Main Body
2 Introduction to cerebral palsy
Learning Objectives
- Understand the types and causes of cerebral palsy.
- Understand the terminology used to describe motor impairments in individuals with cerebral palsy.
Introduction to Cerebral Palsy (CP)
Cerebral Palsy (CP) is the most common neuromotor disorder in childhood. Prevalence of CP in the USA is about 2.6 – 3.1 per 1000[1],[2]. CP is an umbrella term that denotes a disorder of movement and posture caused by a non-progressive abnormality of the developing brain, usually originating in the prenatal or perinatal period. CP may be due to complications during pregnancy (e.g., stroke in the brain of the fetus), congenital malformation in the brain, birth trauma, or complications of premature birth (e.g., brain hemorrhage). It can also be caused by damage in the early developmental years (i.e., 0-2 years).
Subtypes of CP
- Spastic CP is the most common type of CP. It is caused by damage to the part of the brain that controls motor movements (the motor cortex) or the motor pathways as they descend down to the spinal cord. In this type of CP, muscles appear stiff, and movements may be stiff or jerky.
- Dyskinetic or dystonic CP is caused by damage to the basal ganglia or associated pathways. In this type of CP, you see involuntary movements.
- Ataxic CP is caused by damage to the cerebellum. In this type of CP, you see unsteady, imprecise movements and balance difficulties.
Understanding terminology in CP
- Weakness (hemiparesis) or paralysis (hemiplegia) on one side of the body is caused by damage to the opposite side of the cortex, or the same side of the cerebellum. It may affect the entire side of the body, or only part (e.g., only the arm). Individuals with hemiparesis or hemiplegia have varying amounts of ability to use their affected limbs.
- Diplegia describes paralysis or weakness which affects symmetrical parts of the body (both legs or both arms) and suggests damage to both sides of the brain.
- Quadriplegia describes paralysis or weakness which affects all four limbs.
- Gross Motor Function Classification System – Expanded & Revised (GMFCS – E&R) is a system that classifies the level of gross motor movement capabilities in individuals with CP[3].
Learning and development in CP
- About 45% of individuals with CP have an Intellectual Disability (ID).
- Many of those who have CP without ID have some learning differences.
- As a group, those with hemiplegia (paralysis on one side of the body) or spastic diplegia (paralysis of both corresponding limbs, usually legs) tend to be less cognitively impacted than those who have all 4 limbs involved[4].
Key Takeaways
- Cerebral Palsy (CP) is the most common motor disorder in childhood.
- Cerebral palsy is non-progressive, and is caused by abnormal development or damage to the fetal or infant brain.
- Individuals with CP can present with a variety of motor and cognitive issues depending on the part of the brain affected, the severity of the brain damage, and the time of the injury in development.
Resources for Further Learning
- Krigger, K.W. (2006). Cerebral Palsy: An Overview. University of Louisville School of Medicine, American Family Physician, American Family Physician, 73(1):91-100.
- Christensen, D., Van Naarden Braun, K., Doernberg, N. S., et. al. (2014). Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning – Autism and Developmental Disabilities Monitoring Network, USA, 2008. Developmental Medicine and Child Neurology, 56(1), 59–65. ↵
- Maenner, M. J., Blumberg, S. J., Kogan, M. D., Christensen, D., Yeargin-Allsopp, M., & Schieve, L. A. (2016). Prevalence of cerebral palsy and intellectual disability among children identified in two U.S. National Surveys, 2011–2013. Annals of Epidemiology, 26(3), 222–226. ↵
- Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 39(4), 214-23. ↵
- Reid, S. M., Meehan, E. M., Arnup, S. J. and Reddihough, D. S. (2018). Intellectual disability in cerebral palsy: A population‐based retrospective study. Dev Med Child Neurology, 60, 687-694. ↵
