A child with cerebral palsy will have a number of limitations. These limitations can be related to deficits in large motor skills, in small motor skills or in extra movements that are involuntary. This can lead to a child that looks abnormal when he or she is attempting to move or even while at rest. Let's look at the various limitations that a child with CP must deal with :-

Limitations in Range of Motion. Kids with cerebral palsy often have spasticity. If it is spasticity in the legs, they can have a scissors appearance of the legs when the legs are extended. This limits ambulation so that the child needs to be wheelchair bound or perhaps can walk with the use of a walker or other assistive device.

The range of motion of the upper extremities can be limited. Usually this involves having a frozen shoulder and frozen arms in the flexed elbow position. The wrist can be frozen in the flexed position and the hands might be clenched. These kids are often given rolled up hand towels fashioned as such in order to keep the hand from being so clenched together.

Limitations of Fine Motor Control. Children with cerebral palsy can have difficulty with everyday things like spoons, forks, pencils and crayons. This may mean that eating by oneself is difficult without assistive devices that can help with holding and grasping. School may be limited by an inability to use pencils and crayons. Coloring for kids is often a social activity - one that a child with cerebral palsy cannot participate in if their fine motor control is affected. Some kids have tremors of their extremities that make things like feeding and learning how to write almost impossible without assistive devices.

Limitations of Speech. Children with CP can have slurred speech or facial grimaces that impact the ability to speak intelligible speech. They can also have a "voice tremor" that makes the voice constantly tremulous. With difficult speech, the child can have limitations in getting their other needs met because people cannot understand them. For this reason, some children need speech assistive devices to be able to communicate with others. Speech therapy can also help certain children learn to speak correctly and intelligibly. Such speech therapy can start as soon as the child would begin speech and continuing to adulthood. Some kids do extremely well with this type of therapy while others have problems with intelligible speech their entire lives.

Limitations of Bowel and Bladder Function. Depending on where the brain damage is done in cases of CP, children can have impairments in their bowel and bladder function, being essentially incontinent of bowel and bladder. The nerve function from the brain does not send the proper signals to the digestive system or the bladder and catheters in the bladder may need to be placed or the patient may need to be diapered through adulthood.

Limitations of Cognition. While many children with cerebral palsy live in essentially paralyzed bodies and intact brains, others have significant cognitive abilities and learning problems, exacerbated by poor sleep. The range of cognitive ability among children with cerebral palsy is great. Some have no ability to attend school or participate in play with other children while others have some ability to learn and become involved in society in meaningful ways.

Limitations of Truncal Posture. Some children with cerebral palsy have an inability to hold a posture, i.e., to maintain the position of their trunk. These kids don't do well in regular wheelchairs but must reside in molded chairs that keep their posture intact. In some kids, the poor posture leads to scoliosis or curvature of the spine that leads to permanent disfigurement of the trunk and spinal area. Other kids have problems holding their neck up in space and need further bracing to maintain an upright posture.

Limitations of Social and Emotional Development. Children with cerebral palsy are often treated as outcasts, teased by other children and live lonely lives without friends and companions. These kids do not learn proper social development and do not have the range of emotional capabilities as do normal children. This can be allayed sometimes through education of other children as to the causes and features of cerebral palsy so these kids are more accepted by their peers. If these kids have siblings, they tend to have a better social and emotional development as they are more likely to be accepted by their peers.

Limitations of Ambulation. While some kids with cerebral palsy do walk with fair efficiency, others cannot walk without assistive devices or at all. Children with severe cerebral palsy are bound to wheelchairs throughout much of the day, unable to have any ability to step on the ground because of contractures of the feet, knees and hips. This seems to be a problem that can be overcome with physical therapy if this therapy is begun at an early age.

Fortunately, this is the age of physical and occupational therapy where many of the child's limitations can be managed or overcome to make the child's life easier. Large motor skills can be improved through physical therapy and assistive devices, such as walkers and canes that make ambulation safer and faster. If ambulation is not possible, various kinds of wheelchairs and other types of chairs can be designed to reduce contractures and maximize use of the extremities. The same is true with truncal posture and small motor skills. Occupational and physical therapy can be used to maximize function through the use of practice and through the use of assistive devices so the child can eat independently or use a writing implement.

Individual and family therapy can be employed when the child is experiencing emotional difficulties as a result of having cerebral palsy. The entire family may need to be involved so everyone can support the affected child and can learn ways to involve the afflicted child in family events and gatherings. Children with normal mentation are at a special risk of depression because of their condition and they would benefit from individual psychotherapy.