Many people think of cerebral palsy (CP) as a single condition. In reality, it is a group of disorders that affects movement. It is caused by brain damage that often occurs during pregnancy or labour and delivery.
There are four main types of CP: spastic, dyskinetic, ataxic, and mixed type CP. These types are further classified by how they affect the body, with some forms only affecting a few limbs or one side of the body. CP is also graded based on severity and how it affects gross motor skills.
What Is Cerebral Palsy?
Cerebral palsy, or CP, is a movement disorder. It is caused by damage that occurs to the brain, predominantly before birth. It may be caused by maternal infections, a prenatal stroke, gene changes, bleeding into the brain either in the womb or after birth, infant infections that cause swelling, traumatic head injury to an infant, and lack of oxygen to the brain (also known as birth asphyxia).
Signs and symptoms of CP can vary greatly depending on the type and which parts of the body are affected. For some people, cerebral palsy affects the entire body. For others, CP only affects one side of the body or one or two limbs. Generally, symptoms include trouble with movement and coordination, development, and speech and eating.
Just as the symptoms of CP can differ, so can the severity of this condition. Some people with cerebral palsy are profoundly disabled, while others have relatively mild effects. While there is no cure for cerebral palsy, treatments like injections, medications, and physical therapy can improve function and reduce pain.
Classifications of Cerebral Palsy
Cerebral palsy isn’t a single disorder. Instead, it is a group of conditions that are classified by the main type of movement disorder involved. There are four main types of CP: spastic, dyskinetic, ataxic, and mixed cerebral palsy.
Spastic Cerebral Palsy
Spastic CP is the most common type of the disorder. It affects 80% of all people who have cerebral palsy. The name refers to a frequent symptom of CP: stiff muscles, or spasticity.
People with spastic CP have increased muscle tone that causes stiff or spastic muscles. This spasticity tends to result in award, jerky movements.
Spastic CP is further broken down into three categories based on what parts of the body are affected:
- Spastic diplegia/diparesis: muscle stiffness primarily affects the legs. The arms may be less affected or have no involvement. People who have spastic diplegia might have trouble walking because their stiff hip and leg muscles cause their legs to come together, turn inward, and cross at the knees (a condition that may be referred to as scissoring).
- Spastic hemiplegia/hemiparesis: this type of CP only affects one side of the body, typically the arm more than the leg.
- Spastic quadriplegia/quadriparesis: the most severe form of CP, spastic quadriplegia affects the face, trunk/torso, and all four limbs. People with spastic quadriparesis typically are unable to walk and may have other developmental disabilities, such as problems with vision, hearing or speech, seizures, and/or intellectual disability.
Spastic CP is caused by damage to the motor cortex and pyramidal tracts in the brain. The motor cortex controls voluntary movement, while the pyramidal tracts relay signals to muscles. The area of damage to the motor cortex – right side versus left side – affects the area of the body that is affected, with damage to the right side of the motor cortex causing movement problems on the left side of the body, and vice versa.
Dyskinetic Cerebral Palsy
Dyskinetic CP, which may also be referred to as athetoid cerebral palsy, is diagnosed when a person’s primary symptom is uncontrollable movements or dyskinesia. The category also includes choreoathetoid, and dystonic CP. People with dyskinetic CP have difficulty controlling the movements of their hands, arms, feet, and legs. These involuntary movements can make it hard to sit and walk.
These movements cannot be controlled, and may either be slow and writhing or rapid and jerky. A person with dyskinetic CP has muscle tone that can change from too tight (hypotonia) to too loose (hypertonia) within a single day or from day to day. In some cases, the face and tongue are also affected, which can make swallowing, talking, and sucking difficult.
Dyskinetic CP is caused by damage to the basal ganglia and/or cerebellum of the brain. The basal ganglia regulate voluntary motor function as well as eye movement, while the cerebellum controls balance and coordination.
Ataxic Cerebral Palsy
Ataxic CP is characterized by poor balance and coordination, or ataxia. People with this type of cerebral palsy have difficulty with coordination and balance. They may be unsteady while walking and have difficulty with quick movements. They may also struggle with fine motor skills, such as writing, as well as gross motor skills like reaching for something.
Common symptoms of ataxic CP include problems with depth perception, shakiness and tremors, speech difficulties, poor coordination, and spreading feet apart when walking. People with ataxic CP often have reduced muscle tone and experience tremors. This type of CP is caused by damage to the cerebellum, which is responsible for regulating balance and coordination.
