Cerebral palsy is a disorder of movement and posture due to static, nonprogressive injury sustained by the developing brain. The brain damage must occur by 5 years of age. It occurs in 2.5 to 3 per 1000 individuals. Diagnosis before 12 to 18 months of age can be confused with transient tonal problems or progressive degenerative disorders. The movement problems manifest in a variety of forms and can affect the head, trunk, and extremities in a variety of ways. Cerebral palsy is commonly classified by type, distribution, and degree of involvement. Types include spastic, dyskinetic (choreoathetoid), hypotonic, and mixed forms. Distribution relates to the involvement of the extremities. Diplegia, hemiplegia, and quadriplegia are the most common. Rarely one sees a child with monoplegia or triplegia. Severity is rated subjectively as mild, moderate, or severe.
Children with cerebral palsy may have associated medical problems as a direct effect or complication of motor dysfunction or underlying brain damage. Seizures, oral motor dysfunction, gastroesophageal reflux, constipation, urinary tract infections, pneumonia, wheezing, hearing loss, strabismus, visual impairments, scoliosis, contractures, and hip dislocation or subluxation are all seen with increased frequency in children with cerebral palsy. Children with less severe presentations have minimal associated medical problems (i.e., the child with spastic diplegia may have only issues related to spasticity). As the severity of impairment increases to spastic quadriplegia, the incidence and severity of associated problems and need for emergency medical treatment also increase.
In managing the child with severe cerebral palsy in the ED, special attention should be given to seizures, respiratory tract problems, fluid status, nutritional status, bracing, and skin problems.
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