Seizures. Choking. Falls. These three—often traumatizing incidents—are prevalent in children and people of all ages with cerebral palsy.
Cerebral palsy, CP for short, is the most common motor disability in childhood averaging 3.3 children per 1,000 live births. As many as half of all children with CP have one or more seizures, and more than 30% have a limited or no walking ability.
CP affects each person differently; therefore, as a first-aid provider or caregiver, it is imperative to understand CP along with the heightened risk of distressing events.
Understanding cerebral palsy
CP is the result of brain injury and malformation that occurs before, during, or immediately after birth while the infant’s brain is under development. Interestingly, about 2% of CP cases are genetic.
How a brain injury affects motor functioning and intellectual abilities is dependent on the nature of the brain injury, where the damage occurs, and how severe it is. Sometimes the brain damage is not confined to one location. In such circumstances, it is plausible for a child to develop symptoms characteristic of multiple brain injuries.
There is no cure for the non-progressive neurological condition. Still, supportive therapies, medications, and surgery can help many individuals with CP develop their motor skills and ability to communicate with the world.
Types of Cerebral Palsy
There are four major categories of CP: spastic, athetoid, ataxic, and mixed. These are classified based on mobility limitations and the body part(s) being affected. The following is a summary of each type.
- Spastic CP is the most common, making up 70–80% of cases. A person with spastic CP will often have jerky or exaggerated movements, muscles that cannot relax, or stiff muscles.
- Athetoid CP, or non-spastic CP, affects about 10% of people with CP. The person's muscle tone fluctuates, and voluntary control of the muscle is impaired—this means that the affected area of the face, limbs, or torso, for example, may flutter and suddenly move involuntarily.
- Ataxic CP makes up a small percentage of all cases. A person with ataxic CP exhibits problems with balance and coordination. Those with ataxic CP have issues surrounding voluntary movement, balance, and coordination.
- Mixed CP, found in less than 10% of cases, is when a person is showcasing traits of more than one type of CP. A combination of spastic and athetoid CP is the most prevalent.
Seizures and epilepsy
A seizure, which is a single occurrence, is a sudden surge of electrical activity in the brain. Epilepsy is a chronic disorder characterized by two or more seizures. More than 10% of CP patients have epilepsy, which treatment and medication can usually control. Children who experience infrequent seizures or epilepsy are at an increased risk of injury and death than those without seizures.
Witnessing a seizure can be a scary and stressful situation, especially if it is the first time you are in this circumstance. Luckily, there are numerous ways you can help keep things under control.
First aid for seizures
- Remain calm and reassure others. It is normal for people to become nervous when they see someone having a seizure. Try to stay quiet, calm, and reassuring.
- Prevent injury. Help the person sit or lay down. If the person is near a busy street, stairs, or around other hazards, try to protect them from harm as much as possible. Quickly remove nearby dangerous objects and place something soft under their head, such as a pillow or folded jacket.
- Track the length of the seizure. Take note when the seizure begins and ends. Call 911 immediately if, the person's history is unknown, this is the person's first seizure, or the seizure lasts longer than five minutes. If the person is experiencing pain, muscle aches, a bitten tongue, or a fever following a seizure, this may require emergency medical attention.
- Make the person as comfortable as possible. Loosen any tight or restrictive clothing around the neck and chest, loosen belts or buttons, and remove glasses. Do not restrain them. If possible, try to roll the person on their side so that any fluids can drain out of the mouth and to make breathing easier.
- Do not insert anything into the person's mouth. It is a misconception that things such as spoons, fingers, or other objects should be inserted into a person's mouth to prevent them from swallowing their tongue. In fact, it is harmful if anything is inserted into a person's mouth during a seizure, as this can cause them to choke.
- Keep bystanders at a distance. If the seizure happens in a public place, try asking bystanders to keep their distance from the person. They may feel nervousness or embarrassment when they wake up, so it is best to keep only essential personnel around during a seizure.
- Contact the person's doctor. After the person endures a seizure, it is essential for them or their caregiver to contact their healthcare provider to get further guidance regarding the situation.
Eating and swallowing difficulties
People with CP sometimes have dysphagia, or difficulty swallowing, which can lead to improper nutrition and dehydration in children and adults.
People with dysphagia are also more prone to choking, as well as respiratory infections like pneumonia—especially aspiration pneumonia, which occurs with inhalation of food, saliva, liquid, or vomit into the lungs.
How to recognize choking
Hands clutched to the throat is the universal signal for choking. A person with CP may not be able to give this signal. Other signs to look for include:
- Unable to talk.
- Difficulty breathing.
- Noisy or squeaky sounds when breathing.
- Cough, weak or forceful.
- Lips, skin, and nails turning blue or dusky.
- Flushed skin that then becomes pale or bluish.
- Loss of consciousness.
First aid for a conscious choking adult or child over one year with CP
If the individual can cough forcefully, the person should keep coughing. If the person is choking and can’t talk, cry, or laugh, use the following 5-and-5 approach:
- Stand behind the choking adult. For a child kneel down behind them.
