Based on the group of muscles involved,
- Tetraplegia or Quadriplegia: Involvement of the four limbs, the trunk and the head. The great majority of these individuals will not be able to stand up or walk.
- Diplegia: The four limbs are affected, but lower limbs are more involved than upper limbs. Some of the persons with Diplegia will be able to walk alone or with orthosis.
- Hemiplegia: Only the right side or the left side of the body is involved. It represents the mildest form of CP. An individual with hemiplegic CP will have only few limitations in daily activities.
Based on the ‘Quality’ of movement:
- Ataxia: Persons with ataxia have damage to their cerebellum which results in problems with balance, especially while walking. It is the rarest type, occurring in at most 10% of all cases.
- Athetoid or dyskinetic: Persons with this type generally have involuntary body movements. The damage occurs to the extra pyramidal motor system and/or pyramidal tract and to the basal ganglia. It occurs in ~20% of all cases.
- Spastic: Persons with this type have damage to the corticospinal tract, motor cortex, or pyramidal tract. It occurs in ~70% of all cases.
In 30% of all cases of cerebral palsy, the spastic form is found with the one of the other types. There are a number of other minor types of cerebral palsy, but these are the most common.
(1) SPASTIC CEREBRAL PALSY:
Main motor characteristics are,
- Hyper tonicity of the CLASP-KNIFE variety
- Increased tendon Jerk
- Occasional CLONUS
Changes in postures may occur with excitement fear or anxiety, which in increases muscle tension. Position of the head and neck may affect the distribution of hyper tonus. Hyper tonus may be either spasticity or rigidity.
Spasticity does not mean paralysis. Voluntary motion is present and may be laboured, if spasticity is decreased or removed by treatment of drugs, the muscles may be found to be strong or weak. Once spasticity is decreased the antagonists may also be stronger once they no longer have to over come the resistance of tight spastic muscles.
- Intelligence varies but may be more impaired than children with athetoid cerebral palsy.
- Perceptual problems especially of spatial relationships are more common in the spastic type of cerebral palsy.
- Sensory loss occasionally occurs in the child with Hemiplegia. There may be visual field loss and lack of sensation in the hand.
- Rib cage abnormalities and poor respirations.
- Epilepsies are more common than in other types of cerebral palsy.
- Intelligence varies, tending to be lower than in athetoids.
- Perceptual problems especially of spatial relationships are more common in spastic than in athetoids.
- Sensory loss occasionally occurs in the spastic hemiplegic hand and visual field. Growth of hemiplegic limbs is less than normal limb.
- Epilepsy is more common than in athetoids.
(2) ATHETOID CEREBRAL PALSY:
Involuntary movements called ATHETOISIS. These are bizarre, purposeless movement which may be uncontrollable. The voluntary movements may be slow or fast, writhing, jerky, tremor like swiping or rotary pattern or they may be unpatterned.
These are possible but there may be an initial delay before the movement is begun. The involuntary movement may partially or disrupt the voluntary movement making it uncoordinated.
- Intelligence is frequently good and may be very high. Mental defect also occurs.
- Hearing loss of a specific high frequency type is associated with athetoids caused by kernicterus.
- Emotional liability is more frequent than in other cerebral palsies.
(3) ATAXIC CEREBRAL PALSY:
Main characteristics are,
Disturbance of balance:
There is poor fixation of the head, trunk, shoulder and pelvic girdles.
Voluntary movements are uncoordinated. The child over reaches or under reaches for an object and said to have ‘DYSMETRIA’. This inaccurate limb movement in relation to its objective may also be accompanied by intention tremor.
- Intelligence is often low. Visual, hearing, perception problems may occur.
- Mentally subnormal, clumsy intelligent children may present. A pure ataxic is rare.