Mixed Cerebral Palsy: An Overview

Every parent’s greatest wish is to have a happy and healthy child, free from disease or pain. Watching their children struggle with painful joint contractures or impaired swallowing is a tough ordeal. Mixed Cerebral Palsy is a lifelong diagnosis, but treatment options are improving every day and your child can enjoy a high degree of functionality and independence with early intervention. Here, we delve deeper into what mixed type Cerebral Palsy looks like and the treatments available for it.

Understanding Mixed Cerebral Palsy

Cerebral Palsy refers to a group of neurological disorders that affect movement, muscle tone, coordination, and motor skills caused by damage or abnormalities in the developing brain. It is a non-progressive condition that occurs due to brain damage sustained before, during, or shortly after childbirth. The four unique types of Cerebral Palsy (apart from mixed CP) are Spastic CP, Ataxic CP, Hypotonic CP, and Athetoid CP. Cerebral Palsy has no ultimate cure, but tailored treatment programs can manage the symptoms to a considerable extent. 

In Mixed Cerebral Palsy, the patient exhibits symptoms of more than one of the above four types. It accounts for around 15.4% of all Cerebral Palsy cases, making it the second most common type of Cerebral Palsy. In patients with mixed type Cerebral Palsy, there is damage to multiple motor control centers in the brain. The symptoms will depend on where exactly the damage has been sustained.

How Mixed Cerebral Palsy occurs

In children with Mixed Cerebral Palsy, there occurs brain damage that affects multiple control centers of the brain. Depending on where the damage occurred and to what degree, there will be abnormalities in the way the child develops. In general, the types of brain damage that someone with mixed CP may have include:

  • Damage to the motor cortex: The motor cortex transmits signals to other parts of the brain that are responsible for motor function. Damage to the motor cortex is linked with Spastic Cerebral Palsy, and can cause muscle and joint spasticity.
  • Damage to pyramidal tracts: This type of brain damage is also associated with Spastic Cerebral Palsy, and disrupts the motor cortex’s ability to properly send signals to the pyramidal tracts. Children may experience a variety of mobility issues, including exaggerated muscle tone and trouble walking.
  • Damage to the cerebellum: The cerebellum is located at the bottom of the brain, close to the brainstem. Damage to the cerebellum is linked with Ataxic or Athetoid types of Cerebral Palsy. Children may experience trouble with fine motor skills, posture, and gait.
  • Damage to basal ganglia: This is a group of multiple neurons located in the center of the brain. It processes signals from the motor cortex before sending them on to the brainstem. Damage to the basal ganglia is typically linked to Athetoid Cerebral Palsy. Children may experience issues like fluctuating muscle tone, lack of control over voluntary muscle movement, and problems with involuntary muscle movement.

Symptoms of Mixed Cerebral Palsy

The symptoms of mixed type Cerebral Palsy depend on which areas of the brain have sustained damage, and as such, each child will have a unique form of the condition. Children will typically exhibit a mix of the symptoms of two or more types of CP. General symptoms include:

  • Abnormal reflexes
  • Exaggerated muscle tone
  • Jerky / floppy movements
  • Tremors in the limbs
  • Poor posture and/or gait
  • Lack of coordination
  • Muscle pain
  • Missing key developmental milestones

Depending on the extent of the brain damage, mixed Cerebral Palsy may exhibit in either the upper or lower limbs, along one side of the body, or in all four limbs. 

Causes and risk factors for Mixed Cerebral Palsy

Mixed Cerebral Palsy occurs due to brain damage during pregnancy or at birth. Factors that can cause brain damage of this type include:

  • Lack of oxygen at birth
  • Infections sustained at or shortly after birth
  • Severe jaundice shortly after birth
  • Stroke at birth
  • Certain maternal infections
  • Head injury sustained in the first months of life
  • Exposure to toxins such as methylmercury
  • Placental infection or failure

In some cases, the brain damage could be owing to medical negligence on the attending doctor’s part. If parents can prove that this was the case, they can potentially sue the doctor for medical malpractice.

Diagnosing Mixed Cerebral Palsy

It is generally recommended that your child undergoes a developmental screening at 9, 18, and 24 months of age. If your young child has been demonstrating the symptoms of mixed CP, it is important to consult the pediatrician as soon as possible. The pediatrician will closely examine your child and ask you questions about their medical history – when the symptoms first began, how frequently they occur, how mild or severe they are, and so on. You will also need to mention any important developmental milestones they have missed.

If the pediatrician has reason to suspect mixed CP, they will recommend you to a team of specialists. This team will typically include a neurologist, a geneticist, a developmental behavior specialist, and an orthopedic surgeon. The neurologist, in particular, will assess your child for signs of brain damage and use a variety of tests to evaluate their reflexes, posture, muscle tone, gait, and coordination. 

Quite often, the symptoms of mixed tone Cerebral Palsy may mimic other movement or neurological conditions. Getting a final verdict, therefore, may take up to months or even a few years. While this wait can be challenging for parents, it is essential to exercise patience, as an accurate diagnosis is crucial for determining the course of treatment.

