Classic Presentations of Cerebral Palsy

About 1 million people in the United States have cerebral palsy (CP), and CP occurs in 1.5 - 2.5 of every 1000 live births. Cerebral palsy is not one specific disease or disorder. Rather, it refers to a loosely-associated group of disorders that involve motor or postural abnormalities that occur early in the child's development. United Cerebral Palsy (UCP), the national organization devoted to people with cerebral palsy, defines cerebral palsy as a syndrome that includes a number of different types of injury, to a variety of areas within the child's developing brain:

failure of a variety of developing brain cells to migrate from their point of origin to the appropriate functional location in the brain during neurological development
failure of specialized brain cells to deposit myelin on cell fibers, which causes poor transmission of nerve impulses
death of brain cells, including the grey matter within the cerebral cortex
poor function at the synapses, or connections between brain cells, which causes faulty or nonexistent transmission of nerve impulses between the cells

Cerebral palsy is generally considered to be a "static" form of encephalopathy that does not progress throughout the child's life. However, it is important to note that clinical symptoms and developmental abilities do change significantly as children with CP grow up, and their nervous systems develop.

There are four classic presentations of cerebral palsy. While these categories are useful for diagnosing and communicating information about the child's overall condition, it's important to remember that every child is a unique individual with specific strengths, impairments, and medical problems. Without a thorough assessment to explore the unique qualities of each child, we have no foundation for the care giving process.

Spastic Hemiplegic

unilateral upper motor neuron deficit
arm usually affected more than leg
oral-motor dysfunction
specific learning disabilities
may have one-sided sensory deficits
visual field deficits and strabismus
seizures common

Spastic diplegic

legs more involved than arms
scissoring gait pattern
toe-walking
learning disabilities less common
seizures less common

Dyskinetic (extrapyramidal)

hypotonia and movement problems
some spasticity
oral-motor dysfunction
gait disorders
unstable trunk
possible deafness

Spastic quadriplegic

all extremities involved
trunk spasticity OR hypotonicity
limb spasticity
cognitive impairments common
multiple medical problems
seizures common

Going back to the classroom scenario presented in the Introduction, let's think about what type of cerebral palsy Jennifer has.

She walked up to the blackboard in an inclusive classroom setting, with a slight limp because of a slight hemiparesis of her right leg. Because her right arm is significantly impaired from the CP, she writes her spelling words with her left hand. The writing is slow and deliberate because Jennifer does have some underlying learning disabilities. When she reads the words aloud, Jennifer follows her speech and language pathologist's advice to speak slowly and enunciate carefully, to minimize her oral-motor impairments. She also turns her head slightly to the side to compensate for a visual field defect. Except for a seizure disorder that is well-controlled with anticonvulsant medications, Jennifer's medical history is unremarkable and she is able to ride the bus and play with her friends. Jennifer has spastic hemiplegic cerebral palsy.

Katie, on the other hand, uses a specially-fitted wheelchair and wrist splints to compensate for the low tone in her trunk, as well as his limb spasticity. With her severe cognitive impairments, Katie requires a highly-modified curriculum and significant accommodations in her special day classroom. Because of her low tone, and fine motor impairment she requires the services of a one-on-one occupational, speech and physical therapists at school. Katie displays the classic characteristics of spastic quadriplegic cerebral palsy.