Cerebral Palsy (CP) is one of the nervous system impairment that occurs during fetal life in womb, birth or infancy. ‘Cerebral’ comes from the word cerebrum; the two hemisphere of the forebrain and ‘Palsy’ means paralysis accompanied by involuntary tremors. While our brain consists of sensory area to receive stimuli and motor area to give respond, a child with CP has a damage motor area of the brain. This will cause them to loss their ability to control their muscle and body coordination (Tortora & Derrickson, 2011, p.630). Among the causative factor of CP include prematurity of baby during delivery, placental insufficiency, anoxia (low oxygen) during birth or other infection of mother, fetus or infant that can affect the central nervous system (Mahan, Stump, Raymond, 2012, p.1033). According to MyChild™ (n.d), CP is incurable, permanent and chronic. It is irreversible and currently cannot be fixed. Once the brain damage occurs, it does not heal like other cell in the body does. CP is a permanent occasion that neither the injury in the brain undergoes healing process nor worsens during a person life time. As a person is diagnosed with CP, they will have the condition for their entire life. Despite of being a permanent disorder, CP is a non-progressive disorder. The brain lesion occur is a one-time brain injury and will not cause further degeneration. CP is also a non-communicable disease thus does not spread through human contact. However, environmental factor can increase the risk of CP such as abuse, accident, medical malpractice or bacterial and viral infection. Fortunately, CP is manageable. Although the person may experience difficulties in their movement, speech and other motor skill, therapy, surgery, medication and assistive technology can help them to be more independence. Plus with the support from their family, they can enhance the quality of life. (MyChild™, n.d)

1. CEREBRAL PALSY
1. INTRODUCTION
Brain is the most complex organ in the body. Cooperating with the spinal cord, they
form the central nervous system which is the most complicated system in human. The human
brain is equipped with ability to think, analyze and make decision (i.e: Human Intelligence)
make us better than other Allah’s creation. He said in the Quran, "We have indeed created man
in the 'best of molds'." (Qur'an 95:4). A slight change or impairment occurs in the perfect
arrangement of the brain and nervous system may cause a lot of complications. Cerebral Palsy
(CP) is one of the nervous system impairment that occurs during fetal life in womb, birth or
infancy. ‘Cerebral’ comes from the word cerebrum; the two hemisphere of the forebrain and
‘Palsy’ means paralysis accompanied by involuntary tremors.
While our brain consists of sensory area to receive stimuli and motor area to give
respond, a child with CP has a damage motor area of the brain. This will cause them to loss
their ability to control their muscle and body coordination (Tortora & Derrickson, 2011, p.630).
Among the causative factor of CP include prematurity of baby during delivery, placental
insufficiency, anoxia (low oxygen) during birth or other infection of mother, fetus or infant that
can affect the central nervous system (Mahan, Stump, Raymond, 2012, p.1033).
According to MyChild™ (n.d), CP is incurable, permanent and chronic. It is irreversible
and currently cannot be fixed. Once the brain damage occurs, it does not heal like other cell in
the body does. CP is a permanent occasion that neither the injury in the brain undergoes
healing process nor worsens during a person life time. As a person is diagnosed with CP, they
will have the condition for their entire life.
Despite of being a permanent disorder, CP is a non-progressive disorder. The brain
lesion occur is a one-time brain injury and will not cause further degeneration. CP is also a non-communicable
disease thus does not spread through human contact. However, environmental
factor can increase the risk of CP such as abuse, accident, medical malpractice or bacterial and
viral infection. Fortunately, CP is manageable. Although the person may experience difficulties

