Care of the Patient with Cerebral Palsy

Cerebral Palsy (CP) is the most common childhood disability. It affects about three of every 1,000 children in the United States (CerebralPalsy.org, 2025a). It is estimated that more than palsy (CerebralPalsy.org, 2025a). About 10,000 babies born each year will develop CP (CerebralPalsy.org, 2025a). Although there is no known cure, research has provided many ways to help these patients live productive lives. Healthcare workers need to understand the various symptoms of cerebral palsy and what can be done to help these patients.

CP is not a single disease but a group of related disorders that is described by loss or impaired motor function. It is a common cause of motor disability in children. CP results from brain damage before, during, or shortly after birth (CerebralPalsy.org, 2025b). This damage affects the brain regions responsible for motor control and coordination. CP also affects movement and muscle tone, muscle control, muscle coordination, reflexes, posture, and balance (CerebralPalsy.org, 2025a). Not all patients experience every problem. Some children experience mild symptoms, while others face more severe challenges. It is not progressive and remains in a stable condition.

There are four different types of CP (CDC, 2025).

The Gross Motor Function Classification System (GMFCS) is used to classify the abilities of people with CP (Cerebral Palsy Alliance Research Foundation, n.d.).

• Level I: Walks independently, runs, and jumps, with minor balance limitations.
• Level II: walk but may require assistance with uneven terrain, stairs, or long distances.
• Level III: Walks with assistive devices, such as walkers or crutches, and may use wheelchairs for extended distances.
• Level IV: Rely on wheelchairs for mobility, with limited independent movement.

The causes of CP can be hard to find. Sometimes, it is caused by:

• Lack of oxygen to the brain
• Infections during pregnancy 
• Premature birth
• Brain injury after birth leading to brain damage 

CP can lead to various associated health problems known as comorbidities.

Around 50% of people with CP may have a seizure disorder or an intellectual disability (Cerebral Palsy Guide, 2025). Many also have vision and hearing impairments (CDC, 2025). Some people find it hard to eat, swallow, or control bowel and bladder functions. CP affects everyone differently. Some need a lot of help, while others require less support.

Early signs of CP can be seen in babies (CDC, 2025). Babies may have trouble controlling their heads and may have stiff or floppy muscles. Delayed milestones may start to show, such as not rolling over or sitting up at the right time. These early signs can help doctors diagnose CP in a timely manner.

Doctors use different tests to diagnose CP. They look at the baby’s movements and reflexes. Scans, such as MRI or CT scans, may be ordered to examine the brain. They also check for vision and hearing problems, as well as intellectual disabilities.

Early diagnosis is important and can improve a person’s life (CDC, 2025). The outlook for people with CP varies. Some people have mild symptoms and can live full lives. Others have more severe symptoms and need more help. There is no cure for CP, but treatments can help people with CP. The goal is early recognition and promoting increased movement, language skills, and independence.

There are many treatments for CP. These treatments help with movement and other related challenges (Johns Hopkins Medicine, n.d.). A multi-professional team approach to the treatment of CP is needed. Parents are also essential in the care of the child. It is important to consider their goals and desires as well as their cooperation in all aspects of care.

Medical treatments consist of medications for managing muscle spasms and seizures. They also may need corrective surgeries to fix muscle tightness and bone deformities.

Physical therapy is used to enhance movement and strength.

Occupational therapy is used to improve daily living skills, such as eating, writing, and performing activities of daily living (ADLs).

Speech therapy is used to aid communication and swallowing (Johns Hopkins Medicine, n.d.).

These therapies help people with CP learn new skills (Johns Hopkins Medicine, n.d.). Assistive devices, such as braces, walkers, and wheelchairs, can also be beneficial, aiding in movement and daily tasks. Some people use computers to assist them in communication.

(*Please click on the image above to enlarge.)

The Americans with Disabilities Act (ADA) is a law that supports people with disabilities (U.S. Department of Justice Civil Rights Division, n.d.). It aims to provide them equal access to jobs, schools, and public areas. It ensures they have access to healthcare. Another important law is the Individuals with Disabilities Education Act (IDEA). This law ensures that children with disabilities get free, appropriate public education and receive required special services help in school (US Department of Education, 2025).

