Major Morbidity Cerebral Palsy		Cerebral palsy (CP) is a nonspecific, descriptive term that refers to disordered motor function, evident in early infancy and characterized by changes in muscle tone. It is non-progressive, although the full extent of motor disability may not be evident until age 3-4 years. Intellectual and sensory deficits, behavior disorders and seizures may accompany CP, but are not part of the diagnostic criteria. The diagnosis of CP is indicated by delayed developmental milestones, the persistence of developmental reflexes, the presence of abnormal reflexes and the failure to develop maturational reflexes in a timely fashion, such as the parachute response. CP is classified on the basis of the predominant neurologic sign/symptom and the extent of the limb involvement. Spastic diplegia is most common in prematures, followed by spastic quadriplegia. Choreoathetotic CP is typically seen in kernicterus, due to severe hyperbilirubinemia. Almost all patients with hemiplegia walk by the age of 2 years, although some may need the help of a short leg brace. More than 50% of those with spastic diplegia learn to walk, usually by the age of 3 years. Gait is often abnormal and crutches may be necessary. Only 25% of patients with spastic quadriplegia will walk; however of the patients with quadriplegia who have sitting balance by age 2 years, 100% will walk. In addition to decreased motor function, a major problem for the patient with CP is the development of contractures, especially between 2 and 5 years. The various interventions used to treat CP are designed to enhance function, minimize contractures and lessen pain. Occupational and physical therapy are particularly beneficial for the spastic patient. Use of orthotics to increase stability, especially during the early stages of ambulation is common. Various surgeries may also be necessary - lengthening of muscles/tendons, orthopedic procedures and/or casting and selective dorsal rhizotomy, the cutting of 50% of the dorsal nerve roots to decrease lower extremity muscle tone. When a limited number of muscles are causing deformities injection of botulinum toxin into the muscle has been helpful. Oral medications have been disappointing, although the use of intrathecal baclofen is increasingly common. Return to top of page