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Definition

The International Workshop on Definition and Classification of Cerebral Palsy (CP) in 2007 defined cerebral palsy as a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to nonprogressive disturbances that occured in the developing faetal or infant brain. Apart from mainly affectinng motor component of the body, CP also affect sensation, perception, cognition, communication and behaviour. Seisures are uncommon and secondary musculoskeletal problems are also available in people suffering from cerebral palsy

Important points to note in cerebral palsy are that:

  • Brain damage is non-progressive
  • Functional impairments may worsen with time due to adapted potures and demands accompanying adulthood it affects both males and females
  • It is not communicable
  • People with CP can also marry and have children without CP
  • Quality of life for people with CP can be improved with proper multidisciplinnary intervention

Etiology

There is no single cause for CP but the bottom line is that the developing brain is damaged. The damage to the brain can result during pregnancy, during delivery or in the first few years of life after birth. Usually when the brain is damaged after five years it is no longer considered as CP, it is now an acquired brain damage. The causes of CP are grouped into prenatal(during pregnancy), perinatal(during delivery/labour) and postnatal(during the first 28 days of life).

Prenatal Causes (Causes before birth)

  • Vascular problems e.g. middle cerebral artery infarct(death)
  • Marternal infections during first and second trimesters e.g rubella, toxoplasmosis and cytomegalovirus
  • Metabolic disorders

Perinatal Causes

  • Obstructed labour
  • Cord prolapse
  • Antepartum haemorrage
  • Hypoxic–ischemic encephalopathy
  • Neonatal stroke, usually of the middle cerebral artery
  • Severe hypoglycemia
  • Untreated jaundice
  • Severe neonatal infection

Postnatal Causes

  • Infections e.g.
    • Meningitis
    • Malaria
    • Septicaemia
  • Injuries such as stroke
  • Metabolic encephalopathy

Types of CP

Classification of CP may be based on the:

  • Movement disorder
  • Parts of the body affected
  • Scope of motor dysfunction

Cerebral palsy can occur in three main ways (types):

  • Muscle stiffness or spasticity
  • Uncontrolled movement, also called athetosis, now called dystonia
  • Poor balance also called ataxia

Spastic CP

This is a type of cerebral palsy in which the involved muscles become stiff or having high muscle tension. This eventually will cause the organs to be rigid i.e. difficult to move. The 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 patterns when lying on the back.

Spastic CP

Uncontrolled Movement i.e. Athetosis aka Dystonia

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. Athetoid CP image

Poor balance aka 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. Ataxic CP

Ataxic CP

Description of CP based on the parts affected

Apart from describing CP in terms of movement abnormalities, CP can also be described in terms of parts of the body affected. Terms like quadriplegia(affecting limbs, trun and neck), hemiplegia(affecting one side of the body) and diplegia (affecting legs mainly) are commonly used. types of CP based on parts of the body affected


Cardiopulmonary Physiotherapy
Chimwemwe Masina, PT

Author: Chimwemwe Masina

Chimwemwe Masina is currently working as a Resident Physiotherapist at DDT College of Medicine in Gaborone, Botswana. Before joining DDT College of Medicine, he worked in the Ministry of Health at Kamuzu Central Hospital in Malawi, MagWaz Physiotherapy and Wellness Services in Lilongwe, Malawi. as well as Volunteering at Physiopedia.
His interest is in Neuromusculoskeletal Physiotherapy and currently he is an assisting lecturer in Manual Therapy and Lumbar Spine Management.

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