2. in their movement, speech and other motor skill, therapy, surgery, medication and assistive
technology can help them to be more independence. Plus with the support from their family,
they can enhance the quality of life. (MyChild™, n.d)
2. SIGN AND SYMPTOM
Sign is the identifiable effect of disease that can be proven clinically through diagnosis
and tests. While symptom is the effect from the disease that can be felt by the patient and they
would express what they are experiencing to the physician. Symptom is not necessarily visible.
Since the Cerebral Palsy (CP) is diagnosed in the very early age of the children, they usually
unable to communicate effectively about their symptom. Thus, the physician may choose to
identify the signs in recognizing the probability of CP.
CP is classified as a neurological disorder that is related with motor function
impairment. Motor dysfunction will affects the body movement, muscle control and
coordination, muscle tone, reflex, posture and balance. It can also impact fine and gross motor
skills and oral motor functioning. However, impairments resulting from CP range in severity,
usually in parallel with the degree of injury to the brain. Hence, the signs and symptoms are
varying from one individual to the next.
Signs are detected through medical evaluation, clinical tests, and observation. The
physician will also determine the extent, location and severity level of impairment. Examples of
signs of cerebral palsy include; not blinking at loud noises by one month, not sitting by seven
months, not turning head toward sounds by four months, not verbalizing words by 12 months,
seizures or walking with an abnormal step. A parent may also see signs of cerebral palsy when
the child shows motor development delay. (MyChild™, n.d)
The child perceives and notices the symptoms, which are not necessari ly visible to
others. At such a young age, a child is limited in his or her ability to express symptoms and
often relies on the careful observation of parents. Symptoms, relayed to the medical
practitioner, assists in the diagnosis process. Some symptoms of cerebral palsy include:

3. choking, difficulty grasping objects, difficulty swallowing, fatigue, inability to focus on objects,
inability to hear or feeling pain when moving. (MyChild™, n.d)
3. ISSUE & PROBLEMS OF CEREBRAL PALSY
Cerebral palsy (CP) is not a disease and is not hereditary. People or children who have CP
experience some degree of difficulty in making smooth, deliberate movements due to the
damage in the brain. Nevertheless, children with cerebral palsy have abilities and their goals in
life are much the same as everybody else’s.
3.1: Cerebral Palsy Ability Classification
When describing CP, health care providers use two main systems to classify how the
condition affects a person’s abilities.
The Gross Motor Function Classification System (GMFCS) includes categories that
describe a person’s ability to walk, run and perform other large motor skills. The higher the
GMFCS level, the more difficulty a person has performing such skills.
The Manual Ability Classification System (MACS) includes categories that describe a
person’s ability to manipulate objects with the hands. The higher the MACS level, the more
difficulty a person has performing such skills.
Neither the GMFCS nor the MACS describe a person’s thinking and learning abilities.
(Gillette Children’s Specialty Healthcare, n.d.)
a) Gross Motor Function Classification System (GMFCS)
The GMFCS uses five classification levels. The criteria for being classified within a
particular level depend on a person’s age. In general, a person’s classification level is
determined by the primary method of mobility used after age 6.
The information describes characteristics of people, ages 12 – 18, classified within each
GMFCS level;
GMFCS Level I

4. Youth walk at home, school, outdoors and in the community. Youth are able to climb curbs and
stairs without physical assistance or a railing. They perform gross motor skills such as running
and jumping but speed, balance and coordination are limited.
GMFCS Level II
Youth walk in most settings but environmental factors and personal choice influence mobility
choices. At school or work they may require a hand held mobility device for safety and climb
stairs holding onto a railing. Outdoors and in the community youth may use wheeled mobility
when traveling long distances.
GMFCS Level III
Youth are capable of walking using a hand-held mobility device. Youth may climb stairs holding
onto a railing with supervision or assistance. At school they may self -propel a manual
wheelchair or use powered mobility. Outdoors and in the community youth are transported in
a wheelchair or use powered mobility.
GMFCS Level IV
Youth use wheeled mobility in most settings. Physical assistance of 1 – 2 people is required for
transfers. Indoors, youth may walk short distances with physical assistance, use wheeled
mobility or a body support walker when positioned. They may operate a powered chair,
otherwise are transported in a manual wheelchair.
GMFCS Level V
Youth are transported in a manual wheelchair in all settings. Youth are limited in their ability to
maintain antigravity head and trunk postures and control leg and arm movements. Self -mobility
is severely limited, even with the use of assistive technology.
b) Manual Ability Classification System (MACS)
The MACS includes five levels that describe the ability of a child (ages 4 – 18) to use their hands
and handle objects.
LeveI I:

