So what’s the difference between cerebral palsy, brain injury and stroke?

Cerebral palsy, traumatic brain injury and pediatric stroke are often brought together under the same treatment processes and types of rehabilitation. It is common knowledge for many people who work with kids that the approach to take is often quite similar between the three conditions. However, after working with and observing children who have cerebral palsy, brain injury or pediatric stroke, personally I would disagree with this method and viewpoint. In my opinion, there are many reasons why treatment for each condition should be distinct, and the first thing I would like to examine is what makes each condition different from the next.

Comparing terms

To start with, cerebral palsy can be generalized as a condition that a child is born with. The degree of severity of his condition will depend on how severely the brain is affected, and–by following a chain reaction–on the stages of development he has missed. This will lead to impairment as he grows older if the appropriate function is not gained. Children who have cerebral palsy cannot move through the stages of development because they are not acquiring skills in the normal developmental process. In most cases, a child is taken through his individual milestones by the nervous system. For a child with cerebral palsy however, this progression is absent and this normal development does not exist. Therefore, the skills have to be acquired first, and then repeated until they become automatic. This means that when we work with a child with CP, there is no re-gaining of skills, only learning from scratch. These are things that a child will then apply in his daily life, to become a part of his everyday function.

In contrast, traumatic brain injury and pediatric stroke can be seen as having totally different circumstances. Although it will depend on when these injuries occur, often a child with either one of these conditions would have already gone through at least some of the stages of development. This means that he would have already learned and acquired certain skills before the injury. When dealing with a child in one of these situations (and again, depending on his specific age, severity of condition and other factors), treatment will involve rehabilitation–that is, the re-gaining of movement and function which has been lost because of brain damage. This is what sets conditions such as TBI and pediatric stroke apart from cerebral palsy, and is something that should be accounted for in treatment.

Learning vs. regaining skills in treatment

When working with a child that has cerebral palsy, we need to remember that the child will not be regaining skills; he will be learning ones that he has never had before. Therefore, he has to be taught from A-Z what everything stands for, the individual body parts, the way they move, and how normal function should be. In contrast, a child with a brain injury or who has experienced pediatric stroke will need to focus on this idea of regaining skills, which means we are acquiring skills that take place before the injury has occurred. It is for these reasons that the approach to treatment will need to be completely different for a child with cerebral palsy. Rather than following the same steps that patients follow for the other conditions, the child will need to be shown how to turn, roll over, and be able to build on those skills before moving onto the next step.

As a result, a child’s treatment should differ according to how the child gains valuable life function. The methods of learning for kids with brain injury or stroke should not be the same as those for children with cerebral palsy. We take this approach in my clinic’s specialized treatment program called LIFE, and that is why we call our program an education / rehabilitation system rather than one or the other–the approach will change depending on the child’s needs. Here, we teach kids how to acquire these functions, how to do them, and why. If a child does not understand, we repeat them again and again and again under the child begins to follow. By paying attention to a child’s personality and characteristics as well as to his learning and specific condition, the treatment process becomes much more successful and fulfilling for those involved. It is for this reason that I think treatment for children under each category should be approached with regards to the condition itself.

Of course, whether dealing with kids that have cerebral palsy, pediatric stroke or brain injury, the bottom line is the same: the patient must be the one to work harder than the therapist. That’s the reason why at our clinic, we try have a child do everything he has been taught by himself. In the end, the ultimate goal of treatment is to have a child learn to do things independently. By distinguishing each of these conditions, I hope that more parents, caregivers and therapists will learn from and experience success with their child as he learns and discovers the joys, wonders and surprises held by the world around him.

If you have any questions or comments, feel free to leave a comment down below or email me. Thanks everyone!

This article was featured by our friends over at Pediastaff. Thanks guys!

Natan

About the author

Natan Gendelman has written 135 articles for Enabled Kids.

Natan Gendelman is licensed as a physical therapist in Russia and Israel. After moving to Canada, he was certified as a kinesiologist and osteopathy manual practitioner. Natan has more than 20 years of experience providing rehabilitation and treatment for conditions such as cerebral palsy, autism, Down syndrome, pediatric stroke and acquired brain injury. He is the founder and director of Health in Motion Rehabilitation, a Toronto-based clinic whose main objective is to teach their patients the independence necessary for success in their daily lives.

17 thoughts on “So what’s the difference between cerebral palsy, brain injury and stroke?

  1. i am still battling to understand the differences in physio treatment between cp and abi.
    surely repetition of the movements and repeated instructions are a criteria for learning motor skills in both groups. please could you recommend further reading for me.

  2. What is the mildest case of CP you have encountered? Have you encountered a misdiagnosis of CP for TBI/PS? Is there anything that could differ later in age with different a diagnosis? Due to something caused at birth I was later diagnosed with CP, however, I reached every milestone on my own without PT, it never affected my education as I graduated top of my class nor did it affect my face, speech or cause muscle spasms. I did receive regular PT due to a lack of dexterity and weakness in my right hand/leg. If I told someone I have CP they think I’m lying. At age 30 I’ve been thinking of asking a doctor about my diagnosis. My question is, would it be worth it though?? Could anything further be done to help my slight lack of dexterity? Or change anything else?? Is an extremely mild case of CP possible?

