Types of cerebral palsy

 🧠 Types of Cerebral Palsy – Characteristics & Causes

Cerebral Palsy (CP) is classified into four main types based on neuromotor symptoms, the brain region affected, and underlying causes. Each type has distinct clinical features, pathophysiology, and rehabilitation considerations.

1. Spastic Cerebral Palsy

🔹 Most common type (~70–80% of cases)

🧬 Cause:

• Damage to the motor cortex or corticospinal (pyramidal) tracts

• Often due to:

  • Periventricular leukomalacia (PVL) in premature infants

  • Hypoxic-ischemic encephalopathy

  • Intracranial hemorrhage

  • Infections (e.g., meningitis)

Main Clinical Features:

• Hypertonia (spasticity): velocity-dependent muscle stiffness

• Hyperreflexia: exaggerated deep tendon reflexes

• Clonus

• Positive Babinski sign

• Scissor gait (due to adductor spasticity)

• Toe-walking (from gastrocnemius tightness)

• Muscle contractures and deformities (hip dislocation, scoliosis over time)

• Delayed gross motor milestones (sitting, crawling, walking)

• Persistence of primitive reflexes (e.g., Moro, ATNR)

🔄 Subtypes & Affected Regions:

Subtype	Affected Area	Clinical Presentation
Spastic Hemiplegia	One side of the body	Arm > leg involvement; early handedness in toddlers
Spastic Diplegia	Bilateral lower limbs	More common in preemies; crouched gait, scissoring legs
Spastic Quadriplegia	All four limbs + trunk + face	Most severe; high dependency; cognitive/seizure comorbidities

2. Dyskinetic (Athetoid) Cerebral Palsy

🔹 Second most common (~10–15% of cases)

🧬 Cause:

• Damage to the basal ganglia, thalamus, or extrapyramidal tracts

• Frequently due to:

  • Kernicterus (bilirubin-induced brain damage)

  • Severe neonatal jaundice

  • Birth asphyxia

Main clinical Features

• Athetosis: slow, writhing movements

• Chorea: sudden, jerky movements

• Dystonia: sustained muscle contractions with twisting.

• Involuntary, uncontrolled movements

• Fluctuating muscle tone: may switch between hypertonia and hypotonia

• Facial grimacing, drooling

• Speech/swallowing difficulties (dysarthria, dysphagia)

• Emotional lability due to facial and vocal muscle involvement

3. Ataxic Cerebral Palsy

🔹 Rarest type (~5–10% of cases)

🧬 Cause:

• Damage to the cerebellum, responsible for coordination and balance

• Linked to:

  • Genetic mutations

  • Perinatal stroke

  • Congenital cerebellar malformations

• Main clinical features

• Poor coordination and lack of balance

• Hypotonia (low muscle tone)

• Dysmetria: inability to judge distances

• Ataxic gait: wide-based, unsteady walking

• Intention tremors: shaking during purposeful movement

• Dysdiadochokinesia: difficulty performing rapid alternating movements

• Impaired fine motor tasks (e.g., writing, buttoning)

4. Mixed Cerebral Palsy

🔹 Combination of two or more types

🧬 Cause:

• Multiple areas of the brain are damaged, often including:

  • Motor cortex + basal ganglia

  • Motor cortex + cerebellum

• Main clinical features

  • Spasticity + involuntary movements (spastic-dyskinetic)

  • Spasticity + poor coordination (spastic-ataxic)

• Mixed symptoms:

• Unpredictable muscle tone variations

• More complex to diagnose and manage

• Functional limitations vary widely

🧾 Summary Table – Clinical Features of CP Types

Type of CP	Tone	Movement Control	Gait/Balance Issues	Other Features
Spastic	Hypertonia	Poor voluntary movement, stiff	Scissor gait, toe walking	Contractures, hyperreflexia, primitive reflexes
Dyskinetic	Fluctuating	Involuntary (athetosis, chorea)	Poor postural control	Drooling, dysarthria, facial grimacing
Ataxic	Hypotonia	Poor coordination, tremors	Wide-based, unsteady gait	Dysmetria, intention tremors, speech issues
Mixed	Variable	Combination of above	Complex motor dysfunction	Mixed symptoms, often severe

❓ Frequently Asked Questions (FAQ)

🔹 Q1. Is cerebral palsy progressive?

A: No, the brain injury that causes CP is non-progressive. However, secondary complications (like contractures and scoliosis) can worsen without intervention.

🔹 Q2. Can cerebral palsy be cured?

A: There is no cure, but early intervention, rehabilitation, and supportive therapy can significantly improve function and quality of life.

🔹 Q3. What is the most common type of cerebral palsy?

A: Spastic CP is the most common, accounting for approximately 70–80% of all CP cases.

🔹 Q4. What is the role of a DPT in managing CP?

A: DPTs:

• Promote motor development

• Prevent contractures and deformities

• Improve balance and gait

• Use NDT, strength training, orthotics

• Educate caregivers and plan long-term care goals

🔹 Q5. How does CP affect cognitive function?

A: CP primarily affects motor control, but cognitive impairment may coexist, especially in spastic quadriplegia. Not all individuals with CP have intellectual disabilities.