The Center for Cerebral Palsy at UCLA/OIC is dedicated to improving physical ability and independence in children through early diagnosis, comprehensive assessment and individualized treatment. Because cerebral palsy is a complex neurological disorder affecting various aspects of balance, strength, coordination and muscle tone, our team of medical experts takes an interdisciplinary approach to accomplishing its mission.
The Center for Cerebral Palsy at UCLA/OIC is renowned for its excellence in cerebral palsy treatment, research and education. We are the only interdisciplinary clinic in Los Angeles that evaluates and treats individuals with cerebral palsy from childhood through adulthood. Patients and their families are an integral part of the treatment decision-making process, and treatments are tailored to meet the individual patient’s goals and needs.
Our interdisciplinary approach begins on the first visit. Your child will meet with an orthopedic surgeon, physical therapist and orthotist and may meet with a physiatrist and/or a developmental pediatrician. Your child will undergo a state-of-the-art biomechanical assessment of their motor impairments and be introduced to the latest research opportunities in cerebral palsy (CP) offered in conjunction with UCLA Medical Center. As part of the Center, this assessment may also include a referral to our motion analysis laboratory, where we utilize the most up-to-date technologies to assess motor function, control and walking abilities.
In return visits, we may make referrals to other specialists on our team with expertise in occupational and speech therapy, psychology, pain management, developmental pediatrics, gastroenterology, neurology, neurosurgery, nutrition, ophthalmology, genetics, urology and osteoporosis.
Cerebral palsy is the most common childhood physical disability in the United States and throughout the world. There is not a single cause for cerebral palsy, and it is not caused by any specific genetic problem. It is a group of disorders affecting posture, strength and movement that occur as a result of an injury that occurs in the developing brain, typically around the time of birth.
Each child with cerebral palsy is unique. Depending on the location and extent of the injury, it can affect movement, balance, speech, vision and coordination. The damage to the brain may also result in intellectual impairment, seizures, and problems with learning, eating and
Cerebral palsy can be classified into different types by identifying which limbs are involved, the motor dysfunction experienced by the child, and the child’s capacity for independent mobility. The following classification types include:
Limb involvement can be broadly classified as bilateral cerebral palsy, meaning both sides of the body are involved or unilateral, meaning only 1 side of the body is involved. Some terms that are commonly used are:
This classification of cerebral palsy is described by the most prevalent movement disorder. The most common movement disorder in cerebral palsy is spasticity. Kids with spastic cerebral palsy have muscles that tighten or stiffen and prevents normal fluid movement. In many cases, children with cerebral palsy will have more than 1 movement disorder present. Some of the common movement disorders include:
One way to classify cerebral palsy is by examining a child’s capacity for independent mobility (e.g., walking and sitting). The most common classification for mobility is the Gross Motor Function Classification System (GMFCS), and it is divided into 5 levels, I-V, of independent ability based on normal motor milestones – walking, jumping, climbing stairs, etc.
The higher the level of GMFCS, the more affected the child and the less independent mobility they have. GMFCS helps doctors and families understand a child’s current and future motor function, their relative risk for associated problems like scoliosis and hip dislocations, and what equipment, therapy or surgery they might need in the future.
The Center for Cerebral Palsy at UCLA/OIC is dedicated to improving motor function in children through a program of early diagnosis, comprehensive assessment and individualized treatment. This includes:
Cerebral palsy may be caused by a multitude of events before, during or after birth that lead to abnormal development or injury to a child’s growing brain. In most cases, the exact cause of cerebral palsy is not known. However, any factor that causes low birth weight or premature birth increases the likelihood of a child being diagnosed with cerebral palsy. Brain damage that leads to cerebral palsy may occur prenatally, or before birth. Less than 10% of cases are the result of oxygen loss during the birth process.
