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CP is an umbrella etrm covering a group of
non progressive but often changing motor
impairement syndromes that may or may not
involve sensory deficits, and may occur as a
developmental defect due to genetic
breakdown,or as a result of insult or trauma
to the fetal or infant brain.
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Cerebral palsy is a disorder of movement and
posture that appears during infancy or early
childhood. It is caused by non-progressive
damage to the brain before, during or shortly
after birth. It is not a single disease but a
name given to a wide variety of static
neuromotor impairment syndromes,
occurring secondary to a lesion in the
developing brain.
Commonest cause are
 intrauterine anoxia,
 anoxia from prolonged convulsions in early
infancy
 Trauma to the brain during prolonged or
difficult labor
 Result of degeneration of basal ganglia
resulting from rhesus incompatibility.
Antenatal causes
- Vascular events such as MCA infarct
- Maternal infections during 1st and 2nd
trimesters such as rubella, cytomegalovirus
and toxoplasmosis.
- Metabolic disorders and rare genetic
syndromes
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Problems during labor and delivery:
obstructed labor, antepartum hemorrhage,
cord prolapse
Hypoxic ischemic encephalopathy
Neonatal stroke
Severe hypoglycemia
Untreated jaundice
Severe neonatal infection
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Metabolic encephalopathy
Infections : malaria, meningitis, septicemia
Injuries : CVA, Near drowning, trauma,
accidents, child abuse such as shaken baby
syndrome.
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CP can be classified based on topography, body
parts affected, types, predominant
characterisyics of motor findings, severity,
pathology and cerebral imaging technique.
Spastic CP
- Consitutes of 70 % of all children
- Most common type of CP
- Children with this type present with severe
spasticity (defined as an increase in the
physiological resistance of the muscle to passive
motion, characterized by hyperreflexia, clonus
and primitive reflexes.)
These are anatomically distributed into three types.
 Hemiplegia: In hemiplegia, one side of the body
is involved with the upper extremity generally
more affected than the lower.
 - Diplegia: In diplegia, the lower extremities are
severely involved and the arms are mildly
involved. A history of prematurity and low birthweight is common causes of this type.
 - Quadriplegia: In quadriplegia, all four limbs,
the trunk and muscles that control the mouth,
tongue and pharynx are involved. The total body
involvement may be termed as “Tetraplegia”.
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This is a group of disorders where the movement is
generally uncontrolled and involuntary and includes
athetosis, rigidity, tremor ,dystonia, ballismus, and
choreoathetosis.
Dysarthria, dysphagia and drooling accompany the
movement problem.
Mental status is generally normal
“Dyskinesia” accounts for approximately 10 - 15 % of
all cases of CP
Hyper-bilirubinemia or severe anoxia causes basal
ganglia dysfunction and results in dyskinetic CP
Athetosis always has involuntary movements that are
slow and writhing,abnormal in timing,direction and
spatial characteristics
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It shows signs of cerebellar involvement
It is primarily a disorder of balance and
control in timing of coordinated movements
along with weakness, incoordination, a widebased gait and noted tremor.
Results from deficit in cerebellum
Occurs in combination with spasticity and
athetosis.
often transient in the evolution of athetosis
or spasticity
 Not correlated with a particular neural lesion.
 There is an often severe depression of motor
function and weakness
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Children with a mixed type of CP commonly
have mild spasticity, dystonia and / or
athetoid movements
Ataxia may be a component of the motor
dysfunction in patients belonging to this
group
Ataxia and spasticity often occur together.
“Spastic ataxic diplegia” is a common mixed
type that often is associated with
hydrocephalus.
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Cortical blindness, sensory loss, deafness,
mental retardation and epilepsy are primary
impairments, while malnutrition, psychosocial
problems and intellectual impairment may
accompany.
Language and cognitive disturbance lead to
mental retardation and learning disability
Mental retardation accompanies 30 - 65 % in
all cases of CP. It is most common in spastic
quadriplegia
Epileptic seizures
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Respiratory problems:
Aspiration in small quantities leads to
pneumonia in children who have difficulty in
swallowing.
Premature babies have broncho-pulmonary
dysplasia, which leads to frequent upper
respiratory tract infections.
Respiratory muscle spasticity contributes to
the pulmonary problems.
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Bladder and bowel dysfunction:
Loss of coordination of bowel and bladder
sphincters results in constipation and / or
incontinence
Enuresis, frequency, urgency, urinary tract
infections and incontinence are common
problems.
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Hemiplegia
involvement of the arm and leg on one side of the body
The upper extremity is more severely involved than the
lower
they may have seizures, learning and behavioral problems
All hemiplegic children learn to walk by the age of three
years.
They become independent in the activities of daily living
The shoulder is adducted and internally rotated, the elbow
is flexed and pronated, the wrist and fingers are flexed
and the thumb is in the palm.
The hip is flexed and internally rotated, the knee is flexed
or extended and the ankle is in plantar flexion
The foot is generally in varus although valgus deformity
may also be seen.
The hemiplegic side is short and atrophic, depending on
the severity of involvement.
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gross motor involvement of the lower extremities
and fine motor involvement of the upper ones
The main problem in spastic diplegia is walking
difficulty.
Balance disturbance, muscle weakness, spasticity
and deformities result in abnormal gait pattern,
typical for diplegic children
Abnormal gait increases energy consumption,
causing fatigue
Most diplegic children start cruising at 2 years of
age and walk by the age of 4.
Among all types of CP, diplegic children benefit
most from treatment procedures.
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the involvement of the neck, trunk and all four extremities.
have severe motor impairment and other signs and
symptoms of CNS dysfunction such as cognitive
impairments, seizures, speech and swallowing difficulties
The spectrum of severity is variable, from having no sitting
ability or head control to being able to walk with extensive
assistive devices.
majority of quadriplegics cannot be independent and need
lifelong, assistance in daily life.
They are wheelchair bound
Spinal and hip deformities such as hip instability, pelvic
obliquity and scoliosis are very common and interfere with
sitting balance.
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Athetosis, dystonia and chorea” are the main
movement disorders seen in dyskinetic children
initially hypotonic but as they get older, muscle
tone begins to fluctuate
Involuntary movements occur when the child
tries to move.
When the child is totally relaxed in the supine
position or asleep, there is full range of motion
and decreased muscle tone.
Abnormal contractions of many muscles
occurring with the slightest voluntary motion
increase the energy demand considerably.