5.  Handles objects easily and successfully.
 Experiences limitation in performing manual tasks requiring speed and accuracy. (These
limitations don’t interfere with independence in daily activities.)
Level II:
 Handles most objects, but with a reduced quality and/or speed in achieving tasks and
activities.
 Struggles with some activities; might need alternative ways of doing tasks. (These
limitations usually don’t interfere with independence in daily activities.)

6. Level III:
 Handles objects with difficulty.
 Needs help to prepare or adapt activities.
 Does tasks slowly.
 Experiences limited success regarding quality and quantity of tasks and activities.
 Performs activities independently only if they have ben set up or adapted.
Level IV:
 Handles a limited selection of easily managed objects in adapted situations.
 Performs only parts of activities with effort and limited success.
 Requires continuous assistance and/or adapted equipment to attempt an activity.
Level V:
 Cannot handle objects.
 Experiences severely limited ability to perform even simple actions.
 Requires total assistance.
3.2: A Study about the Impact of Cerebral Palsy on the Quality of Life in Patients and Their
Families
This is a prospective, descriptive study that aimed to look at the impact of health-related
quality of life of cerebral palsy (CP) in the lives of patients and their families. The patients
attending the Pediatric Rehabilitation Clinic at University of Malaya Medical Centre were
interviewed prospectively using the Lifestyle Assessment Questionnaire. A total 27 patients
were interviewed. Three (11.1%) patients reported severely affected quality of life. Seven
(25.9%) patients reported moderately affected quality of life and 10 (37%) reported mildly
affected quality of life. The worst score of 76 were reported in 2 patients. The best score of 11
was reported in one patient.

7. The impairment and disability due to CP is likely to be similar in both developing and
undeveloped countries.
4. RISK FACTORS OF CEREBRAL PALSY
Risk factors of cerebral palsy are events that increase the chances of a child developing
cerebral palsy. Events that create a greater risk for a child to develop cerebral palsy are
accidents, traumatic brain injury, medical malpractice, and shaken-baby syndrome. Events
could also include infections, complicated birth, maternal seizures, inflammation and
improperly managed chronic health conditions. These are some of the common risk factors of
developing cerebral palsy.
a) Asphyxia (oxygen deprivation).
Asphyxia is a condition in which the body and most importantly, the brain receives
inadequate or no oxygen supply. The examples of causes of lack of oxygen supply to the
brain are chocking and hyperventilation. There are cases that asphyxia due to
complication during birth which is difficult labor or delivery was the cause of cerebral
palsy. According to the statistic, only 6-8 % of all cerebral palsy was accounted for
asphyxia. (MyChild™, n.d)
b) Infection or health problems.
Certain infections or health problems during pregnancy can significantly increase the
risk of giving birth to a baby with cerebral palsy. Certain infectious disease are known to
heighten the probability of cerebral palsy include German measles (rubella), chickenpox
(varicella), virus that causes flu-like symptoms and may lead to birth defect
(cytomegalovirus), infection cause by parasite (toxoplasmosis). Besides, sexually
transmitted bacterial infection (herpes and syphilis), inflammation of fetal membranes
due to bacterial infection (chorioamnionitis), and exposure to toxin such as methyl
mercury, cigarette smoke, and alcohol intake are also among the infectious disease
(Mayo Clinic, 2010).
c) Infant’s illness.

