Functional concerns over time in people with cerebral palsy

Although the underlying cause of cerebral palsy is nonprogressive, people experience specific changes in function over time due to:

  • contractures, joint subluxation and dislocation—due to changes in the relative length of muscles and bones during periods of rapid growth
  • muscle fatigue, weakness, strains and sprains, joint inflammation and osteoarthritis—due to sustained stress from motor disorders on muscles and joints
  • increasing scoliosis or kyphoscoliosis
  • changes in pattern, type and frequency of seizures (epilepsy)
  • the effects of medications, particularly antiepileptic and antispasmodic medications
  • physical health conditions causing pain, discomfort, muscle weakness, loss of coordination and fatigue
  • loss of confidence and self-esteem leading to psychiatric disorders (eg anxiety, depression, psychosis).

People with cerebral palsy may have premature decline in physical function impacting independence, participation (ie communication, mobility, education, employment, recreation) and wellbeing. Decline in physical function can start in people with cerebral palsy when they are in their twenties.

As ageing occurs, people with cerebral palsy are at increased risk of developing:

  • back pain (particularly in people with scoliosis)
  • lower respiratory tract infections (particularly in people with aspiration)—see Chronic lung disease and aspiration
  • more severe gastro-oesophageal disease with reflux oesophagitis (particularly in people with kyphoscoliosis)
  • symptomatic poor peripheral circulation including chilblains, leg ulcers, lymphoedema and poor skin healing—see Skin problems
  • continence problems including constipation, urinary tract infection and irritable bladder—disorders of sensation, communication difficulties, dysmotility, decreasing mobility and difficulty accessing the toilet may contribute to continence issues.
People with cerebral palsy are at risk of functional decline, impacting their mobility, communication, swallowing and activities of daily living, including self-care. Practitioners should establish the cause of any change in function and rule out differential diagnoses (eg spinal cord stenosis, other neurological disorder); see Differential diagnoses of functional decline in people with developmental disability for differential diagnoses of functional decline, and advice on managing a person with developmental disability who is ageing.

Multidisciplinary referrals are often helpful for assessing and managing functional concerns. People who use communication aids or mobility aids (eg wheelchair) have specific healthcare considerations and often benefit from allied health review.