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Cerebral Palsy: Meeting Patients’ Nutritional Needs

Cerebral palsy actually refers to a large grouping of related movement disorders. Individuals with cerebral palsy are unable to control their bodily movement, because the brain does not correctly signal the body to modulate movement. Some patients have spastic movement (difficult and stiff), others have ataxic movement (balance and depth perception issues), and others have athetoid/dyskinetic (uncontrollable) movement. Many patients have combinations of these problems.

A traumatic birth, maternal substance abuse, maternal infection during pregnancy, meningitis, or brain injury can cause cerebral palsy. The incidence of cerebral palsy has increased with the advances in the medical field that allow for survival of very-low-birth-weight neonates. Many patients with cerebral palsy do not outgrow their reflex reactions, like other children do. Cerebral palsy is sometimes confused with seizure disorders.

The following may occur in the cerebral palsy patient:

• Scoliosis
• Hip dislocation
• Contractures of joints
• Discrepancy in leg length
• Fragile bones with frequent fractures

People with cerebral palsy also are prone to develop chronic lung disease. Airway abnormalities often occur in this population. 

Treatment for cerebral palsy
Cerebral palsy is chronic, because the underlying brain damage is irreversible. However, children can learn to use wheelchairs, walkers, or crutches. Physical, occupational, recreational, and speech therapies often are successful in helping a child with cerebral palsy become more comfortable and independent. Some medication is useful for cerebral palsy, most often antispasmodics, anticonvulsants, and anticholinergics.

Orthopedic surgery sometimes is performed. Nerve blocks sometimes are used. Sometimes certain parts of the body are put in casts to allow other parts to increase strength and range of motion. Eye surgery or corrective lenses may help with strabismus or serious depth-perception problems, and hearing aids sometimes are prescribed for related hearing loss. Patients with cerebral palsy often suffer from depression, attention deficit hyperactivity disorder, and other learning disabilities. Psychological care provision sometimes is necessary to help the patient and caregivers cope with the stresses of daily living. 

Nutritional implications of cerebral palsy

Assessment:

• Roughly 35% of children with cerebral palsy are malnourished
• Cerebral palsy frequently leads to decreased linear growth, and low weight for stature is common (between the 10th and 25th percentile weight for length is typically considered appropriate) 
• No specific graphs for patients with cerebral palsy are available; the basic National Center for Health Statistics growth charts are used, unless a concurrent condition exists 
• Some studies have shown that patients with cerebral palsy often eat enough to meet their energy needs, but not their nutrient needs, which results in a low level of fat-free mass 
• Generally speaking, a child with cerebral palsy who is immobilized should receive 10 kcal/cm of height; a child with mild to moderate activity can receive 15 kcal/cm of height
• Adolescents with athetoid cerebral palsy can require up to 6,000 kcal/day 
• The RDA for protein is used for chronological age, or for height-age if growth is severely stunted 

Feeding issues:

• Speech therapy can help patients strengthen their mouth muscles and more efficiently use their tongue to swallow
• Cerebral palsy patients often have very sensitive mouths and find certain textures of food very unappealing 
• Children with cerebral palsy are probably unable to feed themselves, and a caregiver will often need to spend a very long time feeding them each day, which is stressful for both caregiver and child (the best foods to serve are those that are easiest to feed, while still providing adequate nutrition) 
• Smaller meals spread out throughout the day often are less exhausting for the patient and/or caregivers, as compared to three meals a day
• Nutrient-dense foods are recommended, as chewing and swallowing ability allows
• Many patients with cerebral palsy need a ground/mechanical soft diet with thickened liquid, because of their severely limited chewing reflex
• Weighted utensils, nonslip placemats, and dishes with guards or lips are helpful to many cerebral palsy patients
• Many people with cerebral palsy have gastroesophageal reflux disease 

Issues impacting intake:

• The constipation experienced by many cerebral palsy patients is caused, in part, from poor fluid intake; other causes include excessive sweating and/or drooling 
• Patients with cerebral palsy are prone to tooth decay

Nutrient deficiency:

• Medications commonly used with cerebral palsy lead to a decrease in availability of Vitamin D and K, as well as a decreased level of calcium, magnesium, folate, vitamin B6, vitamin B12, and vitamin C 
• Patients with cerebral palsy run a high risk of developing osteopenia/osteoporosis:
  • Recommend supplements, as necessary, based on dietary intake
  • Keep in mind that usage of anticonvulsant medications decreases serum levels of vitamin D
  • Consider some weight-bearing exercise, if possible
  • Make a referral to a physical therapist 

References and recommended readings

Katz-Wise SL, Poore R. Cerebral palsy. Available at: http://www.revolutionhealth.com/articles/cerebral-palsy/aa56609?id=aa56609&section=section_00. Accessed June 24, 2008. 

Mayo Clinic. Cerebral palsy. Available at: http://www.mayoclinic.com/health/cerebral-palsy/DS00302/DSECTION=treatments-and-drugs. Accessed June 24, 2008.

HealthCommunities.com. Cerebral palsy: overview, types, incidence, causes. Available at: http://www.neurologychannel.com/cerebralpalsy/index.shtml. Accessed June 24, 2008.

Thorogood C. Cerebral palsy. Available at: http://www.emedicine.com/pmr/topic24.htm. Accessed June 24, 2008.

FormsOfCerebralPalsy.com. Forms of cerebral palsy. Available at: http://formsofcerebralpalsy.com/. Accessed June 24, 2008.

Theberge C, Illing A. Nutrition in cerebral palsy. Available at: http://www.nafwa.org/cp1.php. Accessed June 25, 2008.

University of Nevada, Reno, College of Agriculture, Biotechnology, and Natural Resources. Toddler and preschooler nutrition: conditions and interventions. Available at: www.cabnr.unr.edu/nutrition_courses/Ashley/370/Chapter_11.pdf. Accessed June 25, 2008. 

Review Date 8/08
G-0709