These laws are important for Certified Nursing Assistants (CNAs and HHAs) to understand. CNAs and HHAs must follow these laws and respect the rights of people with disabilities. In-home care, CNAs and HHAs help people with cerebral palsy (CP) live at home. The ADA helps ensure that people with CP can receive the home care they need.

Additionally, in 2010, the Affordable Care Act excluded pre-existing conditions and prohibited discrimination due to health status (US Department of Health and Human Services, 2022). This act also established that an insurer could not limit benefits for a pre-existing condition.

These acts have been instrumental in helping patients with disabilities attain a more productive life.

Initially, a patient will undergo a nursing assessment, during which the nurse will interview the child and family to determine the child’s needs. They will also observe the child's level of development. Both of these components will be used to establish realistic long-range goals for nursing care (Belleza, 2024). The nurse will also take a complete patient history and perform a neurological and muscular examination. Using all of the information gathered, they will create a plan of care. Certified Nursing Assistants (CNAs) and Home Health Aides (HHAs) often play a vital role in this plan of care.

CNAs and HHAs play a key role in helping people with CP. They help with daily activities, including bathing, dressing, and eating, as well as with movements, such as transfers and walking.

They also help provide skin care, pain management, seizure monitoring, and proper positioning. Assisting with ADLs is important. CNAs and HHAs help people with CP do these tasks while allowing them to be as independent as possible.

Some people with CP may have trouble eating and may need nutritional support and feeding assistance. CNAs, HHAs, and HHAs help them eat safely and assist with the use of special utensils (Cerebral Palsy Guide, 2025).

Some people with CP have trouble with bowel and bladder control. CNAs and HHAs help provide bowel and bladder care. Skincare and pressure ulcer prevention are important. People with CP may spend a lot of time in one position. This can cause skin breakdown and the formation of pressure ulcers (Cerebral Palsy Guide, 2025). Preventing pressure ulcers is an important aspect of skin care for people with CP.

Therapy and rehabilitation are key parts of care for people with cerebral palsy. CNAs' and HHA's therapy goals are to assist with exercises and activities that enhance movement and daily living skills. It is important to help stay motivated and create a positive environment. A CNA and HHA should encourage people with CP to do their best and help them celebrate small wins.

CNAs and HHAs have a responsibility to:

• Follow the patient's care plan: This ensures consistent and appropriate care.
• Provide safe and respectful care: Patients have the right to be treated with dignity.
• Help people with CP be as independent as possible: Encouraging self-sufficiency is important.
• Help them participate in their community: Social inclusion is vital.

Emily is a 16-year-old female diagnosed with spastic cerebral palsy. She lives at home with her mother, who is her primary caregiver. Emily recently underwent surgery to correct foot drop and tendon lengthening in her lower extremities. After surgery, she needs help with all daily activities and is on bed rest for now.

Emily experiences significant anxiety related to her limited mobility and fear of re-injury. She exhibits increased muscle spasms and reports moderate pain in her legs. Her mother expresses concern about Emily’s emotional state and the challenges of managing her post-surgical care at home.

Emily has a seizure disorder. She controls it with daily anti-epileptic medication. She also has a history of constipation. She used leg braces and a wheelchair for mobility before the recent surgery.

Assessment:

• Due to her bedridden status and increased movement in bed, Emily's skin integrity is thoroughly assessed.
• Nutritional and bowel function are assessed to prevent complications like constipation.
• Pain levels and muscle spasms are evaluated, and pain management strategies are implemented.
• Emotional and psychological assessment is carried out to address Emily’s anxiety and fear.
• An evaluation of her understanding of post-surgical limits.
• An assessment of her mother's grasp on Emily's care.

Intervention (National Institute of Neurological Disorders and Stroke, 2025):

Range of motion exercises are done to keep joints flexible and avoid contractures. These exercises are often ordered by a physical therapist.

• Proper positioning techniques are employed to minimize discomfort and prevent pressure ulcers.
• A bowel management plan is implemented, including increased fluid intake and dietary modifications.
• Non-pharmacological pain management techniques, such as heat therapy, are used.
• Emotional support and therapy to help Emily with her anxiety and make her feel secure.
• Education for the mother on skincare and range of motion exercises is provided.
• Communicate with the physical therapist and the nurse to keep the whole team informed about Emily's condition.

