Cerebral palsy is often classified into several broad categories based on the location and extent of brain damage, the body parts affected, and the kinds of tone and movement difficulties present. Those categories include spastic type cerebral palsy, athetoid cerebral palsy, ataxic cerebral palsy and mixed cerebral palsy. The diagnosis of the type of cerebral palsy in a child may change as he or she gets older. This is not because of any change in the extent of the brain damage but rather because changes in muscle tone and control become more noticeable as the child grows.
In spastic cerebral palsy, different parts of the body may be involved. In ataxic and athetoid cerebral palsies, usually but not always, all parts of the body may be involved. By identifying what type(s) of cerebral palsy a child has, doctors and therapists can recommend treatments. They also can give parents a better idea of what the child's future might hold. Some potential problems can be prevented or corrected if addressed early in a child's life.
Spastic cerebral palsy
If a child has spastic cerebral palsy, it is because she has damage to the part of the brain that controls voluntary movements, the cerebral cortex, or outer layer of the brain. Spastic cerebral palsy is characterized by constant increased muscle tone and weakness in parts of the body affected. The increased muscle tone, called hypertonia, creates tightness or tension in the muscles, leading to a decreased range of movement in the joints. The effects may increase with anxiety or increased effort.
Spastic cerebral palsy is the most common type of cerebral palsy. About 50% of children with cerebral palsy have this particular form; it can also cause bone deformities and shortened muscles (contractures). Spastic cerebral palsy is divided into further classifications, depending on which limbs are affected:
Spastic diplegia affects either both arms or both legs. In cases of diplegia, it's more common to have only the lower two limbs affected. Due to spastic leg muscles, children with diplegia tend to stand on their toes and scissor their legs, bringing their legs and feet strongly together in a crossed position when standing upright. Diplegia is most common in premature babies.
Spastic hemiplegia affects only one side of the body. In hemiplegia, just the right arm and leg, or just the left arm and leg, are affected. Hemiplegia is most common in babies who have strokes or traumatic brain injuries. The arm or leg on the affected side may be shorter or less developed than the arm or leg on the other side. The child may or may not be able to use her affected hand, depending on the degree of impairment and how much sensation there is in the hand.
Spastic quadriplegia affects all limbs on both sides of the body. With quadriplegia, there is difficulty with moving all parts of the body - face and trunk as well as arms and legs. It is most common in babies who experience an interruption in oxygen supply. Children with quadriplegia may also have significant impairment of the facial muscles used in feeding and speaking. Because of the extent of their motor disabilities, children with quadriplegia have difficulty with most activities of daily living.
Spastic monoplegia is a rare condition that affects only one limb. Movement impairment often disappears with time.
Spastic triplegia, which affects three limbs, is also fairly rare.
Athetoid cerebral palsy
Athetoid cerebral palsy affects about 25% of children who have cerebral palsy. Athetoid cerebral palsy is caused by damage to the cerebellum or basal ganglia. These areas of the brain are responsible for processing the signals that enable smooth, coordinated movements as well as maintaining body posture. Thus, this form of cerebral palsy is characterized by uncontrolled, slow, or twisting movements of the body.
These unwanted movements, even when trying to sit still, interfere with movements the child tries to make, such as walking or doing things with his hands. The movements can also interfere with speaking, feeding, grasping, walking and other skills requiring coordination. In some cases, they also affect the muscles of the face and tongue, causing odd facial expressions, frowning, or drooling. The movements often increase during periods of emotional stress and can disappear during sleep.
Ataxic or dyskinetic cerebral palsy
Injuries to the cerebellum can result in ataxic cerebral palsy, which causes poor coordination and an unsteady, wide based gait. Children with ataxic cerebral palsy have a disturbed sense of balance and depth perception, characterized by tremors or shaky movements. In contrast to athetoid cerebral palsy, the ataxic child does not have unwanted movements when sitting still but intentional movements may be clumsy or awkward. That, in turn, affects balance, posture and controlled movements. A child with ataxic cerebral palsy may have a hard time with quick movements or movements that need fine motor control, like writing or buttoning a shirt.
Mixed-type cerebral palsy
Some children have symptoms of more than one of these forms, indicating damage to more than one area of the brain; this is called mixed cerebral palsy. The most common combination involves both spasticity and athetoid movement. The least common mix is athetoid and ataxic, although any mix of types can occur.
Children with cerebral palsy who suffer from mixed type cerebral palsy usually have both the tight muscle tone of spastic cerebral palsy and the involuntary movements of athetoid cerebral palsy. Usually the spasticity is the more obvious first symptom, with the involuntary athetoid movements increasing when the child is between nine months and three years old.
Only a careful review of the medical records can support a likely cause of injuries and whether the actions of the delivery team played a part in causing your child's cerebral palsy. Our lawyers and medical advisor who handle birth injury cases have experience investigating medical mistakes and birth injury malpractice and have access to the type of qualified medical experts necessary to review complicated birth injury cases.
If your child suffered a birth injury resulting in cerebral palsy due to improper care during your pregnancy or at the time of delivery, perhaps we can help. Contact one of our medical advisors - all are professionally licensed - they understand the complex issues of labor and delivery that can result in medical conditions like cerebral palsy. Please call our Medical Malpractice group which handles birth injuries that result in cerebral palsy at 1.800.552.7115 or contact us. If you think you have a medical malpractice case within MN, ND, SD, IA or WI, please call 1.800.207.6771.
Geralis, Elaine, (1998) Children with Cerebral Palsy: A Parent's Guide, Woodbine House, Inc., 1991.
Miller, Freeman, M.D., Bachrach, Steven, M.D., Cerebral Palsy: A Complete Guide for Caregiving, The Johns Hopkins University Press, Baltimore and London, 2005
Pincus, Dion, Everything You Need to Know About Cerebral Palsy, Rosen Publishing Group, Inc. New York, 2000.
Pellegrino, Louis. Cerebral Palsy, in Batshaw, M.L. (ed.), Children With Disabilities, Fourth Edition, Baltimore, MD, Paul H. Brooks Publishing Company, 1997, pages 499-528.
Stanley, Fiona, Blair, Eve, Alberman, Eva. (2000) Cerebral Palsies: Epidemiology & Causal Pathways. Mac Keith Press
Gillette Children's Specialty Healthcare
Origins of Cerebral Palsy
United Cerebral Palsy
Robins Kaplan LLP Lawyers Handling Cerebral Palsy and other Birth Injury Cases
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