Mixed Cerebral Palsy
Many people with cerebral palsy have more than one type of CP. This is due to damage to more than one area of the brain. Mixed-type CP is diagnosed whenever a person exhibits symptoms of two or more types of CP.
Approximately 15.4% of all CP diagnoses involved mixed-type CP. The most common type of mixed CP is spastic-dyskinetic CP. The exact symptoms will vary based on the types of CP involved.
Classification of CP Based on Affected Body Parts
In addition to the four main types of CP, each category can be further broken down based on what body part is affected. The classification is as follows:
- Monoplegia: this occurs when only one arm or one leg is affected. It is rare for CP to only affect one limb.
- Diplegia: This type occurs when two limbs are affected, typically the legs. In children, there may also be mild movement issues in the upper body. Diplegia is often linked with premature birth.
- Hemiplegia: with this type, one side of the body is affected. Typically, the arm is more affected than the leg, and the individual may have a rigidly flexed elbow or leg. It may be associated with prenatal brain bleeding.
- Triplegia: This type occurs when three limbs (such as both legs and one arm) are affected.
- Quadriplegia: this occurs when all four limbs are affected, with the legs usually more affected than the arms. It may also cause poor control over facial muscles.
- Double hemiplegia: with this type, all four limbs are affected (like quadriplegia), but one side is affected more than the other.
How CP Severity Is Graded
As noted above, people with CP can have varying levels of symptoms. The gross motor function classification system, of GMFCS, is used to grade the severity of an individual’s cerebral palsy symptoms. There are five levels of severity, ranging from less impaired (Level I) to more impaired (Level V):
- Level I: able to walk without limitations. By age two, they can sit independently. By age 6, they can navigate curbs and stairs without railings.
- Level II: can walk with some limitations. They might need to use mobility devices or wheelchairs for longer distances.
- Level III: needs mobility devices, including handheld devices (like a cane or walker) for indoors and a wheelchair for longer distances.
- Level IV: limited mobility beyond walking with assistance for short distances. Typically requires a manual or powered wheelchair for mobility.
- Level V: severe movement limitations, requiring a power wheelchair for mobility. They will require assistance for most activities.
Doctors will evaluate a child’s gross motor skills to determine their level of CP based on the GMFCS. In more severe cases, a person will not likely be able to improve their GMFCS level and will likely always require a mobility device.
How BILA Can Help
Learning that your child has been diagnosed with cerebral palsy can be devastating. While in some cases, CP is not preventable, it is often caused by medical negligence during pregnancy, labour and delivery, or after birth.
If your child was diagnosed with CP as a result of a birth injury, you may be able to file a lawsuit against the at-fault medical professionals. The compensation from a lawsuit can help you provide your child with the treatment and support that they need to thrive. At BILA, our cerebral palsy lawyers have decades of experience with birth injury and CP cases across Canada. Contact BILA today to speak with one of our lawyers.
Is CP Always Caused By a Birth Injury?
No. Cerebral palsy can be caused by many factors, including gene mutations, maternal infections, or even a brain injury after birth. However, it may be associated with medical negligence, including failure to diagnose or treat maternal infections, oxygen deprivation during labour and delivery, or prolonged labour without intervention.
If you believe that your baby’s cerebral palsy was caused by a birth injury, you may be able to file a legal action against the doctors, nurses, and other healthcare professionals. Reach out to BILA to schedule a free consultation with a cerebral palsy lawyer in your province.
Is Early Diagnosis Critical for Cerebral Palsy?
Yes. Early diagnosis of cerebral palsy is important so that an infant can receive the appropriate treatments and interventions. While there is no cure for CP, early intervention can optimize neuroplasticity, improve a child’s motor and cognitive outcomes, and prevent complications like contracture and scoliosis. Early diagnosis and intervention can also provide much needed support for parents.
After a CP diagnosis, it can be difficult to consider pursuing legal action. However, it may be necessary to obtain the financial support that you need to care for your child. Contact BILA today to schedule a consultation with a birth injury lawyer in your province.
Will My Child’s CP Type Change?
No. When a person is diagnosed with a specific type of cerebral palsy, that is their diagnosis. The CP itself will not get worse or change over time, as the brain damage has already occurred. However, the symptoms of CP – such as spasticity, musculoskeletal problems, and pain – may change and even get worse over time.
If you believe that your child’s cerebral palsy was caused by preventable medical negligence, BILA can help. Our team of experienced cerebral palsy lawyers will advocate for your family. Contact us today to schedule a free consultation with a birth injury lawyer in your province.
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