Cerebral Palsy And Mental Health: Addressing Psychological Well-Being In Individuals With CP

Introduction 

Cerebral palsy (CP) is a group of neurological disorders that damage the developing brain, that affect movement, muscle control, and coordination.^1,2 Despite physical challenges, CP individuals also experience mental health conditions that profoundly impact their overall well-being and quality of life. This article will explore the mental health aspect of CP, on how we can support individuals with CP, the affected families and caregivers comprehensively, to ensure holistic well-being, and foster fulfilment in life.

Understanding cerebral palsy 

Cerebral palsy (CP) is a neurological disorder that damages the brain before, during or soon after birth, leading to movement, postural, and balance issues, thus difficulty walking, moving the arms, or speaking.^2,3 While the exact lesions and symptoms vary among individuals, it does not get worse over time.⁴

Causes include prenatal genetic abnormalities, infections, brain malformations, and maternal health conditions. Oxygen deprivation, premature birth, or traumatic brain injury during delivery can also contribute. Postnatal incidents such as cerebral strokes, head injuries or medical conditions (e.g., jaundice and asphyxiation) affecting early childhood brain development can also induce CP.^1,5

It can be classified into different types according to the affected body parts and movement impairments as follows:⁶

Table 1. The types of cerebral palsy with descriptions

Impact of mental health on individuals with CP 

Anxiety and depression

Living with CP can generate anxiety due to future physical health uncertainties, and daily challenges and limitations faced. Social difficulties, isolation, discrimination, and even bullying, could also trigger anxiety and depression. 

Social isolation and loneliness

Social interactions and participation barriers could make CP individuals lonely and isolated. Physical limitations, communication difficulties and societal misunderstandings of CP or disabilities also leave individuals being excluded from social activities and relationships.⁷

Body image and self-esteem issues

CP-associated physical impairments can impact individuals’ body image and self-esteem. 

While those with milder disabilities typically view themselves and their abilities better, those with arm function deviation and more severe CP, are having lower self-esteem and more dissatisfaction with their appearances.⁸

Emotional and behavioural difficulties

Due to the sustained brain injury and impairments, CP can show up as emotional and behavioural challenges. With emotion regulatory impairments and impulsivity, CP individuals’ positive reactions and problem-solving through stress and changes can be disrupted, making them more sensitive to stress and less capable of adapting to unexpected circumstances.⁹

Coping with chronic pain and fatigue 

With a high prevalence of CP adults experiencing chronic pain due to muscle stiffness and skeletal abnormalities, they also experience fatigue due to central and peripheral anatomical and physiological systems.^10,11 The increased daily challenges, reduced social participation and quality of life can further intensify emotional distress. (12.5%)

Early identification and intervention 

Early mental health issues identification and intervention among individuals with CP is essential. While timely recognition, screening, and assessment allow for prompt intervention to improve outcomes and overall well-being. Early provision of tailored support such as counselling, therapy sessions, and coping strategies can further empower the CP population with useful coping skills and confidence for effective daily challenges navigation to promote their long-term mental health outcomes. 

Multidisciplinary psychological support for CP population

Table 2. The types of multidisciplinary support that is available to support someone living with CP

Therapeutic interventions for mental health support in CP individuals 

Cognitive-behavioural therapy (CBT)

While cognitive-behavioural therapy (CBT) focuses on identifying and modifying negative thought patterns, beliefs, and behaviours, it also facilitates coping strategies development for better stress and emotional management among the CP population. By challenging the negative thoughts in replace of more positive and adaptive ones, individuals with CP can experience increased resilience, thus improved emotional well-being.¹²

Play therapy 

Play therapy provides children with CP (typically those non-verbal) a safe emotional outlet for exploration and expression, self-esteem building, and problem-solving skills development. Children can also improve their motor functioning, and communicate feelings, thoughts, and fears through play, in facilitation of social skills, in enhancing emotional growth and healing.¹³

Mindfulness and relaxation techniques

Mindfulness and relaxation techniques are valuable in stress and anxiety management. Deep breathing and guided imagery help CP individuals relax, reduce anxiety, and improve focus. A sense of calm and self-awareness can be cultivated, to enhance problem-solving abilities and emotional well-being.^14,15

Individual and group counselling

Individual and group counselling can provide individuals with CP a supportive, non-judgmental environment for emotional expressions, challenging discussions, coping skills development and personal growth. Therapists or counsellors can offer further guidance, validations, and practical tools to facilitate CP individuals’ emotional complexities navigation. 

