Types of Cerebral Palsy
Cerebral palsy (CP) actually refers to a collective group of motor disorders, not a single condition. Cerebral palsy can take many forms, and impact a child in numerous ways. Unfortunately, cerebral palsy classification is confusing due to several recognized systems. Learning the differences and similarities between each type of cerebral palsy can help you as someone taking care for a child with CP, or as someone with the condition yourself.Classifications Based on Severity
Many physicians classify a child’s cerebral palsy by its severity level, with three main possibilities: mild, moderate, or severe. This type of classification is broad, with no specificity as to the extent, location, or type of disorder. With no centralized way to gauge the severity of a child’s CP, different physicians may come up with different levels. A few general guidelines for classifying CP by severity are as follows:
- Mild. A child with mild cerebral palsy can walk and move without assistance or assistive technology. He or she does not have limitations in daily activities. Parents may not notice symptoms of mild cerebral palsy until after the second year of the child’s life.
- Moderate. Moderate cerebral palsy means a child can walk, but only with the use of assistive technology such as braces. The child may also need medications to help control the symptoms of CP.
- Severe. Severe cerebral palsy makes it impossible for the child to walk on his or her own. The child will need a wheelchair, and will most likely also face major obstacles in accomplishing daily activities.
Sometimes, a diagnosis of a child displaying possible CP symptoms will come up with no cerebral palsy. This may happen if the child has a different type of impairment, such as a traumatic brain injury that occurred after the brain finished developing. Again, severity-based CP classifications are broad and will generally not tell a parent or caretaker too much about specific abilities or limitations.Classifications Based on Body Parts Affected
When trying to ascertain the most appropriate treatment protocol, physicians will most likely use a classification system based on topographical distribution, or body parts affected. This system uses the terms “paresis” (weakened) and “plegia/plegic” (paralyzed) to describe limb function. There are several types of CP under this classification style, named for the limbs the cerebral palsy affects:
- Monoplegia. One limb
- Paraplegia. The lower half of the body, including both legs
- Hemiplegia. One arm and one leg, on the same side of the body
- Triplegia. Three of the limbs
- Diplegia. The whole body, but the lower half more so than the upper half
- Tetraplegia. The whole body, but three of the limbs more than the fourth
- Quadriplegia. All four limbs, and often the trunk
- Pentaplegia. All four limbs and trunk, as well as the neck and head
Children with monoplegia may be relatively independent, while those with pentaplegia may experience eating and breathing complications and require lifelong care. Topographical distribution classification of CP can give parents and caretakers an understanding of a child’s physical limitations, as well as the assistive technologies he or she may need for better quality of life.Classifications Based on Motor Function
Medical experts recognize four types of cerebral palsy based on how it affects motor function: spastic, athetoid, ataxic, and mixed. Spastic, or pyramidal cerebral palsy, is the most common type. Data from the Autism and Developmental Disabilities Monitoring (ADDM) CP Network found that 77.4% of children identified with cerebral palsy had the spastic type. The distinguishing factors of spastic cerebral palsy include stiff and tight muscles, joints that are difficult to move, and problems with motion, eating, and/or speaking.
Athetoid cerebral palsy, or extrapyramidal, affects between 10% and 20% of CP patients. The most noticeable sign of this type is involuntary movements, such as jerking of the body parts. Around 10% of CP patients have ataxic cerebral palsy. These individuals tend to have voluntary movements, but with accompanying tremors and trouble with precise motor control. Mixed cerebral palsy patients experience symptoms of more than one type, from damage to multiple parts of the brain. Many combinations of symptoms are possible with mixed CP.Classifications Based on the Gross Motor Function Classification System
The Gross Motor Function Classification System (GMFCS) is a universal five-level system used to describe the gross motor function of children with cerebral palsy. It concentrates mainly on sitting, walking, and wheeled mobility. The need for assistive technology and functional abilities are the main factors physicians assess to place a child on the GMFCS. The lower the score on the scale, the more minor the negative effects on motor function. Children with Level V cerebral palsy have very limited independent movement, even with assistive technology.
Physicians use the GMFCS to rate a child’s extent of physical ability, to help with treatments, therapies, and the right types of assistive technology. It also helps parents and caretakers better understand a child’s motor skills, as well as any improvements over time with age and therapies. Most physicians use GMFCS in conjunction with other classifications of cerebral palsy to specify the extent and severity of a child’s impairment.Sources