Classification

CP encompasses a spectrum of motor disorders of varying tone, anatomical distribution and severity. Clinicians classify patients to describe the specific problem, to predict prognosis and to guide treatment. Classification is based on the change in muscle tone, anatomical region of involvement and severity of the problem. Classification provides a clearer understanding of the specific patient and directs management. Spastic CP Spasticity is defined as an increase in the physiological resistance of muscle to passive motion. It is part of the upper motor neuron syndrome characterized by hyperreflexia, clonus, extensor plantar responses and primitive reflexes. Spastic CP is the most common form of CP. Approximately 70% to 80% of children with CP are spastic. Spastic CP is anatomically distributed into three types.

Clinical classification

Tonus              Lesion site
Spastic                        Cortex
Dyskinetic                    Basal ganglia – extrapyramidal system
Hypotonic / Ataxic         Cerebellum
Mixed                          Diffuse

Anatomical classification
Location                     Description

Hemiplegia           Upper and lower extremity on one side of body
Diplegia                 Four extremities, legs more affected than the arms
Quadriplegia        Four extremities plus the trunk, neck and face
Triplegia                Both lower extremities and one upper extremity
Monoplegia          One extremity (rare)

Below is shortly described each type of CP , for more information on exact type please visit section ( types of cp )

Spastic CP

Spasticity is defined as an increase in the physiological resistance of muscle to passive motion. It is part of the upper motor neuron syndrome characterized by hyperreflexia, clonus, extensor plantar responses and primitive reflexes. Spastic CP is the most common form of CP. Approximately 70% to 80% of children with CP are spastic. Spastic CP is anatomically distributed into three types.

Hemiplegia

With hemiplegia, one side of the body is involved with the upper extremity generally more affected than the lower. Seizure disorders, visual field deficits, astereognosis, and proprioceptive loss are likely. Twenty percent of children with spastic CP have hemiplegia. A focal traumatic, vascular, or

infectious lesion is the cause in many cases. A unilateral brain infarct with posthemorrhagic porencephaly can be seen on magnetic resonance imaging (MRI).

Diplegia

With diplegia, the lower extremities are severely involved and the arms are mildly involved . Intelligence usually is normal, and epilepsy is less common. Fifty per cent of children with spastic CP have diplegia. A history of prematurity is usual. Diplegia is becoming more common as more low- birth-weight babies survive. MRI reveals mild periventricular leukomalacia (PVL).

Quadriplegia (Total body involvement – tetraplegia)

With quadriplegia, all four limbs, the trunk and muscles that control the mouth, tongue, and pharynx are involved . When one upper extremity is less involved, the term triplegia is used. Thirty percent of children with spastic CP have quadriplegia. More serious involvement of lower extremities is common in premature babies. Some have perinatal hypoxic ischemic encephalopathy. MRI reveals PVL.

Dyskinetic CP

Abnormal movements that occur when the patient initiates movement are termed dyskinesias. Dysarthria, dysphagia, and drooling accompany the movement problem. Mental status is generally normal, however severe dysarthria makes communication difficult and leads the observer to think that the child has intellectual impairment. Sensorineural hearing dysfunction also impairs communication. Dyskinetic CP accounts for approximately 10% to 15 % of all cases of CP. Hyperbilirubinemia or severe anoxia causes basal ganglia dysfunction and results in dyskinetic CP.

Ataxic CP

Ataxia is loss of balance, coordination, and fine motor control. Ataxic children cannot coordinate their movements. They are hypotonic during the first 2 years of life. Muscle tone becomes normal and ataxia becomes apparent toward the age of 2 to 3 years. Children who can walk have a wide-based gait and a mild intention tremor (dysmetria). Dexterity and fine motor control is poor. Ataxia is associated with cerebellar lesions.

Mixed CP

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 in this group. Ataxia and spasticity often occur together. Spastic ataxic diplegia is a common mixed type that often is associated with hydrocephalus.

Exceptions

Some children with CP cannot be fitted into these CP groups because they present with many different impairments. Dystonia may be seen in the spastic child, and anatomical classification may not be fully explanatory because clinical findings may overlap. An example is the hypotonic total-body-involved baby who stays hypotonic throughout childhood. Define the pathological abnormalities observed in these children according to the anatomical, and clinical involvement, as described above.