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What are the different forms and symptoms of cerebral palsy?

The specific forms of cerebral palsy are determined by the extent, type, and location of a child’s abnormalities. Doctors classify cerebral palsy according to the type of movement disorder involved — spastic (stiff muscles), athetoid (writhing movements), or ataxic (poor balance and coordination) — plus any additional symptoms.

Doctors will often describe the type of cerebral palsy a child has based on which limbs are affected. The names of the most common forms of cerebral palsy use Latin terms to describe the location or number of affected limbs, combined with the words for weakened (paresis) or paralyzed (plegia). For example, hemiparesis (hemi = half) indicates that only one side of the body is weakened.  Quadriplegia (quad = four) means all four limbs are paralyzed.

Spastic hemiplegia/hemiparesis

This type of cerebral palsy typically affects the arm and hand on one side of the body, but it can also include the leg. Children with spastic hemiplegia generally walk later and on tip-toe because of tight heel tendons.  The arm and leg of the affected side are frequently shorter and thinner. Some children will develop an abnormal curvature of the spine (scoliosis). Depending on the location of the brain damage, a child with spastic hemiplegia may also have seizures. Speech will be delayed and, at best, may be competent, but intelligence is usually normal.

Spastic diplegia/diparesis

In this type of cerebral palsy, muscle stiffness is predominantly in the legs and less severely affects the arms and face, although the hands may be clumsy. Tendon reflexes are hyperactive. Toes point up. Tightness in certain leg muscles makes the legs move like the arms of a scissor. Children with this kind of cerebral palsy may require a walker or leg braces. Intelligence and language skills are usually normal.

Spastic quadriplegia/quadriparesis

This is the most severe form of cerebral palsy, often associated with moderate-to-severe mental retardation. It is caused by widespread damage to the brain or significant brain malformations. Children will often have severe stiffness in their limbs but a floppy neck. They are rarely able to walk. Speaking and being understood are difficult. Seizures can be frequent and hard to control.

Dyskinetic cerebral palsy (also includes athetoid, choreoathetoid, and dystonic cerebral palsies)

This type of cerebral palsy is characterized by slow and uncontrollable writhing movements of the hands, feet, arms, or legs. In some children, hyperactivity in the muscles of the face and tongue makes them grimace or drool. They find it difficult to sit straight or walk.  Children may also have problems coordinating the muscle movements required for speaking. Intelligence is rarely affected in these forms of cerebral palsy.

Ataxic cerebral palsy

This rare type of cerebral palsy affects balance and depth perception. Children will often have poor coordination and walk unsteadily with a wide-based gait, placing their feet unusually far apart. They have difficulty with quick or precise movements, such as writing or buttoning a shirt. They may also have intention tremor, in which a voluntary movement, such as reaching for a book, is accompanied by trembling that gets worse the closer their hand gets to the object.

Mixed types of CP

It is common for children to have symptoms that don’t correspond to any single type of cerebral palsy. Their symptoms are a mix of types. For example, a child with mixed cerebral palsy may have some muscles that are too tight and others that are too relaxed, creating a mix of stiffness and floppiness.

Sources: From National Institute of Neuorological Disorders and Stroke

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