The world of Cerebral Palsy can be confusing and complicated. Here is some information that
may clear a few things up.
What is Cerebral Palsy? Well, the definition is: a condition marked by impaired muscle
coordination (spastic paralysis) and/or other disabilities, typically caused by damage to the brain
before or at birth.
But if you or your child has CP you know it is so much more than just its generic definition. Its
how you live your life, day in and day out, 24/7 365. I’d like to do a breakdown of the types,
levels, and basic functions based on classifications and have it all in one easy to find place.
A great starting point is with severity level. There are 4 different levels and, really, they are
sweeping generalizations of CP, but it helps with communicating the level of impairment when
detailed accuracy is not necessary.
● Mild - ability to move without assistance or assistive devices and there is no limit in the
day to day activities.
● Moderate - braces, assistive devices, adaptive technology and medication will be
needed to accomplish daily activities.
● Severe - will require a wheelchair and other assistive devices and have significant
challenges in accomplishing day to day activities.
● No CP - there are signs of Cerebral Palsy, however they developed after the brain
development was completed which classifies it under the cause, such as traumatic brain
injury or encephalopathy.
So now that we have the severity covered, let’s move on to types based on body parts
affected. There are 8 types, and all 8 contain a prefix based on how the limbs are affected.
The prefixes are
● Pareses - meaning weakened
● Plegia/Plegic - meaning paralyzed
The types breakdown as follows
● Monoplegia/Monoparesis - One limb is affected. Though it is thought to be a
form of hemiplegia/hemiparesis where one limb is significantly more affected than the
other.
● Diplegia/Diparesis - The lower body is primarily affected. Legs more affected than
the arms.
● Hemiplegia/Hemiparesis - the arm and leg are affected on one side of the body.
● Paraplegia/Paraparesis - Just the lower half of the body, including both legs.
● Triplegia/Triparesis - 3 limbs affected, combinations include- both leg and an
arm, or both arms and a leg, or one leg and one arm and the face.
● Double Hemiplegia/Double Hemiparesis - All 4 limbs are affected but one
side of the body is affected more than the other.
● Tetraplegia/Tetraparesis - All 4 limbs are affected but 3 of the limbs are more
affected than the 4th.
● Quadriplegia/Quadriparesis - All 4 limbs are affected.
● Pentaplegia/Pentaparesis - All 4 limbs are affected along with the neck and
head. There are usually eating and breathing complications.
Everything thus far has been pretty clear cut, but hold on, things are about to get muddy. There
is also distinction based off motor function. There are 2 types of classifications, and they include
● Spastic (pyramidal) - increased muscle tone.
● Non-spastic (extrapyramidal) - decreased or fluctuating tone. There are two
subcategories associated with non-spastic cp.
● Ataxic/Ataxia affects coordination such as balance, eye
movement, depth perception, and fine motor skills requiring
eyes and hands to work together are difficult.
● Dyskinetic which is further separated into two subgroups
● Athetoid involuntary movements
of the legs, arms and hands
● Dystonia/Dystonic affects trunk
muscles resulting in a
fixed twisted posture.
They both have multiple variations and it is possible to have a mix of both. These two
distinctions are based on what areas of the brain are injured. Spastic Cerebral Palsy
indicates damage to the pyramidal tract which is two groups of nerve fibers that are responsible
for communicating voluntary movements. The pyramidal tract starts in the cortex of the brain
and connects to the brain stem which communicates the intended movement to the nerves in
the spinal cord. Non-Spastic Cerebral Palsy is injury to areas outside of the pyramidal tract
such as the cerebellum or thalamus causing involuntary or rhythmic movements. Because of
where the injury is located mental impairment and seizures are less likely.
There are also two
terms used to describe muscle tone,
● Hypertonia/Hypertonic - describes increased muscle tone, that often results in
very stiff and/or rigid limbs. This kind is associated with Spastic Cerebral Palsy and
accounts for around 80% of the cases of Cerebral Palsy.
● Hypotonia/Hypotonic - describes decreased muscle tone, resulting in floppy
and/or loose limbs. This kind is associated with Non-Spastic Cerebral Palsy.
Still with me? Well, in case that wasn’t confusing enough, there is also a classification system
based on the extent of ability and impairment limitations. It’s referred to as the Gross Motor
Function Classification System (GMFCS). GMFCS uses a five level classification where
the higher the number indicates a higher level of severity. It is used to help determine the
treatments, therapies, possible surgeries and assistive devices and technologies to best help. If
a person fits into multiple levels of the GMFCS the lower level is chosen.
● GMFCS Level l - ability to walk without limitations.
● GMFCS Level ll - has limitations while walking. Such limitations would include
walking long distances, balancing, and the use of wheeled mobility to navigate uneven
terrain.
● GMFCS Level lll - requires adaptive equipment to walk indoors and wheeled
mobility outdoors. Ability to sit with no or minimal support and has a bit of independence
with standing transfers.
● GMFCS Level lV - mobility possible with wheeled powered mobility assistance, with
very limited self-mobility.
● GMFCS Level V - limited head and trunk control with extensive assistive technology
and physical assistance required.
Why all the terms and classifications? Well much like any spectrum disorder, Cerebral Palsy is
an umbrella term and encompasses so much with many variations. My hope is having all this in
one place is useful in understanding the specific terms used by doctors and therapists, and can
make this potentially scary prospect easier to handle for families and parents just becoming part
of the CP community!
