Classification of cerebral palsy

Cerebral palsy (CP) is classified according to the type of body movement and posture problem.

Spastic (pyramidal) cerebral palsy

A person with spastic cerebral palsy develops tight muscles in some parts of the body that are unable to relax. Affected joints become stiff and difficult to move. Usually, a person has problems controlling movements, poor coordination and balance, and difficulty talking and eating.

There are four types of spastic CP, grouped according to how many limbs are affected.

• Hemiplegia or diplegia: One arm and one leg on the same side of the body (hemiplegia) or both legs (diplegia or paraplegia) are affected. These are the most common types of spastic cerebral palsy.
• Monoplegia: Only one arm or leg is affected. Monoplegia is usually a variation of diplegia or hemiplegia.
• Quadriplegia: Both arms and both legs are affected. Usually the trunk and muscles that control the mouth, tongue, and windpipe are affected as well. This makes eating and talking difficult. Babies with spastic quadriplegia may:
  • Have problems sucking and swallowing.
  • Have a weak or shrill cry.
  • Have a very relaxed and floppy body or a very stiff body. When held, they may arch their backs and extend their arms and legs.
  • Be irritable and jittery when awake. For example, they may startle easily.
  • Sleep a lot or show little interest in what is going on around them.
• Triplegia: Either both arms and one leg or both legs and one arm. Triplegia may be a variation of quadriplegia.

Nonspastic (extrapyramidal) cerebral palsy

The nonspastic forms of cerebral palsy include dyskinetic cerebral palsy (subdivided into athetoid and dystonic forms) and ataxic cerebral palsy.

• Dyskinetic cerebral palsy is associated with muscle tone that fluctuates between being loose and tight. In some cases, rapid and jerky or uncontrolled slow continuous movements occur involuntarily. These movements most often affect the face and neck, hands, feet, arms, legs, and sometimes the torso.
  • Athetoid (hyperkinetic) cerebral palsy characteristics include relaxed and limp muscles during sleep, with some involuntary jerking (chorea) or writhing (athetosis). If the face and mouth muscles are affected, problems may develop related to unusual facial expressions, drooling, speaking, and choking when sucking, drinking, and eating.
  • Dystonic cerebral palsy is when the body and neck are held in a stiff position.

• Ataxic cerebral palsy is the rarest type of cerebral palsy and involves the entire body. Abnormal body movements affect the trunk, hands, arms, and legs. Ataxic cerebral palsy causes problems with:
  • Balance.
  • Precise movements; for example, the person may reach too far or too close to touch objects and may also have poor hand control (intention tremor).
  • Coordination. A person with ataxic CP may walk with the feet unusually far apart.
  • Hand control. Often only one hand is able to reach for an object; the other hand may shake with attempts to move it (intention tremor). The person may not be able to button clothes, write, or use scissors.

Mixed cerebral palsy

Some children have symptoms of more than one type of cerebral palsy. For example, spastic legs (symptoms of spastic diplegic cerebral palsy) and problems with facial muscle control (symptoms of dyskinetic cerebral palsy) may both develop.

Total body cerebral palsy affects the entire body to some degree. Complications of cerebral palsy and other medical problems are more likely to develop when the entire body is involved rather than isolated parts. Total body cerebral palsy may include any of the following:

• Spastic quadriplegic cerebral palsy
• Dyskinetic cerebral palsy
• Ataxic cerebral palsy