8. Illnesses in a newborn baby that can greatly increase the risk of cerebral palsy include
bacterial meningitis, viral encephalitis, as well as severe or untreated jaundice. Bacterial
meningitis is a bacterial infection that causes inflammation in the membranes that
surround the brain and spinal cord. Viral encephalitis is a viral infection that causes
inflammation of the brain. Meanwhile, severe or untreated jaundice is a condition that
appears as a yellowing of the skin and that occurs when certain byproducts of "used"
blood cells aren't filtered from the bloodstream (Mayo clinic, 2010).
d) Traumatic brain damage.
Usage of vacuum extractors and forceps can cause traumatic brain damage and cerebral
palsy. These medical devices are used by doctor to assist in the delivery of babies.
Forceps can be helpful in delivery through the birth canal by gripping around the head
of the baby. However, the infant can sustain serious injury if the forceps are gripped to
tightly or if the baby’s head is twisted in the wrong direction. Vacuum extractors devices
can assist in delivery baby by applied gentle vacuum pressure. However, these devices
can also cause mechanical injury trauma the baby’s skull, face and brain. Used
incorrectly, these devices can severely damage the brain, causing bleeding and may
result in cerebral palsy (MyChild™, n.d).
e) Placenta complication.
Premature birth and complicated deliveries can result from placental complications.
Placental complication can result in excessive bleeding, cause lack of blood, oxygen,
nutrient reach to the fetus. Placenta complications include placenta abruption and
placenta praevia. Placenta abruption is a complication of pregnancy, wherein the
placental lining has separated from the uterus of the mother. It occurs in 1% of
pregnancies worldwide. Meanwhile, placenta praevia is a complication of pregnancy,
where the placenta blocks the cervix. It occurs in roughly one of every 200 pregnant
women. Therefore, placental complication can increase the probability of a child
developing cerebral palsy (MyChild™, n.d)
5. TREATMENT AND INTERVENTION OF CEREBRAL PALSY

9. As we all know, cerebral palsy cannot be cured, but we must put intensive care about
people with cerebral palsy to help them faced trough this world better. Some of the treatment
therapies and care are
5.1: Speech, language and dysphagia therapy
Performed by speech pathologist, aimed to solve difficulties in communicating for
people with cerebral palsy, speech and language therapy teach and encourage patient correct
speech disorders, restore speech, improve listening skills, able to use communication aids as
well as learn sign language. This therapy help in reducing the upset of communication problem
usually affect both sides of patients and caregiver relationship (Cerebral Palsy Source, 2005).
Dysphagia is condition that makes swallowing difficult and painful. Dysphagia therapy,
aimed to correcting abnormal muscle action that involve with feeding. It helps in improving
sucking movement, coordinating tongue movement, and oral movement pattern (Cerebral
Palsy Source, 2005).
5.2: Occupational therapy
The objective is to help cerebral palsy patient live as independently as they could in all
areas of their life. Boosting their personal strength to help them overcome their disabilities,
hence enhance their cognitive, physical and fine motor skill as well as self of accomplishment.
They also teach to perform daily activities such as dressing, bathing, and eating themselves
independently to create sense of confidence in them (Cerebral Palsy Source, 2005).
5.3: Physiotherapy
Generally consists of few types of therapy, but basically are aims to improve patient’s
gross motor skill which are ability to function the large muscle in the body like arms and legs.
Physiotherapy has greatly impact to improve patient’s balance and movement. Patients are
learnt to walk, standing without aid, use wheelchair or other adaptive device, and other
movement technique. Besides, physiotherapy also helps to prevent further musculoskeletal

