Hesperian Health Guides
Types of Cerebral Palsy
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Cerebral palsy is different in every child. Different experts have worked out different ways of describing it. But do not worry about labeling a child’s particular type of cerebral palsy. This does not usually help his treatment.
It is helpful, however, to recognize 3 main ways that cerebral palsy can appear. In a particular child, it may appear in one or another of these ways—but usually in some sort of combination.
1. MUSCLE STIFFNESS OR 'SPASTICITY'The child who is ‘spastic’ has muscle stiffness, or ‘muscle tension’. This causes part of his body to be rigid, or stiff. Movements are slow and awkward. Often the position of the head triggers abnormal positions of the whole body. The stiffness increases when the child is upset or excited, or when his body is in certain positions. The pattern of stiffness varies greatly from child to child.
TYPICAL SPASTIC POSITIONS WHEN LYING ON THE BACK:
Head twists to one side.
This arm may stiffen straight out.
Legs stiffen and knees press together.
This arm stiffens bent.
Fist grips thumb.
Shoulders and head press back.
Legs turn in.
|Stiffness, with the knees bent or with legs separated, occurs more commonly in the child with spasticity and athetosis combined (see below).|
|Less commonly the head and shoulders may stiffen
forward . . .
|. . . or the arms may stiffen straight across the body, with the head pressed back.|
|When you try to stand the child the legs often stiffen or cross like scissors.||The child who learns to walk may do so in a stiff, awkward position, with the knees pulled together and bent. Feet often turn in.|
2. UNCONTROLLED MOVEMENTS OR 'ATHETOSIS'These are slow, wriggly, or sudden quick movements of the child’s feet, arms, hands, or face muscles. The arms and legs may seem jumpy and move nervously, or just a hand or the toes may move for no reason. When he moves by choice, body parts move too fast and too far. Spastic movements or positions like those shown above may continually come and go (constantly changing muscle tension). His balance is poor and he falls over easily.
Most children with athetosis have normal intelligence, but if the muscles needed for speech are affected, it may be hard for them to communicate their thoughts and needs.
|Typical athetoid arm and hand movements may be as a regular shake or as sudden ‘spasms’. Uncontrolled movements are often worse when the child is excited or tries to do something.|
arm and hand movement
|This child has severe athetosis.|
3. POOR BALANCE OR 'ATAXIA'The child who has ‘ataxia’, or poor balance, has difficulty beginning to sit and stand. She falls often, and has very clumsy use of her hands. All this is normal in small children, but in the child with ataxia it is a bigger problem and lasts longer (sometimes for life).
Because children who have mainly a balance problem often appear more clumsy than disabled, other children are sometimes cruel and make fun of them.
|TEST FOR ATAXIA:|
|To keep her balance the child with ataxia walks bent forward with feet wide apart. She takes irregular steps, like a sailor on a rough sea or someone who is drunk.||Hold a finger or a toy in front of the child and ask him to touch it on the first try. The child with ataxia cannot do it.|
Many children who have spasticity or athetosis also have problems with balance. This may be a major obstacle in learning to walk. However, much can often be done to help a child improve her balance.
Note: Children with any type of cerebral palsy as babies are often mainly limp or floppy. Stiffness or uncontrolled movements begin little by little. Or the child may be limp in some positions and stiff in others.
Parts of the body affected
DEPENDING ON WHICH LIMBS ARE INVOLVED, THERE ARE 3 TYPICAL PATTERNS:
|ARM AND LEG ON ONE SIDE (HEMIPLEGIC)|
arm bent; hand spastic or floppy, often of little use
She walks on tiptoe or outside of foot on affected side.
this side completely or almost normal
|BOTH LEGS ONLY (PARAPLEGIC) or with slight involvement elsewhere (DIPLEGIC)||BOTH ARMS AND BOTH LEGS (QUADRIPLEGIC)|
upper body usually normal or with very minor signs
Child may develop contractures of ankles and feet.
When he walks, his arms, head, and even his mouth may twist strangely.
Children with all 4 limbs affected often have such severe brain damage that they never are able to walk.
The knees press together
Legs and feet turned inward
Although most cerebral palsy children fit one or another of these patterns, check also for minor problems in other parts of the body.