Cerebral Palsy (CP) is a neurodevelopmental condition that results in varying motor impairment depending on the brain area affected, timing of the brain injury, and the severity of the injury1,2. CP is the most common childhood physical disability worldwide3, 4, 5. Surgeon William Little first described CP as a disorder resulting from asphyxia during delivery or injury at birth, leading to brain damage6. It is currently defined as “a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing brain7.” There are a variety of other physical and neurological impairments that can result from CP and significantly impact the individual’s life1,2,8.

CP has a worldwide prevalence ranging from 1 to 3 cases per 1,000 live births. Children who are premature or have low birth weight are at a greater risk for developing CP4,9. The majority of events causing CP occur in the prenatal period with about 10% of cases occurring postnatally4. Some areas of the world, notably high income, have seen a decline in the prevalence of CP over time. A study in Europe observed a decrease in the prevalence of CP from 1.90 to 1.77 per 1000 live births10. An Australian study saw a similar decline in CP prevalence from 1995 to 200911. Another European study described a fall in CP prevalence for children with very low birthweight of less than 1500 grams12. Studies in the United States have also reported a stable or declining prevalence of CP13,14. In many high-income countries the prevalence of CP ranges between 1.4 and 2.6 per 1000 live births15, 16, 17.

A recent systematic meta-analysis estimated the overall prevalence of cerebral palsy (CP) at 1.6 per 1,000 live births in high-income countries, compared to 3.4 per 1000 in low- and middle-income countries18. In Mexico, one study reported an incidence of 4.4 per 1000 live births19, while research in rural South Africa found a prevalence as high as 10 per 1,00020. These figures may still underestimate the true burden in low- and middle-income countries, partly due to survival bias18. Moreover, tracking trends in CP prevalence in these regions remains challenging given the scarcity of reliable data18.

A range of environmental, socioeconomic, biological, and infrastructural factors influence both the prevalence and impact of CP in different parts of the world. Overall research observations suggest that CP has an increased burden on children in lower income countries. In this article we intend to provide an updated overview of development, risk factors, characteristics, comorbidities, and treatment of cerebral palsy with a focus on low- and middle-income regions where the burden is highest.