstances.
The aim is adequate nutrition, safe swallowing and a feeding plan that works for the child and family.
Early Intervention Matters
Early intervention does not cure cerebral palsy, but beginning appropriate support early can help children develop skills during important periods of brain development.
Intervention may focus on:
movement;
play;
communication;
hand function;
feeding;
family education; and
participation in everyday activities.
Families should be active partners in setting meaningful goals.
What Parents Should Do If They Are Concerned
Parents should speak with a healthcare professional if they notice persistent problems with movement, posture, muscle tone or development.
Do not rely only on advice to "wait and see" when significant developmental concerns are present.
Ask for a proper developmental and neurological assessment.
Children suspected of having cerebral palsy should have access to multidisciplinary assessment and early intervention where services are available.
Can Cerebral Palsy Be Prevented?
Not every case can be prevented.
However, some measures can reduce the risk of brain injury associated with CP.
These include:
appropriate antenatal care;
prevention and treatment of infections;
safe childbirth care;
good neonatal care for premature babies;
appropriate treatment of severe newborn jaundice;
vaccination against infections that can cause meningitis;
prevention of serious head injuries; and
timely management of severe childhood illness.
Prevention should not become a reason to blame parents when a child develops cerebral palsy.
In many cases, no single preventable event can be identified.
Living With Cerebral Palsy
A diagnosis of cerebral palsy should not define a person's entire identity.
Children and adults with CP can participate in education, employment, relationships, family life, sport, recreation and community activities.
Barriers often arise not only from the physical condition itself but from:
inaccessible buildings;
lack of assistive devices;
communication barriers;
stigma;
discrimination;
limited educational support; and
inadequate rehabilitation services.
Improving inclusion therefore involves both healthcare and society.
Cerebral Palsy Myths and Facts
Myth: Cerebral palsy gets progressively worse.
Fact: The original brain disturbance is non-progressive, although secondary health and musculoskeletal problems can change over time.
Myth: Everyone with cerebral palsy has an intellectual disability.
Fact: Intellectual ability varies widely. Many people with CP have typical intelligence.
Myth: Someone who cannot speak clearly cannot understand you.
Fact: Speech difficulty does not automatically indicate reduced understanding or intelligence.
Myth: Cerebral palsy is contagious.
Fact: It is not an infectious disease and cannot be transmitted between people.
Myth: Every case of cerebral palsy happens because something went wrong during childbirth.
Fact: Many cases originate before birth, and the exact cause is sometimes unknown.
Myth: Children with cerebral palsy cannot live fulfilling lives.
Fact: With appropriate support and accessible environments, people with CP can participate meaningfully in family, education, employment and community life.
Frequently Asked Questions
What is the first sign of cerebral palsy?
There is no single first sign. Possible early signs include abnormal muscle tone, unusual movements, poor head control, asymmetry and delayed motor development.
At what age is cerebral palsy diagnosed?
Some high-risk infants can now be identified during the first months of life using specialist assessments. Other children are diagnosed later when movement or developmental differences become clearer.
Does cerebral palsy affect intelligence?
Not necessarily. Some people have intellectual disability, while others have average or above-average intellectual ability.
Can cerebral palsy get worse?
The brain injury itself does not progressively worsen, but secondary problems such as pain, joint changes and muscle contractures can develop or change over time.
Can cerebral palsy be cured?
There is currently no cure that reverses the underlying brain abnormality, but treatment and rehabilitation can substantially improve function, comfort, independence and quality of life.
Can a child with cerebral palsy walk?
Many children do walk, either independently or with mobility aids. Others use wheelchairs for efficient and safe mobility.
Can someone with cerebral palsy live a long life?
Yes. Many people with CP live well into adulthood. Life expectancy varies according to the severity of impairment and associated medical complications.
Is cerebral palsy inherited?
Most cerebral palsy is not inherited in a simple way. Genetic factors may contribute to some cases, and genetic evaluation may sometimes be recommended when the clinical history suggests it.
The Bottom Line
Cerebral palsy is a lifelong neurological condition caused by abnormal development or injury of the developing brain.
It mainly affects movement, posture and balance, but each person's experience is different.
The condition itself is non-progressive, although a person's physical and health needs can change over time.
There is currently no cure that reverses the underlying brain disturbance, but early identification, rehabilitation, appropriate medical treatment, assistive technology, education and family support can make a major difference.
Most importantly, cerebral palsy should never be used to make assumptions about a person's intelligence, potential or quality of life.
The goal of care is not simply to make someone move in a particular way.
It is to help each person achieve the greatest possible health, independence, participation and quality of life.
References
Centers for Disease Control and Prevention. (2026). Cerebral Palsy (CP). CDC.
National Institute for Health and Care Excellence. Cerebral palsy in under 25s: assessment and management. NICE guideline NG62.
American Academy for Cerebral Palsy and Developmental Medicine. Early Detection of Cerebral Palsy Care Pathway.
American Academy for Cerebral Palsy and Developmental Medicine. Cerebral Palsy Care Pathways.
World Health Organization. Package of interventions for rehabilitation: Cerebral palsy.
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