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Cerebral Palsy

Cerebral Palsy Overview







Population Characteristics:1,2

  • Prevalence: 764,000 children and adults have cerebral palsy (CP) in the US 
    • Range of 2.3 to 3.6 per 1,000 Americans have CP
  • Incidence: 8,000-10,000 new cases of CP per year in the US
  • 500,000 children under the age of 18 years have CP in the US
  • Between 61% to 76.9% of CP cases are spastic CP
    • 30% of spastic CP are unilateral involvement
    • 69% have bilateral involvement
    • ~.7% are "unaccounted" spastic CP


  • CP is a broad umbrella term for a variety of neurological disorders that occur as an infant or in early childhood that are permanent and non-progressive over time. Consequently, there are a variety of causes for CP, of which most are environmental and are exacerbated by genetic predisposition. These causes include:
    • Strokes
    • TBI's
    • CNS infections (eg meningitis, encephalitis)
    • Malnutrition
    • Infections passed down from the mother
    • Hypoxemia

Signs and Symptoms:4,5,6

  • The signs and symptoms seen in CP varies greatly in terms of:
    • Severity of symptoms
    • Location of symptoms
      • Unilateral or bilateral involvement
      • Upper and/or lower extremity involvement
  • Spastic CP symptoms:
    • Increased mm tension and joint contractures, leading to subsequent hypomobiliy
    • Abnormal gait: Increased bilateral hip flexion/adduction, knee flexion, and ankle plantarflexion throughout gait cycle
    • Muscle weakness and/or paralysis
    • Decreased motor control and balance
    • Hyperreflexia and clonus
  • Additional CP symptoms: 
    • Vision/hearing/speech problems
    • Learning/cognitive/behavioral abnormalities
    • Seizures
    • Scoliosis
    • Respiratory, bowel, and bladder dysfunction 
    • Delayed progression through motor milestones
    • Decreased coordination
    • Dystonia or chorea


  • No single diagnostic test exists for CP, as a comprehensive neurological examination is required in order to make an accurate diagnosis
    • The neurological exam emphasizes recognition of cardinal symptoms of CP such as presence of hyperreflexia, clonus, and dystonia 
    • CT and MRI scans are used as an additional diagnostic tool in order to assess physical neurological insult to the CNS
      • Roughly 17% of CP cases have no abnormal findings on MRI or CT images; consequently the diagnosis is based primarily upon clinical findings


  • The prognosis of CP is highly dependent upon the severity and number of symptoms present
  • Prematurity of birth and low birth weight are associated with better survival rates 
  • ~90% of children with CP survive to adulthood
    • A 2-year-old with severe CP has a 40% chance of living to 20 years while those with mild cases of CP have a 99% chance of living to 20 
  • Prognosis of walking is improved when:
    • A child is independent in sitting by age of 2
    • Is able to crawl between 1.5-2.5 years 

Physical Therapy Interventions:10-15

  • Intensive practice of task-specific, goal-oriented activities is advocated in terms of improving functional outcomes
  • Constraint-induced therapy and bimanual training that are goal-directed are equally effective in improving individualized outcomes in upper extremity functioning
  • Strength training has been shown to increase strength and motor activity without adverse effects
  • Treadmill training has been shown to have "encouraging results"12 in improving gait 
  • Motor learning coaching has been shown to have a significantly greater effect on motor function and mobility than neurodevelopmental techniques 
  • Passive stretching alone has not been shown to be efficacious 
  • Equipment device perscreption/education and recommending/fitting of orthoses with orthotist







1. Yeargin-Allsopp M, Van Naarden Braun K, Doernberg NS, et al. Prevalence of cerebral palsy in 8-year-old children in three areas of the United States in 2002: a multisite collaboration. Pediatrics. 2008;1232(3): 547-554. 

2. Prevalence and incidence of cerebral palsy. MyChild Web site. Available at: Accessed April 29, 2014. 

3. Marret S, Vanhulle C, Laquerriere A. Pathophysiology of cerebral palsy. Handb Clin Neurol. 2013;111: 169-176.

4. Cerebral palsy. Johns Hopkins Medicine Web site. Available at: Accessed April 29, 2014. 

5. Cerebral palsy. PubMed Health Web site. August 22, 2013. Available at: Accessed April 29, 2014.

6. Rossi R, Alexander M, Cuccurullo S. Cerebral Palsy (CP) In: Cuccurullo S, editor. PHysical Medicine and Rehabilitation Board Review. New York: Demos Medical Publishing; 2004. Available at: Accessed April 29, 2014. 

7. Korzeniewski SJ, Birbeck G, DeLano MC, et al. A systematic review of neuroimaging for cerebral palsy. J Child Neurol. 2008;23(2): 216-217. 

8. Hutton JL. Cerebral palsy life expectancy. Clin Perinatol. 2006;33(2): 545-555.

9. Hemming K, Hutton JL, Colver A, et al. Regional variation in survival of people with cerebral palsy in the United Kingdom. Pediatrics. 2005;116(6); 1383.

10. Sakzewski L, Ziviani J, Boyd RN. Efficacy of upper limb therapies for unilateral cerebral palsy: a meta-analysis. Pediatrics. 2014;133(1): e175.

11. Sakzewski L, Ziviani J, Abbott DF, et al. Randomized trial of constraint-induced movement therapy and bimanual training on activity outcomes for children with congenital hemiplegia. Dev Med Child Neurol. 2011;53(4): 313-320. 

12. Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of strength-training programs for people with cerebral palsy. Arch Phys Med Rehabil. 2022;83(8): 1157-1164.

13. Bar-Haim S, Harries N, Nammourah I, et al. Effectiveness of motor learning coaching in children with cerebral palsy: a randomized controlled trial. Clin Rehabil. 2010;24(11): 1009-1020.

14. Wiart L, Darrah J, Kembhavi G. Stretching with children with cerebral palsy: what do we know and where are we going? Pediatr Phys Ther. 2008;20: 173-178.

15. Damiano DL, Alter KE, Chambers H. New clinical and research trends in lower extremity management for ambulatory children with cerebral palsy. Phys Med Rehabil Clin N Am. 2009;20(3): 469-491.