- For support, wrap one arm across the person's chest. Lean the person forward, bending them at the waist, so that their upper body is parallel with the ground.
- With the heel of your other hand, deliver a firm blow between the person's shoulder blades. Perform the back blows 5 times. If the object does not dislodge, begin abdominal thrusts.
Abdominal thrusts (Heimlich maneuver)
- Stand behind the choking adult. If a child is choking, kneel down behind the child. Place one foot slightly in front of the other for balance.
- Wrap your arms around their waist. Lean the person forward slightly.
- Make a fist with one hand. Position the thumb side of your fist slightly above the person's navel and below the breastbone.
- Grasp your fist with your other hand. With a quick, upward thrust, press hard into their abdomen—as if you are trying to lift the person up. Perform 5 upward thrusts.
- Alternate between 5 blows and 5 thrusts until the object is dislodged or until the person loses consciousness.
- If you are not familiar with back blows, it is acceptable to use abdominal thrusts as the first-line treatment.
- If you're the only rescuer, perform back blows and abdominal thrusts before calling 911 or your local emergency medical services for help. If another person is available, ask that person call for help while you perform first aid.
- If the person becomes unconscious, perform standard cardiopulmonary resuscitation (CPR).
Musculoskeletal disorders are often present in people with CP and can lead to gradual loss of function, decreasing one’s expected survival time.
Mobility begins to decline, especially during middle and older adulthood, which drastically increases the risk of falling. Adults with CP tend to have more issues with falling than children and adolescents with the disorder; however, people of all ages with CP can easily fall due to involuntary movements and imbalance issues.
Physical and aquatic therapy, mobility aids, and sometimes surgery are ways to help prevent falls. Healthcare providers encourage caretakers to enroll children with CP into physical therapy as soon as possible after diagnosis.
A rough fall for people with cerebral palsy can lead to sprains, broken bones, and an increase in CP symptoms.
How to recognize a broken bone
A cracked or broken bone can cause the following signs and symptoms:
- Intense pain in the injured area that gets worse when the person moves it. Numbness in the wounded area is also common.
- Visible deformity or bone protruding through the skin.
- Bluish skin color.
- Heavy bleeding at the injury site.
First aid for a broken bone
If you suspect that an individual has a broken bone, provide first-aid treatment and help them get professional care immediately:
- Stop any bleeding. If the person is bleeding, elevate and apply pressure to the site by using a sterile bandage. A clean piece of clothing or cloth will also work. If available put on clean gloves, to prevent exposure to bloodborne pathogens.
- Immobilize the injured area. If you suspect a broken a bone in the person's head, neck, or back, help them stay as still as possible. If you suspect a broken bone in a limb, immobilize the area using a splint or sling. A person can make a splint by using a strips of wood, ruler, branches, layers of cardboard, foam, etc.
- Do not move the injured person until the broken bone is stable.
- Apply cold to the area. Wrap a bag of ice or an ice pack in a piece of cloth and apply it to the injury.
- To prevent shock lay the person down, elevate their feet about 12 inches (30 centimeters) above their head. If possible, cover the person with a coat or blanket.
- Call 911 or emergency medical services to get help and begin CPR if the person is unconscious or not breathing, or both. Also, you should notify emergency medical services if you suspect the person has a broken a bone in their head, neck, or back, the fractured bone has pierced through the skin, or they are bleeding heavily.
- Otherwise, help the person get to the emergency department immediately by car or other means so a healthcare provider can diagnose their condition and recommend appropriate treatment.
To prepare yourself for emergency situations for all ages, you can enroll in a certified first-aid training course.
Cerebral palsy: Hope through research — An educational resource for patients and caregivers about cerebral palsy by the National Institute of Neurological Disorders and Stroke.
Birth Prevalence of Cerebral Palsy — Read about the prevalence and characteristics of cerebral palsy from the Centers for Disease Control and Prevention.
Neurodegenerative disorder with progressive spasticity and brain white matter abnormalitie — Review an article that discusses the progressive spasticity and brain white matter abnormalities of this autosomal recessive disorder.
What is a seizure? — Johns Hopkins provides an in-depth review of seizures in this publication.
What to do when someone is having a seizure — Study an infographic provided by the University of Pittsburgh’s School of the Health Sciences that shows what to do when someone is having a seizure.
Choking first aid — Review Mayo Clinic’s step-by-step guide that explains what to do in a choking emergency.
Choking adult or child over 1 year — In this article, the National Institute of Health (NIH) explains what to do when a person older than one is choking.
Performance of adults with cerebral palsy related to falls, balance and function: a preliminary report — Read a report that describes the functional mobility of adults with CP.
Types of cerebral palsy and walking problems — Cerebral Palsy Guidance provides answers and assistance to caregivers of children with CP. This article reviews the types of CP and walking difficulties.
Broken bones — The NIH published this easy to understand overview of how to recognize a broken bone and the steps for providing first aid.