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Cerebral palsy (CP) describes a group of permanent disorders of movement and posture caused by a non-progressive disturbance in the developing brain. The original brain disturbance does not progress, but its effects and a person's support needs can change across childhood and adulthood. CP is not synonymous with birth asphyxia, intellectual disability, or inability to communicate. The NICE guideline for cerebral palsy in people under 25 covers recognition, multidisciplinary care, communication, eating and drinking, associated conditions, and transition.
Quick reference
| Topic | Condition-specific guidance |
|---|---|
| Motor presentation | May be spastic, dyskinetic, ataxic, or mixed; distribution and functional effect vary |
| Cause | A disturbance or injury affecting the developing brain; prenatal, perinatal, neonatal, genetic, vascular, infectious, and other pathways may contribute |
| Course | The brain disturbance is non-progressive, while movement, pain, musculoskeletal health, communication, and participation may change |
| Diagnosis | Clinical assessment supported by developmental history and targeted investigation; imaging does not replace examination |
| Communication | Speech, language, cognition, hearing, vision, and motor access should be assessed separately |
| AAC | Based on unmet communication needs and individual access assessment, not on diagnosis or motor severity alone |
Recognition and diagnosis
Possible early signs include delayed or atypical motor development, unusual tone or posture, early hand preference, persistent feeding difficulty, or movement patterns that differ from expected development. Later presentation may include spasticity, involuntary movement, impaired coordination, contracture, pain, or difficulty with mobility and daily activities.
Diagnosis is clinical and should integrate pregnancy and birth history, development over time, neurologic and musculoskeletal examination, hearing and vision, and the pattern of function. Brain MRI and targeted genetic, metabolic, or other testing may help identify an explanation or an alternative diagnosis. A normal or nonspecific scan does not by itself exclude CP.
Functional classification systems can describe gross motor, hand, communication, eating and drinking, or visual function. They support shared description and planning; they do not measure intelligence, potential, effort, or quality of life.
Loss of previously acquired abilities, unexpected focal findings, a course that appears progressive, or findings inconsistent with the established diagnosis should prompt clinical re-evaluation. NICE specifically advises reviewing the diagnosis when the clinical course or investigations do not fit CP (NICE recommendations).
Coordinated care and safety
Care should be organized around the person's goals and may involve primary care, developmental or rehabilitation medicine, neurology, orthopedics, physical and occupational therapy, speech-language pathology, nutrition, dentistry, psychology, education, and social services. Relevant reviews may include pain, hip and spine health, movement and tone, epilepsy, sleep, respiratory health, nutrition, bowel and bladder function, hearing, vision, mental health, and participation.
Seek urgent medical assessment for new respiratory distress, repeated choking with difficulty recovering, a prolonged or first seizure, sudden marked change in alertness or movement, severe unexplained pain, dehydration, or acute loss of function. A gradual change in mobility, swallowing, communication, pain, or endurance also warrants timely review rather than being attributed automatically to CP.
Speech, language, and communication
CP can affect respiratory support, voice, articulation, rate, coordination, facial expression, language, literacy, or cognitive-communication in different combinations. Some people have clear speech and age-expected language. Reduced speech intelligibility does not establish reduced comprehension or cognition.
Assessment should identify what the person understands and expresses across familiar and unfamiliar partners, how fatigue and positioning affect performance, and whether hearing, vision, pain, medication, or motor demands are limiting participation. Useful partner practices include allowing response time, addressing the person directly, confirming the intended message, and offering an accessible way to repair misunderstandings.
Eating, drinking, and saliva
Possible swallowing concerns include coughing or choking, wet or changed voice, congestion during meals, recurrent chest illness, prolonged meals, food or drink remaining in the mouth, reduced intake, poor growth, dehydration, or distress. Aspiration may occur without an obvious cough, so the whole respiratory and nutritional picture matters.
Clinical feeding and swallowing assessment should consider posture, head control, respiratory status, oral movement, endurance, sensory responses, independence, preferences, and caregiver support. Instrumental assessment may be indicated when physiology or safety cannot be determined clinically. Texture, pacing, positioning, equipment, and non-oral nutrition decisions require individualized assessment and shared discussion; they should not be selected from the diagnosis alone. See the AACPDM respiratory-health care pathway and ASHA Pediatric Feeding and Swallowing.
AAC and access planning
AAC may support a person whose speech does not meet communication needs in one or more settings. There are no motor, cognitive, behavioral, or age prerequisites for beginning an AAC assessment. A multimodal plan can preserve speech, vocalization, gesture, sign, writing, partner strategies, and low-tech communication while adding other tools.
Assessment should feature-match language and literacy, movement, vision, hearing, seating, endurance, communication environments, preferences, and change over time. Direct touch, adapted pointing, switches, eye tracking, partner-assisted scanning, and other access methods are possibilities to evaluate, not diagnosis-based prescriptions. Include vocabulary for health, pain, consent, relationships, learning, work, and emergencies; train communication partners; and maintain a low-tech backup. See the AAC assessment and acquisition guide and ASHA AAC Practice Portal.
Participation, transition, and follow-up
Plans should support the person's chosen roles at home, in education, at work, in health care, and in the community. Access needs may change with growth, orthopedic procedures, fatigue, pain, aging, new environments, or changes in hearing, vision, movement, or communication. Transition planning should transfer clinical history, current equipment and access methods, communication supports, feeding plans, emergency information, and the person's own priorities.
Prognosis is individual. Motor classification, associated conditions, environmental access, health complications, and available supports can inform planning, but none defines a person's communication, relationships, education, or quality of life. Reassessment is appropriate after a meaningful functional change and at major life or care transitions.
Key sources
- NICE: Cerebral palsy in under 25s—assessment and management
- CDC: About Cerebral Palsy
- American Academy for Cerebral Palsy and Developmental Medicine: Respiratory Health in Cerebral Palsy
- American Academy of Pediatrics: Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy
- ASHA: Augmentative and Alternative Communication
- ASHA: Pediatric Feeding and Swallowing