Cerebral Palsy

Cerebral Palsy (CP) is a lifelong condition caused by a non-progressive injury to the developing brain. It most often occurs before, during or shortly after birth and affects movement, posture and coordination. Although the original brain injury does not worsen over time, its effects on the body can change and accumulate in adulthood, leading to pain, fatigue, joint problems and increasing difficulty with everyday activities.

Many people with CP are well supported in childhood but find that services and information become more fragmented in adult life. Adults with CP may notice new challenges with mobility, spasticity, pain, work, relationships and independent living.

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What Is Cerebral Palsy?

Cerebral Palsy is an umbrella term for a group of conditions affecting movement and posture due to damage to the developing brain. Key points:

• The brain injury is non-progressive – it does not continue to worsen.
• The effects on the body can change over time, especially with growth, ageing, pain, fatigue and lifestyle factors.
• CP can range from very mild movement difficulties to severe disability affecting mobility, communication and self-care.

Although Cerebral Palsy begins in early life, it is not just a paediatric condition. Increasing numbers of people are living into older adulthood with CP, and many require specialised adult neurorehabilitation at various points across the lifespan.

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Types of Cerebral Palsy

CP is commonly classified by the main movement pattern and the distribution of symptoms.

By Movement Pattern

• Spastic Cerebral Palsy
  • The most common type.
  • Increased muscle tone (stiffness), tight muscles and exaggerated reflexes.
  • Can lead to contractures, abnormal postures and difficulties with fine and gross motor skills.
• Dyskinetic (Athetoid / Dystonic) Cerebral Palsy
  • Involuntary movements, including twisting, writhing or jerky movements.
  • Muscle tone may fluctuate between too tight and too floppy.
  • Often affects face and upper body, making speech and eating more difficult.
• Ataxic Cerebral Palsy
  • Problems with balance, coordination and depth perception.
  • Unsteady, shaky or clumsy movements, especially when reaching or walking.
• Mixed Cerebral Palsy
  • Features of more than one type (for example, spasticity and dystonia).

By Distribution

• Hemiplegia – one side of the body is more affected (arm and leg on the same side).
• Diplegia – both legs are more affected than the arms.
• Quadriplegia – all four limbs and often trunk and orofacial muscles are significantly affected.

Understanding the pattern of CP is important for planning treatment, equipment and rehabilitation.

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Symptoms and Challenges in Adulthood

Although many adults with CP have developed strong coping strategies, new or changing problems often emerge with age.

Movement and Mobility

• Increased spasticity and stiffness, particularly in the legs, hips and shoulders
• Worsening gait, scissoring, toe-walking or crouch gait
• Difficulty with balance and transfers (moving from bed to chair, in/out of car)
• Greater reliance on walking aids, wheelchairs or powered mobility
• Increased risk of falls and injuries

Musculoskeletal Problems

• Joint pain and early-onset osteoarthritis (especially hips, knees, spine)
• Contractures (permanent muscle shortening), deformities and postural asymmetry
• Scoliosis and spinal pain
• Overuse injuries in less-affected limbs and the upper body, particularly in wheelchair users

Spasticity, Dystonia and Fatigue

• Spasticity and dystonia interfering with comfort, sleep and function
• Muscle spasms and clonus (rhythmic jerking)
• Fatigue that limits activity, work and social participation
• “Boom–bust” patterns – doing too much on good days, then crashing

Communication, Swallowing and Cognition

• Dysarthria (slurred or effortful speech)
• Communication difficulties, sometimes compounded by physical or cognitive changes
• Swallowing difficulties (dysphagia) and risk of choking, especially with more severe CP
• Cognitive and learning difficulties in some individuals, though many have average or above-average intelligence

Bladder, Bowel and Other Health Issues

• Bladder urgency, frequency, incontinence or retention
• Constipation and bowel management problems
• Respiratory issues, particularly with scoliosis or poor posture
• Increased risk of pressure damage due to reduced mobility

Emotional and Social Impact

• Anxiety and depression
• Challenges in work, education, relationships and parenting
• Loss of services when transitioning from paediatric to adult care
• Need for advocacy and support in navigating health and social care systems

These issues can significantly affect independence and quality of life, and often benefit from structured, goal-focused adult rehabilitation.

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Causes and Risk Factors

Cerebral Palsy is caused by damage to the developing brain. This can occur:

• Before birth (antenatal)
• Around the time of birth (perinatal)
• In early infancy (postnatal)

Possible contributing factors include:

• Premature birth and low birth weight
• Lack of oxygen to the baby’s brain (hypoxic–ischaemic injury)
• Brain haemorrhage or stroke in the fetus or newborn
• Severe jaundice or infections (such as meningitis or encephalitis)
• Maternal infections during pregnancy
• Genetic or developmental brain abnormalities
• Head injury in early childhood

In many cases, no single definite cause is identified.

The underlying brain injury is static, but the way the body responds to that injury can change over time, especially with growth, ageing, pain and lifestyle.

