introduction

Introduction
In the 1860s, an English surgeon named William Little wrote the first medical descriptions of a puzzling disorder that struck children in the first years of life, causing stiff, spastic muscles in their legs and, to a lesser degree, their arms. These children had difficulty grasping objects, crawling, and walking. They did not get better as they grew up nor did they become worse. Their condition, which was called Little's disease for many years, is now known as spastic diplegia. It is just one of several disorders that affect control of movement and are grouped together under the term cerebral palsy.
Because it seemed that many of these children were born following complicated deliveries, Little suggested their condition resulted from a lack of oxygen during birth. This oxygen shortage damaged sensitive brain tissues controlling movement, he proposed. But in 1897, the famous psychiatrist Sigmund Freud disagreed. Noting that children with cerebral palsy often had other problems such as mental retardation, visual disturbances, and seizures, Freud suggested that the disorder might sometimes have roots earlier in life, during the brain's development in the womb. "Difficult birth, in certain cases, " he wrote, "is merely a symptom of deeper effects that influence the development of the fetus."
Despite Freud's observation, the belief that birth complications cause most cases of cerebral palsy was widespread among physicians, families, and even medical researchers until very recently. In the 1980s, however, scientists analyzed extensive data from a government study of more than 35,000 births and were surprised to discover that such complications account for only a fraction of cases -- probably less than 10 percent. In most cases of cerebral palsy, no cause could be found. These findings from the NINDS perinatal study have profoundly altered medical theories about cerebral palsy and have spurred today's researchers to explore alternative causes.
At the same time, biomedical research has also led to significant changes in understanding, diagnosing, and treating persons with cerebral palsy. Identification of infants with cerebral palsy very early in life gives youngsters the best opportunity for developing to their full capacity. Biomedical research has led to improved diagnostic techniques -- such as advanced brain imaging and modern gait analysis -- that are making this easier. Certain conditions known to cause cerebral palsy, such as rubella (German measles) and jaundice, can now be prevented or treated. Physical, psychological, and behavioral therapy that assist with such skills as movement and speech and foster social and emotional development can help children who have cerebral palsy to achieve and succeed. Medications, surgery, and braces can often improve nerve and muscle coordination, help treat associated medical problems, and either prevent or correct deformities.

Much of the research to improve medical understanding of cerebral palsy has been supported by the National Institute of Neurological Disorders and Stroke (NINDS), one of the federal government's National Institutes of Health. The NINDS is America's leading supporter of biomedical research into cerebral palsy and other neurological disorders. Through this publication, the NINDS hopes to help the more than 4,500 American babies and infants diagnosed each year, their families, and others concerned about cerebral palsy benefit from these research results.

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