Cerebral palsy (CP) is a neurological disorder that affects a person’s movements, muscle tone, and coordination. These effects can differ from one child with cerebral palsy to the next, and it’s generally due to the type and extent of the disorder each person has. There are four main types of cerebral palsy reflecting abnormalities in different parts of the brain, and resulting in various kinds of symptoms.
Spastic Cerebral Palsy
The National Institute of Neurological Disorders and Strokes (NIH) states that spastic cerebral palsy is the most common form of the disorder, affecting around 80% of all diagnosed cases of cerebral palsy. Spastic cerebral palsy causes children to have exaggerated reflexes (spasticity) and stiff, sometimes painful muscles. The majority of children will experience some degree of difficulty walking, depending on the type and extent of spasticity they have.
Spastic cerebral palsy is broken down into three different subtypes, which include:
- Spastic diplegia – involves muscle stiffness, generally in the leg area but the arms may be mildly affected too and can cause difficulty walking
- Spastic hemiplegia – when primarily one side of the body is involved, with movement difficulties primarily in the arm on the affected side
- Spastic quadriplegia – characterized by motor dysfunction all over the body, is the most severe type of spastic cerebral palsy, and usually comes with other associated disorders
Children with diplegic cerebral palsy, also known as spastic diplegia, may display a number of different symptoms and traits, with the most common including:
- Hip and leg muscles are very tight causing the legs to cross at the knees and to pull inward, creating a “scissoring” effect
- Walking on toes
- Difficulty walking or inability to walk unassisted
- Abnormal development of motor skills
- Coordination and balance issues
Diplegic cerebral palsy is usually detected during infancy when the baby fails to meet physical developmental milestones. One of the major signs physicians look for when diagnosing this form of cerebral palsy is an infant/toddler who uses their arms to crawl, without using their legs. Some may not attempt to crawl at all.
In the type of cerebral palsy known as spastic hemiplegia, one side of the body is affected, usually the arm more than the leg. The child can often adapt, and most are eventually able to walk.
Spastic quadriplegia is the most severe type of spastic cerebral palsy. Also known as spastic quad CP, it’s marked by the inability to control and coordinate muscles of the legs and arms. Children with spastic quad have a heightened risk of developing spinal deformities, language and feeding disorders, seizures, muscle contractions, and cognitive issues.
Dyskinetic Cerebral Palsy
Dyskinetic cerebral palsy is the second most common type of cerebral palsy after spastic forms. It is marked by abnormal movements in the arms, hands, and legs, making it difficult to control body movements and coordination. Children with this form of cerebral palsy can exhibit slow, writhing-type movements or quick, jerking movements. In turn, walking and sitting down can be difficult. Muscle tone can be variable and change from tight to loose from day to day. Many have troubles with controlling their face and tongue movements, resulting in difficulties with speech.
There are several types of movement disorders seen in dyskinetic cerebral palsy:
- Dystonia – where movements are twisting and repetitive, this can be present in one part of the body or the entire body and the movements are unplanned and involuntary, usually stimulated by initiating a voluntary movement
- Athetosis– characterized by slow, writhing movements with extreme fluctuations causing difficulty maintaining a posture
- Chorea – which are abrupt, fidgety unpredictable movements that make the child appear uncoordinated and clumsy
These movement disorders can exist together in different combinations, presenting issues with fine motor skills, including grasping small objects, as well as gross motor dysfunction, such as walking.
Ataxic Cerebral Palsy
Children with Ataxic Cerebral Palsy exhibit uncoordinated, jerky movements. This is the least common type of CP. The movements are initiated by a voluntary effort, which then becomes interrupted and uncontrolled, causing a lack of balance or coordination. There can be difficulties in walking and writing due to instability, effects on speech and swallowing, as well as eye movements.
Mixed Cerebral Palsy
Sometimes, children develop a mix of the aforementioned types of CP. A combination of dyskinetic and spastic cerebral palsy is the most common, but children can develop a mix of any type of CP. Symptoms will depend on which types of cerebral palsy the child has. Mixed cerebral palsy can also result in additional associated medical problems and disorders.
Common symptoms and medical problems experienced by children with mixed cerebral palsy include
- Stiff muscles with involuntary movements
- A combination of spastic and floppy movements
- Cognitive issues
- Issues with speaking and swallowing
- Hearing problems
- Drooling and facial grimaces
- Vision problems, including “lazy eye” and /or cortical blindness
How are Cerebral Palsy Types Diagnosed?
Physicians are able to diagnose the type of cerebral palsy a patient has by reviewing the history, doing a physical examination and sometimes imaging or other tests.
The Gross Motor Classification System is used as a measure of severity, and one of the ways symptoms can be characterized. It consists of an in-depth checklist of the child’s physical abilities and weaknesses.