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Diagnosis

Cerebral Palsy is usually diagnosed in childhood by a paediatrician or paediatric neurologist based on:

• A detailed developmental history
• Examination of movement, tone, posture and reflexes
• Brain imaging (such as MRI) where needed
• Exclusion of progressive neuromuscular or metabolic diseases

In adulthood, the focus is less on making the initial diagnosis and more on:

• Understanding the current pattern of motor and functional problems
• Identifying secondary complications (contractures, arthritis, pain, fatigue, swallowing issues)
• Assessing how these are affecting independence, work, relationships and mental health
• Planning appropriate rehabilitation, equipment and support

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Management and Treatment

There is no cure for the underlying brain injury in CP, but targeted treatment and rehabilitation can significantly improve comfort, function and participation at all stages of life.

Spasticity and Movement Management

• Physiotherapy – stretching, strengthening, gait training, balance work and posture management
• Occupational therapy – optimising upper limb function, self-care tasks, and equipment use
• Orthotics – splints, ankle–foot orthoses (AFOs), seating inserts and other supports
• Medications to reduce spasticity and spasms (e.g. oral antispastic agents)
• Botulinum toxin injections for focal spasticity in specific muscles
• In selected cases, more advanced spasticity interventions (for example, intrathecal baclofen pumps or surgical procedures), usually via specialist centres

Management of Pain, Fatigue and Musculoskeletal Problems

• Assessment of joint health, posture and movement patterns
• Pain-relieving strategies: medication, hands-on therapy, positioning and pacing
• Hydrotherapy or aquatic therapy where available
• Energy conservation and fatigue management, balancing activity and rest
• Weight management and general fitness where possible

Posture, Seating and Mobility

• Specialist seating assessments and provision of wheelchairs and posture management systems
• Training in safe transfers and use of hoists or other equipment
• Environmental modifications at home and work to support independence

Communication, Swallowing and Cognition

• Speech and language therapy to support speech clarity, communication strategies and augmentative/alternative communication (AAC) where needed
• Swallowing assessment and management plans (texture modification, posture, exercises)
• Cognitive strategies and support for organisation, planning and memory where relevant

Emotional Wellbeing and Social Participation

• Psychological support for anxiety, depression, adjustment and self-esteem
• Support around relationships, sexuality, parenting and family roles
• Vocational rehabilitation and help with returning to or maintaining employment or education
• Social care input around care packages, direct payments and support workers

Effective management is usually multidisciplinary, with health and social care teams working together.

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How We Can Help at The Royal Buckinghamshire Hospital

The Royal Buckinghamshire Hospital provides consultant-led inpatient neurorehabilitation for adults with Cerebral Palsy who need a period of intensive, coordinated input to address significant changes or challenges.

We typically work with adults who:

• Are experiencing increasing spasticity, pain, fatigue or falls
• Have noticed a step change in mobility or independence
• Are dealing with new or worsening problems with self-care, transfers, seating or equipment
• Need comprehensive review and optimisation of posture, seating, mobility aids and home setup
• Are planning for a change in circumstances (e.g. moving home, starting or maintaining employment, changes in care arrangements)

Our Multidisciplinary Approach

Programmes are tailored to each person’s goals and may include:

• Rehabilitation medicine
  • Overall medical leadership and coordination
  • Spasticity management, including medication and consideration of interventions
  • Management of pain, fatigue and other associated conditions
• Neurophysiotherapy
  • Mobility, balance and gait training
  • Strength and conditioning within safe limits
  • Spasticity, posture and contracture management
  • Falls risk assessment and prevention strategies
• Occupational therapy
  • Self-care, domestic tasks and community activities
  • Fatigue and energy management
  • Assessment and provision of equipment and home adaptations
  • Seating, wheelchair and posture management in collaboration with physio
  • Vocational rehabilitation and advice on work or education
• Speech and language therapy
  • Communication and conversation strategies
  • Support with communication aids where required
  • Swallowing assessment and management for dysphagia
• Neuropsychology / clinical psychology
  • Support with mood, anxiety, adjustment and long-term coping
  • Strategies for managing fatigue, motivation and behaviour
  • Support for families and carers where helpful
• Specialist nursing and rehabilitation assistants
  • 24-hour implementation of therapy recommendations
  • Promoting independence on the ward
  • Support with complex care needs where present

We work closely with community services, wheelchair and equipment providers, social care and employers to ensure that progress made during admission is supported after discharge.

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When to Seek Medical or Rehabilitation Advice

This page provides general information and is not a substitute for individual medical advice.

You should consider seeking review from your GP, neurologist, rehabilitation consultant or specialist therapist if you:

• Notice increasing pain, stiffness or problems with mobility
• Are experiencing more falls or near-misses
• Struggle more with self-care, transfers, work or daily tasks than before
• Have new difficulties with swallowing, breathing or weight loss
• Feel low, anxious or overwhelmed by changes in your function or circumstances

Urgent medical help (999 or emergency department) is needed if you experience:

• Sudden new neurological symptoms (such as weakness, loss of sensation or acute vision problems)
• Severe chest pain, shortness of breath or signs of infection with confusion
• A significant injury after a fall (for example, suspected fracture or head injury)

Your usual clinical team can help decide whether community-based support, outpatient therapy or a period of inpatient rehabilitation at The Royal Buckinghamshire Hospital would be most appropriate at a particular time.