Cerebral palsy can be classified in several ways: (1) By the region of the body affected, such as hemiplegia which affects one side of the body, diplegia which primarily affects both legs, and quadriplegia which affects all four limbs. (2) By the type of motor impairment, with spastic cerebral palsy being the most common type and affecting muscle tone, and other types including athetoid, choreiform, ataxic, and rigid. (3) Temporally based on when the brain injury occurred such as prenatal, perinatal, or postnatal causes. Cerebral palsy results from a non-progressive

1. Cerebral Palsy: Classification
By: vaibhav mittal

2. introduction
• The term cerebral palsy
was first used in 1843
by the English
orthopedic surgeon
William Little in a series
of lectures entitled
“Deformities of the
Human Frame”
• It was known for many
years as “Little’s
disease”

3. introduction
• Cerebral palsy is a heterogeneous disorder of
movement and posture that has a wide
variety of presentations, ranging from mild
motor disturbance to severe total body
involvement.

4. Distinctive features
• There are three distinctive features common to all
patients with cerebral palsy:
(1) some degree of motor impairment, versus autism;
(2) an insult to the developing brain, making it different
from conditions that affect the mature brain in older
children and adults; and
(3) a neurological deficit that is nonprogressive, versus
other motor diseases of childhood, such as the
muscular dystrophies

5. Age
• The insult to the brain is believed to occur
between the time of conception and age 2
years, at which time a significant amount of
motor development has already occurred
• By 8 years of age, most of the development of
the immature brain is complete, as is gait
development, and an insult to the brain
results in a more adult-type clinical picture
and outcome.

6. ORTHOPAEDICS ASPECTS
• Although the neurological deficit is permanent and
nonprogressive, the effect it can have on the patient is
dynamic, and the orthopaedic aspects of cerebral palsy
can change dramatically with growth and development
• Growth, along with altered muscle forces across joints,
can lead to
(1)progressive loss of motion,
(2)contracture, and eventually
(3)joint subluxation or dislocation, resulting in
(4)degeneration, that may require orthopaedic
intervention

7. ETIOLOGY
• Injury to the developing brain can occur at any
time from gestation to early childhood and
typically is categorized as
1)Prenatal
2)Perinatal
3)Postnatal

8. • This includes risk factors inherent to the fetus
(most commonly genetic disorders)
• Factors inherent to the mother (seizure disorders,
mental retardation, and previous pregnancy loss)
• Factors inherent to the pregnancy itself (Rh
incompatibility, polyhydramnios placental
rupture, and drug or alcohol exposure).
• Trauma, head injury Infections Lack of oxygen
Stroke in the young, Tumor, cyst

9. • External factors, such as TORCH syndrome
(toxoplasmosis, other agents, rubella,
cytomegalovirus, herpes simplex), also can lead
to cerebral palsy in th prenatal period.
• Oxytocin augmentation, umbilical cord prolapse,
and breech presentation all have been associated
with an increased occurrence of cerebral palsy.
• Hypoxic-ischemic encephalopathy, which is
characterized by hypotonia, decreased
movement, and seizures, is a common cause of
cerebral palsy during the postnatal period.

10. Classification
• Because of the wide variability in presentation and types of
cerebral palsy, there is no universally accepted classification
scheme
• Cerebral palsy can be classified by the
(1) the region of the body affected.
(2) the neuroanatomical region of the brain that was injured
It also can be classified
(3) temporally in relation to the time of birth, as previously
Described.

12. Hemiplegia
In hemiplegia, one side of the body is involved,
with the upper extremity usually more affected
than the lower extremity.
Patients with hemiplegia, approximately 30% of
patients with cerebral palsy, typically have
sensory changes in the affected extremities as
well.

13. Hemiplegia
limbs on only one side

14. Diplegia
Diplegia is the most common anatomical type
of cerebral palsy, constituting approximately
50% of all cases.
Patients with diplegia have motor abnormalities
in all four extremities, with the lower
extremities more affected than the upper.
The close proximity of the lower extremity tracts
to the ventricles most likely explains the more
frequent involvement of the lower extremities
with periventricular lesions

15. Diplegia/ Paraplegia
•both legs•both legs w/ slight
involvement
elsewhere

16. This type of cerebral palsy is most common in
premature infants
Intelligence usually is normal.
Most children with diplegia walk eventually,
although walking is delayed usually until around
age 4 years.

17. Quadriplegia
In quadriplegia, all four extremities are equally
involved, and many patients have significant
cognitive deficiencies that make care more
difficult
Head and neck control usually are present,
which helps with communication, education,
and seating.

18. Quadriplegia

19. Physiological Classification
Physiologically, cerebral palsy can be divided into a
(1)spastic type, which affects the corticospinal
(pyramidal) tracts, and
(2)an extrapyramidal type, which affects the other
regions of the developing brain
• The extrapyramidal types of cerebral palsy include
(1)athetoid
(2)choreiform
(3)ataxic
(4)rigid
(5)hypotonic

20. Physiological Classification

21. 3 MAIN TYPES
1. PYRAMIDAL
- originates from the motor areas
of the cerebral cortex
2. EXTAPYRAMIDAL
- basal ganglia and cerebellum
3. MIXED

22. Spastic CP
• Increased muscle tone,
tense and contracted muscles
– Have stiff and jerky or
awkward movements.
– limbs are usually
underdeveloped
– increased deep tendon
reflexes
• most common form
• 70-80% of all affected

23. Booth showed histologically
that this altered muscle
function leads to the
deposition of type I collagen in
the endomysium of the
affected muscle, leading to
thickening and fibrosis, the
degree of which correlated to
the severity of the spasticity.
Joint contractures,
subluxation, and degeneration
are common in patients with
spastic cerebral palsy.

24. Athetoid/ Dyskinetic CP
• Fluctuating tone
– involves abnormal involuntary
movements
– that disappear during sleep and
increase with stress.
– Interferes with speaking, feeding,
reaching, grabbing, and any other
skills
– 20% of the CP cases,

25. Choreiform
Choreiform cerebral palsy is characterized by
continual purposeless movements of the
patient's wrists, fingers, toes, and ankles. This
continuous movement can make bracing and
sitting difficult.

26. Rigid
Patients with rigid cerebral palsy are the most hypertonic
of all cerebral palsy patients.
These patients have a “cogwheel” or “lead pipe” muscle
stiffness that often requires surgical release.

27. Ataxic CP
• Poor balance and lack of
coordination
– Wide-based gait
– Depth perception usually affected.
– Tendency to fall and stumble
– Inability to walk straight line.
– Least common 5-10% of cases
Ataxic cerebral palsy is very rare
As a result of an injury to the
developing cerebellum.

28. It is important to distinguish true ataxia from
spasticity because with treatment many children
with ataxia are able to improve their gait
function without surgery.

30. MIXED CP
• A common combination is
spastic and athetoid
• Spastic muscle tone and involuntary
movements.
• 25% of CP cases, fairly common

31. Thank you…..