Strategies of psychological well-being promotion in CP individuals 

Adaptive physical activities

.It is possible to improve the self-esteem, mood and overall well-being of an individual with CP. This is achieved by encouraging and promoting accessibility through the provision of modified exercises, equipment and accessible facilities to facilitate physical activities that are tailored to the abilities and interests of someone living with CP. 

Assistive devices and mobility

The provision of appropriate assistive devices and mobility aids can enhance mobility and independence among CP individuals. While effective environmental navigation by mobility aids and orthotic devices can empower individuals with a sense of autonomy and confidence, the use of assistive visual, hearing, and communication devices can further promote self-advocacy and the importance of self-expressions in interpersonal relationships. 

Pain management 

Regarding the high prevalence of chronic pain among CP, developing appropriate pain management strategies that suit the specific needs of CP individuals, such as physical therapy, medication, and assistive devices are crucial in alleviating distress, promoting social participation, quality of life, thus overall mental wellbeing.¹⁶

Body image and self-acceptance 

Body acceptance and positive self-image cultivation can be promoted through psychotherapy. While negative thought replacement can be facilitated through CBT, focus shifting to self-compassion and own strengths and abilities through counselling and appropriate psychoeducation can address body image concerns, fostering self-esteem and overall mental health.¹²

Sensory integration 

Motor abnormalities are often accompanied by hypo- or hyper-sensitivities and other disturbances in CP that cause significant obstruction to everyday activities. Thereby, sensory integration techniques, such as the use of sensory-based interventions, offering of sensory breaks, and the creation of sensory-friendly environments, are essential to reduce distress, facilitate emotional regulation, and behavioural efficiency, thus overall psychological well-being.¹⁷

Rehabilitation and therapy 

Physical improvement can impact psychological well-being. While ongoing rehabilitation and therapy services can optimise physical functioning and independence, they can also increase confidence, reduce frustration, and enhance overall well-being among the CP population.¹

Nutrition and wellness

Physical health is closely linked to mental well-being. Having a balanced, nutritious diet along with healthy lifestyle implementation, such as regular physical activities, adequate sleep, stress management and relaxation techniques are essential in supporting overall well-being. 

Supporting families and caregivers 

Mental support for families and caregivers of CP individuals is vital in helping them to navigate through the adversities. Acknowledging various difficulties is necessary for tailored support. Family therapy can provide a secure space for open communication and emotional expressions, enhancing problem-solving, relationship-building, and resilience-building. Furthermore, adequate resources and support such as information, available interventions, and community support services for CP, are beneficial for families to access valuable insights and experiences. Caregiver self-care encourages social connection maintenance and supports network access. Counselling and psychotherapies should also be available promptly whenever emotional distress occurs with coping strategies provided. Education and training programs also empower families to actively participate in the care and well-being of the CP population. 

Overcoming stigma and promoting inclusion 

Addressing societal misconceptions and stereotypes

There have been a number of social myths and misconceptions towards the CP population, triggering social isolation, loneliness and self-esteem struggles. Education campaigns and community dialogues are essential in challenging biases by corresponding facts to foster understanding and empathy.⁴

Inclusive opportunities promotion

By providing an accessible and inclusive environment, CP individuals can still fully participate and thrive. While anti-bullying initiatives in inclusive education ensure equal learning and social interaction opportunities, a more diverse and accepting workforce created among employment practices can facilitate further enthusiasm, abilities and career development among the CP population. 

Raising awareness and advocating for the rights of CP

While public campaigns and media representation can dispel misunderstandings about CP, public awareness is crucial. Education to individuals with CP, their families, and healthcare professionals among symptomatic management can improve the overall quality of life. Political advocates further safeguard the accessibility rights among the physically disabled. A more accessible and inclusive society can be cultivated for better psychological support. 

Summary

Mental health conditions can be associated with cerebral palsy (CP) thereby providing appropriate support is essential to address psychological well-being in improving their quality of life. Notwithstanding the early interventions, tailored mental health services for both the individuals and families affected by CP. Strategies such as awareness promotion, challenging stigma and the provision of educational and employment-inclusive environments are also essential. CP populations can thus be empowered, with improved resilience through holistic care for a fulfilling life.