Treatment for Mixed Cerebral Palsy

Treatment for mixed type Cerebral Palsy involves therapy options to manage the pain and ensure as much mobility and independence as possible. The doctor will work with your family to design a tailored treatment program depending on your child’s exact symptoms. The typical components of a program for mixed CP include:

  • Physical Therapy: Physical therapists use a variety of flexibility and strength training exercises along with massage therapy to reduce muscle pain and improve limb and joint mobility. Early intervention through Physical Therapy helps to avoid the risk of limb deformities later. Physical Therapy also focuses on encouraging children to be active and play so as to maintain a healthy body overall.
  • Occupational Therapy: The goal of Occupational Therapy is to help your child gain as much functionality as possible, especially with everyday tasks and skills that require bilateral coordination and motor control. The therapist will use a variety of exercises, games, and toys to impart the skills necessary for your child to manage their day independently.
  • Speech and Language Therapy: Children with mixed CP often have trouble speaking and swallowing owing to lack of control over the muscles in their mouth and jaw. Therapists will guide them through safe swallowing practices, articulation exercises, and special breathing exercises to help them speak more clearly and chew their food better. This not only helps with intelligible communication but also ensures that the child is getting enough nutrition.
  • Cognitive Therapy: Some children with mixed Cerebral Palsy will have cognitive issues like learning disorders. Trained therapists will work with your child to teach them their letters and numbers through cue cards, visual learning aids, communicative devices, special games, and other appropriate tools. If your child has neurodevelopmental conditions like ADHD or Autism, special therapists will work on treating those too.
  • Assistive devices: These can help your child communicate better and move around more independently. There are a variety of options depending on the extent of the symptoms, from crutches and walkers to motorized wheelchairs and handheld communication devices.
  • Surgery: Children with severe symptoms may benefit from surgery to correct especially painful contractures or floppy joints, or to prevent further deformities or dislocations later on. This will help them benefit better from Physical Therapy too. Consult your orthopedic surgeon for the best options for your child. In addition, surgery can correct complications associated with Cerebral Palsy, such as hearing impairments or vision problems.
  • Stem Cell Therapy: This is a relatively new form of treatment for mixed type Cerebral Palsy. It involves drawing stem cells from within the patient’s body (autologous) and using them to replace damaged brain cells. Studies continue on its applications, and it can potentially be a cure for Cerebral Palsy someday.

FAQs

What are three early signs of Cerebral Palsy?

Some of the early symptoms of Cerebral Palsy include abnormal muscle tone, unusual gait, and delays in reaching developmental milestones like rolling over or crawling.

What is the mildest form of Cerebral Palsy?

In certain cases, the brain damage sustained by the child is mild enough that the symptoms do not become apparent until the child is much older, when motor disabilities become visible. Children with mild Cerebral Palsy can usually get by with milder forms of treatment.

What is Ataxic Cerebral Palsy?

Ataxic Cerebral Palsy is a type of Cerebral Palsy caused due to damage to the cerebellum. Children with ataxic Cerebral Palsy will have trouble with balance and coordination, as well as with fine motor skills.

What does Cerebral Palsy look like in babies?

Some of the Cerebral Palsy symptoms that parents should watch out for in babies include unusual posture or movements, spasticity or floppiness in the limbs, exaggerated reflexes, and delays in hitting developmental milestones.

Can a baby with Cerebral Palsy do tummy time?

Tummy time is a quick and easy form of home therapy for young children with Cerebral Palsy. It provides a stretch to the back and the knees that helps prevent postural deformities, improve balance, and develop better head and neck control.

How does a child with Cerebral Palsy walk?

Around half of all children with Cerebral Palsy are able to walk independently with proper Physical Therapy. One in 10 children will use some form of mobility device.

Does Cerebral Palsy affect the eyes?

Visual problems are among the common complications in Cerebral Palsy, and can take the form of cataracts, strabismus (turned eye), and refractive problems. Surgery can help to fix many of these.

Do Cerebral Palsy babies smile?

A normally developing baby should be able to smile from around three months of age. While not smiling does not necessarily indicate Cerebral Palsy, it could point to some developmental issue and is worth taking note of.

Is Cerebral Palsy obvious from birth?

The signs and symptoms of Cerebral Palsy tend to appear over time as the child grows. In severe cases, however, some signs like poor muscle tone or limb deformities may be noticeable at birth.

Can Cerebral Palsy cause a lazy eye?

Children with Cerebral Palsy frequently display vision problems. Lazy eye, or amblyopia, may occur due to an imbalance in the muscles that keep the eyes in place, hindering them from working together and affecting visual ability.

What causes Spastic Cerebral Palsy?

Spastic Cerebral Palsy occurs due to damage to the pyramidal tracts and/or the motor cortex of the brain. It is the most common form of Cerebral Palsy.

How old is the oldest person with Cerebral Palsy?

The oldest person who ever lived with Cerebral Palsy is Bernadette Rivard, who was 83 years old when she passed. In general, depending on the severity of the condition, children with Cerebral Palsy can expect to live between 30 to 70 years.

In conclusion, finding out that your child has mixed CP disease can be tough. However, it is important to remember that your child needs your love and patience more than ever. Work with the child’s doctor to secure the best possible treatment for them early on. Soon enough, your child will start benefiting from therapy and enjoying a happy, pain-free life side by side with their peers.

Dr Na'eem Sadiq is a respected stem cell specialist at Plexus, and a prominent neurologist in Bangalore. He studied neurology and clinical neurophysiology in London, and worked with some of the most prestigious medical institutions in England, and the Middle East. He completed his MBBS at Bellary Government Medical College, and a postgraduate degree in psychiatry from NIMHANS in Bangalore.

Dr Na'eem has perfected his knowledge and expertise in Continuing medical education (CME), and training in tissue culture, Stem Cell Therapy, and neurology. Dr Na'eem Sadiq possesses an undying passion to improve people’s lives. This led to the creation of Plexus, a neuro and Stem Cell Research centre in Bangalore in neurosurgery, and neurorehabilitation.