Discussion of Outcomes:

Emily's care plan worked well. Checking her skin often and making sure she was in good positions stopped pressure ulcers. Her bowel plan helped her with constipation, making her feel better. Her pain got better with the right pain help. Talking and support helped her feel less worried. Her mom learned to do her exercises and check her skin. The therapy team changed her plan based on what the CNA saw. This helped Emily get better care.

Strengths:

• A comprehensive approach was used, addressing both physical and emotional needs.
• Collaboration with the healthcare team ensured continuity of care.
• Education and support were provided to the mother, empowering her to participate in Emily’s care.
• The CNA was able to identify and help treat multiple issues.

Weaknesses:

• Limited access to specialized equipment at home may hinder optimal care.
• The mother’s emotional strain could impact her ability to provide consistent care.
• The CNA is limited in what medical treatment they can provide.

Liam is a 10-year-old boy diagnosed with cerebral palsy (CP), living at home with his parents and younger brother. He uses a walker for mobility and wears braces on both legs. Liam has mild speech difficulties and occasional issues with feeding due to muscle control challenges. While he attends school virtually and is intellectually capable, he struggles with daily tasks like dressing, bathing, and safe ambulation. His parents have enlisted the support of a Home Health Aide (HHA) to assist with Liam’s daily care and improve his quality of life at home.

The assigned HHA worked closely with Liam’s family and care team to implement a comprehensive care plan, focusing on the following key interventions:

• Activities of Daily Living (ADL) Support: Assisted Liam with dressing, bathing, toileting, and feeding while promoting his independence by breaking tasks into smaller steps and using adaptive tools (e.g., dressing aids and adaptive utensils).
• Mobility and Positioning: Helped with transfers, supervised use of the walker, and used pillows and positioning aids to prevent pressure ulcers and support proper posture. The HHA also checked braces daily for proper fit and skin safety.
• Feeding and Nutrition: Provided feeding assistance using adaptive utensils and encouraged slow, safe eating practices to prevent choking while promoting as much independence as possible.
• Skin Care and Hygiene: Conducted regular skin checks, maintained hygiene to prevent infections, and helped rotate Liam’s positions to prevent pressure sores.
• Emotional Support and Communication: Used simple language, allowed extra response time, and encouraged the use of a communication app. The HHA also engaged Liam in conversations about his interests to build rapport and emotional resilience.
• Safety and Infection Control: Maintained a clean, clutter-free environment, ensured safe transfers, followed hand hygiene protocols, and monitored for signs of infection or illness.
• Coordination with the Healthcare Team: Documented daily progress and reported any concerns with equipment or Liam’s health to the nurse and therapy team.

Discussion of Outcomes

Over several weeks, Liam showed increased confidence in completing tasks with minimal assistance. He began dressing himself with adaptive tools and expressed pride in helping with his own feeding. His mobility improved with daily movement support and consistent use of his walker. Emotional outbursts decreased as he gained more independence, and communication became easier through routine use of the communication app.

The family reported feeling more supported and less overwhelmed. Liam’s participation in daily routines increased, and his emotional well-being improved. There were no signs of skin breakdown, and his risk of infection remained low due to consistent hygiene practices.

Strengths and Weaknesses of the Approach

Strengths:

• Person-centered care: Tailoring strategies to Liam’s specific needs helped foster independence and self-esteem.
• Holistic support: Addressing physical, emotional, and safety aspects created a well-rounded care environment.
• Collaboration: Working closely with Liam’s family and care team ensured continuity and consistency in care.

Weaknesses:

• Time limitations: Some activities required more time than allotted during scheduled visits, occasionally leaving parents to continue care.
• Need for specialized training: While the HHA was well-trained, more advanced communication device training would have improved interaction.

Cerebral palsy (CP) is a condition that affects how people move. It happens because of damage to the brain. There are different types of CP, and each type affects people in unique ways. People with CP may also have other health problems, which are called comorbidities.

Many treatments are available for CP, designed to improve movement and address other related issues. Certified Nursing Assistants (CNAs and HHAs) are crucial in helping people with CP. They assist with:

• Daily tasks: Helping with activities like bathing, dressing, and eating.
• Therapy: Supporting therapy exercises and activities.
• Communication: Helping with speech and other communication needs.
• Safety: Ensuring a safe home environment.
• Infection control: Preventing the spread of infections.

CNAs and HHAs work as part of the healthcare team, following the care plan and reporting any changes in the patient's condition. Their goal is to help people with CP live full and meaningful lives.

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