10. problem, by improving muscle strength and prevent it from deterioration trough correct
physiotherapy techniques (Cerebral Palsy Source, 2005).
5.4: Biofeedback
Biofeedback is a common physical therapy that uses machines on specific part of the
body. The machines are connected to various muscles in the body with electrodes. Patients
with cerebral palsy can control overactive muscle and develop coordination trough
manipulating their movement by using this technique (Cerebral Palsy Source, 2005).
5.5: Medication and drug therapy
This treatment is usually use for calming muscle spasm and contractions. The drugs act
as relaxing agents and aid in stopping the muscle from contracting uncontrolled. The three
main drugs for cerebral palsy are:
i. Diazepam, which is effective in a total body relaxation, resulting in less muscle
contractions ,
ii. Baclofen, a muscle relaxant used in controlling spasticity, blocking nerve signals from
the spinal cord and
iii. Dantrolene, that interferes in the actual muscle tissue’s natural contraction
mechanisms, which result in fewer contractions.
Besides that, since seizures are very common in cerebral palsy, there are also drugs used
in therapy for cerebral palsy patients who have seizures. These are anti -seizure medicines
include Depakene, Dilantin, Epival, Klonopin, Tegretol, and Zarontin. In addition, anticonvulsant
medication also helps stem seizures. Examples of anticonvulsants are including Topamax,
Lamictal, Trileptal, Zonegran, and Neurontin (Mayo clinic, 2010).
5.6: Nutrition care

11. Nowadays, nutrition rehabilitation can help in improving their nutrition. Basically, it is
not known what is the best food to be offered to children with cerebral palsy, but
recommendations include food that can be eaten with the least frustration or distress.
Generally, foods of liquid or semisolid consistency should be the main focus for nutritional
rehabilitation (Cerebral Palsy Source, 2005).
The identification of nutritional problems has great potential to help improve weight,
muscle mass, decreased irritability, and circulation in order to halt the incidence of malnutrition
in individuals with cerebral palsy. They are also recommended to take supplementation or
increase orally the energy, protein, calcium, vitamin D, copper, folic acid, iron, phosphorus,
magnesium, Vitamin B12, and zinc regarding these nutrition common nutritional deficits
(Theberge & Illing, 2005).
It is strongly agree that patients with cerebral palsy’s nutrition needs can be met orally,
but requires caloric enhancers and must be texture appropriate to boost their appetite, easy
them to swallow and digest. Finally, the other areas of treatment can assist the patients such as
surgical procedure can be done to insert gastronomy tubes which allow the patient to get more
food down. This method shown to be effective in improving weight gain, growth and fat
deposition in cerebral palsy population, as well as decreasing caregiver burden. However,
evidence supporting gastronomy tubes feeds as an effective intervention is depends on
methodologies, populations and outcomes measured. Lastly, the caregiver play most important
role in this issue, they need to increase awareness regarding the need and possible corrective
method to improve cerebral palsy patient’s nutrition (Theberge & Illing, 2005)
CONCLUSION
Parent should observe the development of their children warily to trace any sign of
abnormality that may occur. They should not neglect if any possible sign of Cerebral Palsy take
place. They should see the doctor immediately because early detection and intervention would

12. give lesser impact to the children in later life. There are two main systems used by the health
care provider in classifying the ability of cerebral palsy children. First are the Gross Motor
Function Classification System (GMFCS) and the other one is the Manual Ability Classification
System (MACS). Both of the systems consist of five classification levels that can indicate the
level of capability of the children.
The impact of cerebral palsy on the quality of life has been reported as mildly affected,
moderately affected and severely affected according to a study that had been carried out. It
also has been identified that there are many common risk factors of cerebral palsy include
asphyxia, infection, infant illness, traumatic brain damage and placenta complication. It is
certain that Cerebral palsy cannot be cured or heal, however this diseased need intensive care
that help the patients live their lives better such as undergo therapies and taking medicine as
well optimize their nutrition in feeding. Therefore, any parties are need to involved and play
their important role to improve the conditions of people with cerebral palsy, including
professional care professions and caregivers.
Although the children with Cerebral Palsy are different from the other children and may
be classified as disable children, we should treat them like the other normal children. We
should not neglect, differentiate or isolate them. Instead, full support is very important for
them to gain strength and live happily despite of having debility.

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