The factors associated with a cerebral palsy diagnosis are:
Though more rare, cerebral palsy can occur to an otherwise healthy child if there is an injury to the brain during early development. Examples of this include:
Signs and symptoms vary greatly. Not all signs are noticeable at birth in every child with cerebral palsy. Symptoms may become more obvious throughout development. Common signs of cerebral palsy include:
At the Center for Cerebral Palsy at UCLA/OIC, we take the proper steps to identify, diagnose, and treat your child’s cerebral palsy. We perform a comprehensive evaluation by an expert team of doctors and diagnosis is made by the clinical team.
There is no specific test for cerebral palsy. While some centers and specialists use MRI as an aid to diagnosis, there is very poor overlap between current MRI capabilities and CP diagnosis. However, in uncertain cases, we will use MRI infrequently to rule out other causes for motor problems – brain malformations, etc.
Given the lack of specificity in current diagnostic tools, the CCP at UCLA/OIC is leading two ongoing research studies to improve our diagnostic abilities. One study is evaluating the usefulness of EEG (a non-invasive study that can measure brain activity) in early diagnosis. If you are interested in participating, please contact the CCP. The other study is evaluating newer MRI techniques for diagnosis in mice.
Based on the diagnosis, your doctor might perform additional tests or procedures such as neurotoxin (Botox or Dysport) injections to improve muscle tone and movement. Your child may also be referred to our Kameron Gait and Motion Analysis Laboratory to obtain an in-depth understanding of their movement patterns. The gait analysis provides information to our team to assist in treatment decisions such as orthopedic surgery, physical therapy, bracing or medication.
The goal of treatment for children with cerebral palsy is to improve limitation and prevent complications. This requires a coordinated multidisciplinary team of specialists during your child’s growing years. This team of clinicians at the Center for Cerebral Palsy at UCLA/OIC will develop an individually designed treatment program tailored to your child’s condition using a combination of strategies aimed at improving quality of life, function and independence. A treatment plan may include:
Physical and occupational therapy are important parts of early intervention for children with cerebral palsy and may be a part of your child’s ongoing treatment for many years. Our goal is to help your child grow up to be independent and able to take care of their daily needs.
While we try to limit surgery, many children and adolescents with cerebral palsy require surgery to improve joint mobility, walking efficiency, spinal alignment and hip position. Patients at the Center are seen every 6-12 months, and medical management is optimized to prevent unnecessary surgery. If surgery is necessary, the surgical plan is developed utilizing clinical exam, X-rays and, in some patients, gait analysis. Surgeries are performed at UCLA’s Mattel Children’s Hospital. Appropriate pre-operative assessments are completed at OIC and UCLA, and post-operative bracing and therapy is offered at UCLA and OIC.
Spasticity is the most common symptom of cerebral palsy. In addition to orthopedic surgery, therapy and bracing, we offer spasticity management treatment options that can increase ease of movement and decrease unwanted muscle activity in children. Those treatments include neurotoxin injections (Botox and Dysport), Intrathecal Baclofen pump (delivers medicine directly into the fluid around the spinal cord) and selective posterior rhizotomy (a neurosurgical procedure to eliminate spastic reflexes) in consultation with our neurosurgery colleagues at UCLA.
A small percentage of children with cerebral palsy have involuntary movement disorders called dystonia or choreoathetosis. Deep brain stimulation, or DBS, has been found effective in treating these disorders. DBS is often described as a “brain pacemaker” which uses strategically placed electrodes to send pulses to the brain to correct the abnormal activity and ease the symptoms of dystonia and choreoathetosis. The orthopedic surgeons at OIC do not perform this procedure, but they work closely with the pediatric neurosurgeons at UCLA, who have the expertise to perform these treatments, which can result in a better quality of life for your child and your family.
At OIC, we take a collaborative approach to diagnosing and treating cerebral palsy. Our team of experts are led by:
Our doctors are supported by a specialized team of medical professionals exclusively focused on pediatric orthopedics. This team may include:
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