The term cerebral palsy offers little information about what daily challenges a person faces. It also does not offer clarity about the types of treatments that may or may not be helpful.
This is important information to consider when interacting with people, sometimes professionals, who are less familiar with CP.
Having a thorough assessment and understanding of which movement disorders, disorders of tone and other related symptoms are present and how they affect the way the individual moves, feels and coordinates movement, is imperative to determining which treatments are likely to be most successful.
Types of Cerebral Palsy
The type of CP may refer to abnormal muscle tone (the amount of background activity and tension in a muscle), involuntary movements or both. There may also be other conditions and symptoms beyond movement and coordination that interfere with the individual’s daily activities. These may include epilepsy, sensory impairments (vision, hearing and/or communication), difficulty eating and swallowing, and more.
The following types of cerebral palsy were created to highlight the primary movement or muscle tone disorder interfering with the individual’s motor control and function. As researchers learn more about cerebral palsy the present organization of CP as particular types may change in response to capture more information. Stay tuned for updates.
- Spasticity in Cerebral Palsy-currently called Spastic CP
- The majority of individuals with CP have the spastic form (approximately 85 percent). In spastic CP the individual has abnormal muscle tone and the muscles are stiff, making movement difficult. The graphic to the right illustrates common areas where an individual’s body may be affected by spasticity-also known as topography.
- In people with diplegia mostly the lower half of the body is affected.
- In people with hemiplegia mostly one side of the body is affected.
- And in people with quadriplegia, all four limbs are affected and the muscles of the trunk, face and mouth may also be affected.
- Increasingly more researchers and clinicians have begun using the terms bilateral CP (affecting both sides of the body) and unilateral CP (affecting one side of the body) to replace diplegia, hemiplegia and quadriplegia. The terms you hear will depend on the the preferences of the professionals.
- Dyskinesia in Cerebral Palsy currently called Dyskinetic CP
- Dyskinetic CP is an umbrella term characterized by three different types of involuntary movements referred to as dyskinesias and they include dystonic, athetoid, and choreic. About 10 to 20 percent have this form of CP as their predominant movement disorder. A person with dyskinetic CP may have one or more of these types of involuntary movements and athetosis and chorea are commonly seen together and referred to as choreoathetosis.
- Dystonia-intermittent or lengthy muscle contractions that cause twisting and repetitive movement sequences, abnormal posture or both. The movement patters are often triggered by attempts at voluntary movement.
- Athetosis-slow, continuous, involuntary twisting movements that prevent stable posture
- Chorea-a sequence of one or more involuntary movements that are abrupt and appear irregular. Unlike dystonic movements, choreiform movements look more rapid, unpredictable and ongoing. Choreic movements may appear to flow randomly from one muscle group to another and may involve the trunk, neck, face, tongue, legs and arms. They may also occur with athetosis, referred to as choreoathetosis, or they may occur with dystonic movements. Choreic movements subside during sleep.
- Dyskinetic CP is an umbrella term characterized by three different types of involuntary movements referred to as dyskinesias and they include dystonic, athetoid, and choreic. About 10 to 20 percent have this form of CP as their predominant movement disorder. A person with dyskinetic CP may have one or more of these types of involuntary movements and athetosis and chorea are commonly seen together and referred to as choreoathetosis.
- Dystonia in Cerebral Palsy sometimes called Dystonic CP
- The definitions around types of cerebral palsy are changing. It has been determined that as many as 70 percent of the people with spastic CP also have some degree of dystonia in CP making it a critical subject of research that has been historically overlooked and under treated. For educational purposes we include it under the dyskinesias in CP just above, but feel it also requires a separate section because of the number of people with CP affected by it and its complexity.
- Dystonia in CP is hard to diagnose and more needs to be learned about it. Because of these factors, we have created a whole new section on Dystonia in Cerebral Palsy or DCP. Dystonia is often seen independent of chorea and athetosis and in these cases physicians and therapists may refer to it as Dystonic CP instead of Dyskinetic CP as a way of emphasizing dystonia specifically rather than all three dyskinesias.
- Ataxia in Cerebral Palsy currently called Ataxic CP
- About 1 to 10 percent of people with CP have ataxia. People with ataxia may have challenges with balance, depth perception and coordination. It is often characterized by wobbly or shaky purposeful movements (occurring with the intention to move), difficulty with muscles overshooting or undershooting to meet a specific target, and may also involve difficulty coordinating precise finger movements for fine motor skills such as writing or using utensils. A diagnosis of ataxic CP is often made by ruling out other forms of CP. Patients can have congenital (from birth) hypotonia, or restricted growth and learning difficulties, with motor milestones and language skills commonly being delayed. There can be tremors, or shakiness, that happens with purposeful movements. People with a diagnosis of Ataxic CP were born at term.
- Mixed Cerebral Palsy
- When a person show signs of more than one of the previous three forms of CP during evaluations, they can be diagnosed with mixed cerebral palsy . The most common mixed form includes spastic CP and dyskinetic CP movements, but other combinations are also possible. *Update 11-4-2024–At this time it is understood that most people with CP have more than one type of CP present making the term “mixed cerebral palsy” an unnecessary or repetitive category under the CP umbrella. We will keep this term here since many physicians and therapists may still refer to it.
The information from this page appears in our free and downloadable cerebral palsy tool kit.
