Introduction

Cerebral Palsy (CP) is a group of neurological disorders which impair brain function, movement, and muscle coordination. It is caused by damage to the developing brain or abnormalities that arise. Some cases have reported a complete lack of development of the areas of the brain responsible for muscle coordination. CP is detected in early infancy and/or childhood. Common symptoms in children are listed below:¹

• Ataxia: lack of voluntary control over their movements
• Spasticity: exaggerated reflexes combined with stiff/tight muscles
• Weakness in at least one or more limbs (arm/leg)
• Crouched/scissored gait leading to walking on one’s toes 
• Muscle tone variation - extreme stiffness or floppiness
• Tremor (shaking) combined with random involuntary movements
• Delays in reaching motor development milestones
• Difficulties with fine motor skills such as buttoning a shirt

Causes of CP

Most cases of CP are congenital, meaning the individual is born with the condition, however, there are other causes for this condition. These include brain bleeds or a lack of oxygen supply to a baby’s brain, an infection during pregnancy, asphyxiation during birth (temporary loss of oxygen), meningitis, and a serious head injury.²

Overview of CP as a lifelong condition

Many individuals with CP struggle in childhood due to the excess strain the condition places on the body however, many individuals lead relatively normal adult lives. In the most severe cases of CP, an individual may expect a shortened life expectancy alongside impairments to their daily functioning.³

Background information on Cerebral Palsy

Types of CP

There are three main types of CP: Spastic, dyskinetic, and mixed, and CP can be further divided into subgroups based on the clinical presentations of the individual and which parts of the body are affected.³

• Spastic: presents with muscle tightness and spasms
• Dyskinetic: presents with issues with control of the muscles
• Mixed: presents with a combination of the above two types

There are also the following subtypes: 

• Diplegic: affects mainly the arms rather than the limbs
• Quadriplegic: affects all the limbs (arms and legs)
• Hemiplegic: affects the limbs on one side of the body more than the other
• Monoplegic: affects only one limb
• Paraplegic: affects the legs but not the arms

Ageing and general health considerations in older adults with CP

Most research surrounding CP has centred around children yet adults seem to get minimal support and attention while still dealing with the same condition. CP most notably affects movement and motor skills but alongside these disturbances are delays in intellectual abilities, impaired sensation and cognitive performance, altered behaviour and communication, as well as secondary musculoskeletal disorders.⁴

Changes to physical health

Adults diagnosed with CP report various physical symptoms and each case must be considered individually. Some people report premature ageing starting from their early twenties which may be attributed to their overall poorer health. Premature ageing seems to co-occur with musculoskeletal problems. Possible causes for this decreased function may be due to changes in muscle flexibility, strength and endurance, spasticity, arthritis, accidental falls and fractures, pain, fatigue, and other reported problems. These individuals are also at an increased risk of developing osteoporosis. However, many of these issues often start before the individual reaches adulthood and may simply worsen with age.⁴

Communication problems

Speech and sound errors are reported in adults with CP yet many of these also begin in early childhood. One common problem that is reported is dysarthria, wherein speech and language issues are attributed to weakness of the muscles in a person’s throat.⁵ It is also an umbrella term for malfunctioning of any component of the speech production loop. Subsequently, due to muscle weakness, individuals with CP also report feeding difficulties and may struggle to chew or swallow their food. These symptoms may also be seen in early childhood but worsen with age.⁴

Cardiovascular health

Some studies have investigated the association between CP and other non-infectious disorders. It has been found that obesity and cardiovascular disease incidence seem higher in patients with CP.⁶ One article reports that patients with CP are 75% more likely to develop a cardiovascular or lung disease but not other diseases such as cancer. Compared with the general population, adults with CP were 2.6 times more likely to develop heart failure, 5.5 times more likely to have a stroke, 1.6 times more likely to develop hypertension, and 2.3 times more likely to develop ischaemic heart disease. These results demonstrate the need for adequate attention and resources to be directed to adults, and not just children, with cerebral palsy.⁷ Another study by Hammam et al. (2021) examined children and found that the muscles of the cardiovascular system were weaker in children with CP which may explain the higher rates of cardiovascular disease in later adulthood. The impairments to their vascular structure place these children at a greater risk of developing premature atherosclerosis compared to the general population.⁸ Therefore, more studies are needed to examine cardiovascular interventions in childhood to prevent the development of cardiovascular diseases in adulthood. 

Respiratory issues

Respiratory issues are another concern for individuals with CP as they are more susceptible to developing upper and lower respiratory tract infections. Pneumonia is one common lower respiratory tract infection that occurs due to aspiration. These respiratory illnesses may present with symptoms such as fever, lethargy, cough, sore throat, runny nose, increased secretions, and/or shortness of breath. Difficulty swallowing may lead to reflux or cause aspiration pneumonia. Impaired elasticity of the lungs or weakness of the chest wall can reduce lung capacity causing restrictive lung disease. Another issue seen in adults with CP is that a weak cough can lead to mucus retention which then leads to atelectasis, chronic inflammation, and infection. This could lead to further problems such as obstructive lung disease, bronchiectasis, and other lung diseases.⁹

Mental health

Due to the various comorbidities listed above, both children and adults with CP are at an increased risk of developing mental health issues. Anxiety and depression rates are particularly high among adults with CP. The greater prevalence of mental disorders may be explained by various factors. The Cerebral Palsy Research Network provides these as a few examples:¹⁰

• CP is initially caused by an injury or congenital impairment within the brain. This may lead to the individual having a reduced capacity for adapting to new or unexpected situations which causes greater stress and a reduced ability to cope with this stress
• Fatigue is a common clinical presentation in adults and children with CP, which may explain the higher-than-average rates of depression
• Unaddressed pain, disrupted sleep, and poor nutritional health may also result in poor mental health in adults with CP

Listed below are other factors impacting the emotional well-being of individuals with CP: 

• Limited experience for socialisation 
• Restricted interactions with their peers and adults during childhood
• Negative experiences or treatment due to having a disability 
• Problems in the workplace or other employment issues 
• Relationship difficulties 
• Problems with family 

Management and support strategies

Supporting a loved one struggling with CP is difficult but there are actions to take which make their life easier. Adults with severe cases of CP may need 24-hour support and assistance such as specialist feeding if they have difficulties swallowing. Assistance can also look like aiding them with communication, assistance with daily tasks such as grocery shopping or laundry, but overall managing their symptoms and reducing their pain. It is important to treat individuals with CP the same as any other adult when offering help. The main goal for patients with CP is to keep active and mobile so they can remain as independent as possible.¹¹

Summary

Overall, CP can vary in its clinical presentation and is dependent on the individual. The condition may be congenital (from birth) or it may result from a severe brain injury. The result in both scenarios is damage to the area of the brain responsible for movement and coordination. The three main types of CP can be further divided into subgroups depending on the part of the body that is impaired. These impairments might affect only one limb or affect all the limbs depending on the case. All forms of CP are associated with further health complications ranging from physical to mental. Cardiovascular and respiratory diseases are the most common comorbidities associated with CP in adulthood. This may result from weakness of the muscles surrounding the heart and lungs leading to a greater susceptibility to infection and later inflammation. Another concern for adults with CP is the greater mental health risk. Due to social isolation, chronic health problems, and greater barriers in life, individuals with CP are more likely to experience anxiety and depression alongside other mental health conditions. When caring for an adult with CP, it is important not to reduce these individuals to their illness and keep in mind that simple tasks may be more difficult for them.