Cerebral Palsy affects muscle tone, gross and fine motor functions, balance, coordination, and posture. These are considered primary conditions of Cerebral Palsy. There are associative conditions, like seizures and intellectual impairment, that are common in individuals with Cerebral Palsy. And, there are co-mitigating factors that co-exist with Cerebral Palsy, but are unrelated to it.

What are associative conditions?

Cerebral Palsy is a neurologic condition. The cause of Cerebral Palsy is either brain injury or brain malformation occurring during fetal development, at birth, or after birth while the brain is still developing. The actual brain damage does not progress, which differentiates Cerebral Palsy from similar conditions. The brain damage occurs in parts of the brain that affect muscle tone, gross and fine motor functions, balance, control, reflexes, and posture. These are mainly orthopedic in nature and are considered primary conditions of Cerebral Palsy.

Primary conditions can lead to secondary conditions. For example, 86 percent of those with Cerebral Palsy have oral motor dysfunction, an inability to control facial muscles. Oral motor dysfunction can result in difficulty swallowing, breathing, or communicating; these are considered secondary conditions of Cerebral Palsy.

Associative conditions (such as intellectual impairment, epileptic seizures, hearing impairment, or vision impairment) do not result from the same brain injury that caused Cerebral Palsy, but do occur frequently in those with the condition. In fact, research shows these conditions occur alongside Cerebral Palsy so frequently that parents of children diagnosed with Cerebral Palsy are advised to have their child evaluated for associative conditions upon diagnosis.

An individual may also have health conditions, called co-mitigating factors, which co-exist with Cerebral Palsy but are unrelated to it. Unlike associative conditions, researchers have not concluded these conditions have a high correlation with Cerebral Palsy, but the multidisciplinary treatment team will take co-mitigating factors into consideration when forming a comprehensive treatment plan for a child with Cerebral Palsy.

Proper terminology

Because the terminology used is so specific, yet remarkably similar, terms such as primary, secondary, associative and co-mitigating conditions are used interchangeably, yet incorrectly. It is helpful to know the difference between the terms when attempting to understand Cerebral Palsy.

Primary conditions – These are a direct result of the brain lesion or brain malformation. Primary conditions affect motor coordination, motor control, muscle tone, posture and balance. Gross motor, fine motor, and oral motor functioning are also considered primary conditions of Cerebral Palsy.

Secondary conditions – Primary conditions, in turn, may lead to secondary conditions such as inability to chew, inability to swallow, breathing difficulties, bladder and bowel control issues, and communication difficulties. If the brain lesion or malformation that caused Cerebral Palsy did not exist, these secondary conditions would not be present.

Associative conditions – Research has shown that individuals with Cerebral Palsy often have associative conditions not caused by the same brain injury or malformation which caused Cerebral Palsy, but proven to be common with individuals who have Cerebral Palsy. If the brain injury or malformation that caused the Cerebral Palsy did not occur, these conditions may still be present in the individual. Associative conditions include intellectual impairment, epileptic seizures, hearing impairment, and vision impairment.

Co-mitigating factors – An individual may also have health conditions separate from Cerebral Palsy. Unlike associative conditions, researchers have not concluded that these conditions have a high correlation to Cerebral Palsy. Co-mitigating factors exist regardless of Cerebral Palsy. Examples of co-mitigating conditions of Cerebral Palsy include autism, attention deficit hyperactivity disorder, and asthma.

Every child’s condition is unique

The list of possible primary, secondary, and associative conditions, as well as co-mitigating factors, can be grouped into categories, but not all conditions will be experienced by an individual with Cerebral Palsy. Some may encounter conditions not listed, as well.

Cerebral Palsy can take a mild, moderate, or severe form depending on a host of factors. The type, location, and extent of impairment are considered, as well as any associative conditions and co-mitigating factors, when creating a treatment plan. Over the course of the person’s life, he or she may encounter any number of associative or co-mitigating factors.

Cerebral Palsy is non-progressive, meaning the brain injury or malformation will not progress in severity. However, secondary conditions resulting from the brain damage may develop and change over time. For example, brain injury can cause facial muscle impairment which doesn’t change over time. Chewing, swallowing and aspiration can occur when facial muscles are impaired. Aspiration can lead to pneumonia, and pneumonia is a health condition that can become worse or better over time.

Impairments can change with – or without – proper management. As a person ages, the muscular-skeletal structure may age prematurely depending on postural conditions, care, treatment and therapy. Other health conditions or life circumstances may also affect the individual’s condition over time. These can include access to health care, health insurance benefits, exposure to toxins, new health conditions, socialization, exercise, and traumatic accidents or events.