What is Cerebral Palsy?

Cerebral Palsy is a condition that affects muscle control and movement. It's usually caused by an injury to the brain before, during or after birth. Children with a diagnosis of Cerebral Palsy may have difficulties in controlling muscles and movements as they grow and develop.

There is no cure for cerebral palsy, but physiotherapy and other therapies can often help people with Cerebral Palsy become more independent.

There are 3 main types of Cerebral Palsy. Many people will have a mixture of these types.

Spastic Cerebral Palsy
Present in around 75-88% of people with cerebral palsy, spasticity means the muscle tone is tight and stiff causing a decreased range of movement. As the muscle tone is so tight, spasticity can be very painful with muscles often going into spasm. It can affect many different areas of the body.

Dyskinetic Cerebral Palsy
Sometimes referred to as dystonic, athetoid or choreoathetoid cerebral palsy. It's present in about 15% of people with cerebral palsy. Dyskinetic cerebral palsy causes uncontrolled, involuntary, sustained or intermittent muscle contractions as the muscle tone changes from tight to loose, often accompanied with slow, rhythmic movements. The whole body can be affected which can make it difficult to maintain an upright position. Speech can also be affected as the person may experience difficulty in controlling the tongue, vocal chords and breathing.

Ataxic Cerebral Palsy
Ataxia is defined as an inability to activate the correct pattern of muscles during movement. Balance is affected and the person may have poor spatial awareness or find it difficult to judge their body position in relation to things around them. It's present in about 4% of people with Cerebral Palsy and can affect the whole body. Most people with Ataxic Cerebral Palsy can walk but they will be unsteady with shaky movements. Speech and language can also be affected.

Mixed Cerebral Palsy
Many people with Cerebral Palsy will have a combination of the above types. You may also come across terms such as Hemiplegia or Diplegia. These terms refer to the part of the body affected by the Cerebral Palsy. For example, Hemiplegia means that the person is affected on one side of the body. Diplegia is where two limbs are affected. Monoplegia where one limb is affected and Quadriplegia where all four limbs are affected.

Mealtime Difficulties

This brief introduction to some of the issues around mealtimes, for those with Cerebral Palsy is a guidance, not exhaustive, nor about diagnosis, but information for staff and others working with our pupils with CP

Bite reflex
This is when the person being fed immediately 'locks' their mouth onto anything that is introduced into it. They have no control of this and it may only happen occasionally. Sometimes a speech and language therapist can advise on techniques that may help with this and demonstrate how to 'unlock' the jaw if the reflex occurs. The use of a plastic spoon will lessen the chance of injury to the mouth or damage to the teeth.

Choking
Choking is often caused by poor positioning of the head and trunk. Regular choking can cause considerable anxiety at mealtimes for both the enabler and the disabled person. In the worst case scenario it may even result in death. Receiving advice about how to react to choking may help lessen any anxiety and make those concerned more confident that they know how to react in an emergency. A doctor, physiotherapist or speech and language therapist should be able to advise. Persistent choking should always be investigated by the doctor.

Constipation
This is common in people with cerebral palsy, especially if they have reduced mobility. An underlying medical problem, poor diet and/or inadequate fluid intake may be the cause. Often the situation can be improved by adding more fruit, vegetables and whole grains to the person’s diet. If the problem is happening frequently, seek medical advice.

Diet
A nourishing and balanced diet is an important factor in maintaining health and well-being. This can sometimes be difficult to do for some people who experience difficulty eating, especially if they can only eat certain types of food or can only manage small amounts. Some people with cerebral palsy experience a lot of involuntary movements. These movements burn up energy, which needs to be taken into account when the person’s diet is being planned. A person with cerebral palsy may need to consume extra calories to compensate for the additional movement. Sometimes a food supplement is suggested or prescribed to help ensure that a person’s nutritional needs are being met.

Health Visitors can advise on food consistencies and suitable diets. Speech and language therapists can also advise especially in relation to the food texture and consistency an individual will find most manageable.

Dysphagia
This is a technical term for swallowing difficulties.

Equipment and utensils
As children mature and begin to attempt to feed themselves, there are as number of utensils that may be helpful. Special plates, bowls, cups, adapted cutlery and non-slip mats to help keep the dish in place are all available. The Occupational Therapist should be able to advise on what equipment would be most appropriate and how it can be obtained.

Excessive drooling
This difficulty can be particularly troublesome for a person who has no awareness that they are dribbling or is unable to wipe their mouth themselves.

High palate
This is not uncommon in people with cerebral palsy. Should food gather in this space, it is likely to stick there. If this occurs it needs to be removed during the meal to avoid the possibility that it may later drop down and cause choking.

Hypersensitivity
Some disabled people will experience additional difficulty with eating because they are unusually sensitive to being touched on their face or in their mouth.

Positioning
Positioning is important for the disabled person to be in the best possible position for eating. This will vary from person to person depending on their medical condition. The physiotherapist or occupational therapist, together with the speech and language therapist, are the best people to advise on positioning.

Reflux
Reflux is a problem resulting in discomfort during or after eating. On occasions it may cause vomiting. There are several reasons for reflux such as medical or anatomical problems, allergy, or limited movement patterns.

Tongue thrust
This occurs when there is a strong, inappropriate and unconscious forward movement of the tongue that pushes food out of the mouth. This should not be confused with behaviour that looks similar but is really a conscious attempt by the person to communicate that they do not wish to eat what is in their mouth.

Tube or non-oral feeding
Tube feeding may be necessary for some people who are not able to suck or swallow adequately to get proper nutrition or to avoid food passing into the lungs rather than the stomach.

Vomiting
Frequent vomiting may be distressing for all. Sometimes the problem can be helped by improved positioning and avoiding lying down too soon after eating.