Introduction to Cerebral Palsy

1. CEREBRAL PALSY AND ITS
TYPES.
BY Vinishaa
BPO-II Year
NIEPMD, Chennai

2. INTRODUCTION TO CEREBRAL PALSY
Cerebral palsy is a non progressive, neuro – muscular disorder of
the brain which may be prenatal, natal or postnatal in origin.
It is a group of permanent disorders of the muscle tone, movement,
posture and balance which may be associated with seizures
,intellectual disability, communication disorder and hearing & visual
impairment.
It is a upper motor neuron lesion –Lesion at brain cortical and sub
cortical region.

4. CAUSES
Prenatal Causes: (From conception until setting in of labor pains)
-Maternal viral infections such as TORCH
infections(Toxoplasmosis, Rubella, cytomegalo virus or herpes
simplex).
- Consanguineous marriage
- Drugs during pregnancy
- Metabolic disorders in mother
- Kernicterus ( high level of bilirubin in a baby’s blood)
- Poor prenatal care
- Early or late primi mothers

5. Natal Causes:(During labor)
- Birth injury (Cord around the neck, placenta previa)
- Complications at birth
- Breech delivery
- Anoxia
Post Natal Causes:(Acquired after birth)
- Infections of central nervous system
(TB,meningitis,encephalitis)
- Hydrocephalic baby
- Head injury
- Cerebro - vascular accidents
- Jaundice

6. CLASSIFICATION OF CEREBRAL PALSY
Physiological
- Spastic
- Ataxic
- Athetoid or
dyskinetic
- Mixed
- Flaccid
Topographic
- Hemiplegia
- Paraplegia
- Monoplegia
- Diplegia
- Quadriplegia
Etiologic
- Pre Natal
- Natal
- Post Natal

7. 1.PHYSIOLOGICAL CLASSIFICATION
- It focuses on neuro – muscular symptoms of the
disorder(According to tone of muscle)

8. SPASTIC CEREBRAL PALSY
- It occur due to injury in motor cortex.
- 70 to 80 % are of spastic type.
- Hypertonic condition( Increased resistance to
any movement)
- Spasticity is the exclusive impairment present
(velocity dependent).
- Change in postures may occur with emotional
outbreaks, which increase muscle tension.
- Spasticity does not mean paralysis, there may
be some voluntary movements.

9. -As compared to other types of cerebral palsy, spastic CP is more
easily manageable by the person affected , and medical treatment
can be pursued throughout life.
-Spasticity can lead to onset of muscle – stress symptoms like
arthritis and tendinitis.
-Managed with occupational therapy and physiotherapy.
-If spasticity is too much for the person to handle, other remedies
like antispasmodic medications and neurosurgery known as
rhizotomy.

10. ATHETOID CEREBRAL PALSY
- It occur due to injury in basal ganglia of mid
brain.
-10 to 15% cases are of athetoid type.
- Athetoid cerebral palsy or dyskinetic cerebral
palsy is mixed muscle – both hypertonia and
hypotonia mixed with involuntary motions.
- Abnormal amount of involuntary and
uncontrolled motion of limbs, heads and
eyes(writhing and rotary patterns) & dysarthria.

11. -These movements often increase during
periods of emotional stress and disappear
during sleep.
-Generally does not get any contractures or
deformities as both the muscle groups are
equally strong.
-Non fitted with any orthosis as there are
chances of some injury due to involuntary
movements.

12. ATAXIC CEREBRAL PALSY
-It occur due to injury in cerebellum.
-5 to 10% of cases are ataxic types.
-Disturbance of balance and coordination
are the main characteristics.
-some may have hypotonia and tremors.
-The child reaches out to objects but,
unable to achieve it because of over
shooting or under reaching.

13. - Stability of the head on the trunk and
the body on the pelvis is poor.
- Child appearing clumsy in nature.
- Nystagmus may be present.
- Mental ,visual and perceptual problems
are too often present.
- Wide based gait.
- Tendency to fall and stumble.
- Instability to walk in straight line.

14. MIXED CEREBRAL PALSY
- Mixed cerebral palsy is symptoms of
athetoid, ataxic and spastic CP ,appearing
each to varying degrees.
- Mixed CP is the most difficult to treat as
it is extremely heterogeneous and
unpredictable in its symptoms and
development over the lifespan.

15. FLACCID CEREBRAL PALSY
- Present with flaccid weakness
- Loose and floppy limbs, with reduced
muscle tone.
- Relatively rare
- Child develops deformities like kyphosis
and genu recurvatum easier than other
types.

16. 2.TOPOGRAPHICAL CLASSIFICATION
- Classification of cerebral palsy based on the parts of body
affected. It includes 6 types:

17. 1.MONOPLEGIA
Only one limb is affected usually an arm.

18. 2.QUADRIPLEGIA
All four limbs are affected.

19. 3.TRIPLEGIA
Involvement of three limbs.
Usually both the arms and one leg are
affected.

20. 4.HEMIPLEGIA
One side of the body is affected .The arm
is usually more involved than the leg.
Circumduction of the leg.

21. 5.PARAPLEGIA
Involvement of both the legs.

22. 6.DIPLEGIA
Involvement of four limbs with the legs
more affected than the arms.
Spastic diplegia gaits (true equinus, jump,
apparent equinus and crouch)
Spasticity of hip adductors lead to
scissoring gait.

23. DOUBLE HEMIPLEGIA
Same as diplegia, but with arms affected
more than legs.

24. 3.ETIOLOGICAL CLASSIFICATION
Based on the time of the occurrence of brain damage to the young
child.
- Prenatal
- Natal
- Postnatal

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