Different forms of cerebral palsy
There are four main types of cerebral palsy according to the way it affects the movements, the part of the body affected and how severe the effects are.
Spastic cerebral palsy
Dyskinetic cerebral palsy
Ataxic cerebral palsy
Mixed cerebral palsy
Spastic cerebral palsy
Children with spastic cerebral palsy have exaggerated reflexes and stiff, sometimes painful muscles. They show some degree of difficulty in walking according to the type and the extent of spasticity they have. Spastic cerebral palsy is again three subtypes as,
Spastic diplegia
Spastic hemiplegia
Spastic quadriplegia
Spastic diplegia
▪️ Muscle stiffness generally presents in the leg area. Hip and leg muscles are very tight which may cause the legs to cross at the knee and pull inwards making a “scissoring’’ effect.
▪️ Walks on toes.
▪️ Arms also may be mildly affected.
▪️ Can cause difficulty in walking, may require a walker or leg brace.
▪️ Tendon reflexes in the legs are hyperactive.
▪️ Infants use their arms to crawl without using their legs, or some do not attempt to crawl at all.
Spastic hemiplegia
▪️ One side of the body is affected.
▪️ Typically affects the arm on one side of the body, but sometimes include the leg.
▪️ The arm leg of the affected side is frequently shorter and thinner.
Spastic quadriplegia
▪️ The most severe type of cerebral palsy.
▪️ Unable to control and coordinate muscles of the legs and arms.
▪️ Children will often have severe stiffness in their limbs, but a floppy neck.
Dyskinetic cerebral palsy
This is the second most common type of cerebral palsy after spastic type. These children are characterized by slow and uncontrollable writhing or jerky movements of the hands and legs. They have hyperactivity in the muscles of the face and tongue. Muscle tone can be variable and change from tight to lose. Movement disorders like dystonia, athetosis and chorea can be seen in this type of children. These disorders may affect fine motor skills (eg- grasping small objects) and gross motor functions. (eg- walking)
Ataxic cerebral palsy
This is the least common type of cerebral palsy. These children show uncoordinated jerky movements. They walk unsteadily with a wide-based gait. They have difficulty in quick or precise movements or a hard time controlling voluntary movements. Also, they have effects on speech, swallowing and eye movements.
Mixed cerebral palsy
This type of cerebral palsy does not show symptoms of a single type of cerebral palsy, but a blend of several types. The most common type is a combination of dyskinetic and spastic cerebral palsy.
Other conditions associated with cerebral palsy
🔸 Intellectual disability
The child will have limitations in both cognitive functioning (thinking skills) and adaptive behaviour (the ability to adapt to the environment).
🔸 Spinal deformities
Spinal deformities like scoliosis, kyphosis and lordosis can make sitting, standing and walking difficulties and cause chronic back pain.
🔸 Seizure disorder
These children have co-occurring epilepsy, which is more common among children who are unable to walk or have limited mobility.
🔸 Delayed growth and development
In babies, there is too little weight gain. Young children have abnormal shortness and teenagers show shortness and lack of sexual development. The muscles and limbs affected are smaller than normal.
🔸 Impaired vision
Most of the children with CP have strabismus (cross-eye). Another vision impairment presented is amblyopia (lazy eye), optic atrophy (deterioration of the optic nerve due to damage), nystagmus (repetitive uncontrollable eye movements in a vertical or horizontal direction), visual field defects (loss of one side of the visual field), refractive errors (near and farsightedness and astigmatism or blurred vision).
🔸 Hearing loss
Some children have partial or complete hearing loss as a result of jaundice or lack of oxygen to the developing brain. Hearing problems can also affect speech and communication skills.
🔸 Speech and language disorders
Many children with cerebral palsy have dysarthria, a motor speech disorder. They have difficulty in controlling the muscles used for speech.
🔸 Drooling
These children drool as they have poor control of the muscles of the throat, mouth and tongue.
🔸 Abnormal sensations and perceptions
Some children with CP present pain or feel difficulty in some simple sensations such as touch.
🔸 Learning difficulties
Those who with impaired fine motor and gross motor coordination as well as language and communication problems may have trouble in learning. Brain damage may affect the development of language and intellectual functioning.
🔸 Infections and long term illnesses
Adults with CP have a higher risk of heart and lung disease and pneumonia.
🔸 Contractures
This may increase muscle spasticity and joint deformities.
🔸 Malnutrition
Due to impaired oral motor control problems with feeding like sucking and chewing may occur. This may lead to poor nutrition, dehydration and low weight.
🔸 Dental problems
Due to poor dental hygiene, many children with CP have a risk of developing gum diseases and cavities.
Praveena Rajapaksha
References
https://www.cerebralpalsyguidance.com/cerebral-palsy/types/
https://www.ninds.nih.gov/disorders/patient-caregiver-education/hope-through-research/cerebral-palsy-hope-through-research
https://www.cerebralpalsyguide.com/cerebral-palsy/coexisting-conditions/
https://www.ninds.nih.gov/disorders/patient-caregiver-education/hope-through-research/cerebral-palsy-hope-through-research#3104_10
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