    • Hi Roxy! Thank you for your question! With respect to TBIs, it’s unfortunate because everything today is labeled underneath the umbrella of ‘CP’ even though TBIs, CP, and strokes are very different from each other. For the children that I work with, each requires a different approach and treatment. That being said, there really is no need for you to go to the doctor to be labeled with a diagnosis if you have been able to function on your own. I would recommend practicing working symmetrically to help improve your dexterity and strength. For example, when you are walking, try practicing keeping your hands clasped together in front of you. This will help you stay more balanced and it will prevent you from leaning your weight on just one side of your body. If ever you are doing tasks using your left hand, try also using your right hand as well. Practicing these things will help you to teach your body to use both sides at the same time. I hope this was helpful! Please let me know if you have any other questions :)

  3. Hi!

    This is a brilliant piece of article!
    It may not be your field, but I’d really like to have your opinion on something: people are using rodents in order to model CP conditions. They permanently occlude the right carotid and put neonates in hypoxic conditions for a short period. This induce an injury on the Right side of the brain and, therefore, impairments on the Left forelimb.
    Have you heard about that?
    Would you consider this kind of model as a good model for CP study?

    Thank you

  4. Hi Nathan,
    I found your article very helpful in terms of understanding different approaches to CP and pediatric stroke. I would like to know how you would approach a case of pediatric stoke in terms of rehabilitation vs. compensation. As kids are quite eager to get back to functioning in their day to day lives would you spend time training their unaffected side new skills or would you concentrate on retraining the affected side. For example in the case of dense hemiplegia?

    • Thank you Tara for your comment! I would always work symmetrically by engaging both sides, instead of just working with just the affected side, or just the unaffected side. The unaffected side, which already has proper movement, would teach the ‘bad side’ proper function when you work this way. But if you only stimulate the unaffected side, the affected side will never recover. Even worse, you may have to deal with a chain of consequences (such as surgeries, botox, afo’s, etc.). I hope this was helpful, and feel free to ask me any other questions! :)

  5. Natan,

    I really enjoyed this article and it really helped me understand the reason for categorizing TBI and CP differently, but my question is where the line is? What if a child is in a car accident at 4 months old? While some skills have been acquired, most have not. Is there an age cut off for when a TBI can no longer be considered CP?

    • Hi Graham,

      Thank you for your question! My opinion is that there is no line between TBI and CP. They are completely separate. When I treat a child who has sustained a brain injury (i.e. they got into a car accident at 4 months old), I must keep in mind many things: how the injury occurred; what medications they were put on right after the brain injury; what other medical procedures were implemented; were they put on a breathing machine after the accident (because this usually means they suffered from a coma); what the extent of the psychological impact of being in the accident is; etc. It’s not just from a functional standpoint and the amount of acquired skills that must be taken into account, its also the impact of the injury in different areas of the brain. So the approach I must take in treating children with TBI are very different compared to those who have CP or have had a stroke. For a child that has been born with CP, you have to work from scratch (there is no fear aspect or psychological impact from a traumatic accident, etc.). So in my opinion, I would categorize TBI and CP completely separately. I hope this helps in answering your question! :)

  6. Hi I just wanna know will a child with cp ever going to live an independent life after going for rehabilitation and be able to go to normal school II doctors said the cp may be mild TX.

  7. My grandson was born with a very weak left side. He needed PT from 4-12 months and could not hold his head up on his own until he was 6 months, by the time he finished his PT he was almost walking on his own. Then when he was 14 months he was speaking in 6-8 word sentences and had hypospadeus repair. He was under sedation for 4 1/2 hours and then it took them an extra hour for him to come out of it and he was then sent home a few hours later, after that he stopped talking. It took him a few months before we heard another word. He is almost 3 1/2 now and still does not speak as good as he did at 14 months, but he knows and comprehends things that 4-6 yr olds do I am even teaching him to read. He had an MRI a few months ago to see if he had a stroke but it was normal. What are other options I have of seeing what my grandson has. His Neurologist said some kind of event did happen because he still has a slight weakness in his left side when he smiles, and was surprised at the results. He was exposed to drugs when my daughter was pregnant and I know this is probably a factor, but knowing what he has so we can treat it for what it is instead of saying possibly this or that would be much better for him.

    • Hi Eileen,

      Thanks for your comment. According to the symptoms which you have described, it is possible that your grandson may have experienced a mini stroke at birth. However, since we have not personally seen and assessed your child, and due to the many factors that are involved in his case, we cannot diagnose him or say for sure what he may have. I would try consulting more than one child neurologist or child health practitioner who has experience treating similar cases, and to continue doing as much research as possible. I hope that helps, and if you have any other questions please do not hesitate to ask.

      Best,
      Natan Gendelman

  8. A very good basic article to introduce concepts about specific neural disorders. Brain Injury can be either insidious and traumatic. This can or cannot include strokes: i.e. cerebral vascular accidents.

    CP, as stated, is generally considered a situation that happens at or prior to birth.

    It is important for parents and other caregivers to note that while repeating a task helps learning often it is the WAY something is repeated that is equally important. It is crucial to get a supervised home program that is designed just for your child.

    Rehabilitation is a team effort and occupational, physical and speech therapies are usually needed for maximum benefit.

    This article should be taken by ALL parents whose children have similar issues, to their therapists. A great conversation starter!!

    Susan N. Schriber Orloff, OTR/L
    CEO/Executive Director
    Children’s Special Services, LLC
    ATL. GA USA

    • Hi Susan, thanks for your comments! You touch upon some key points that parents should keep in mind as well. Like you said, rehabilitation is a team effort, and it’s important that each of the therapies follow in the footsteps of one another to reinforce and maximize a child’s learning.

      Really appreciate the feedback! Hope to hear from you again soon :-)

  9. I enjoyed reading your article and for the most part agree with what you have written. I am a nurse and agree that most kids that have had traumatic brain injuries or a stroke have already acquired those skills that children with CP have not. Where I’m not agreeing with you is that not all pediatric stroke survivors have already been though their mild stones, for example those that have had a stroke at birth. Where would you put them? Would you consider them to be those with CP or Pediatric stroke?

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