Classifications of Cerebral Palsy

Cerebral Palsy is an umbrella term that covers a spectrum of different problems including motor control disturbance, epilepsy, vision, speech, hearing and recurrent chest infection. Once the diagnosis has been made on the basis of medical history and physical examination, child physical disability is classified for ease of communication among health professionals as well as for suggesting proper prognosis and treatment. The classification system is based on the physiology of the motor dysfunction, the number of limbs involved and the functional status of the child.

Physiological Grouping - Depending upon type of muscular control loss.

Spastic Cerebral palsy plasticity is defined as a velocity-dependent increased muscle tone, determined by passively flexing and extending muscle groups across a joint. It is the commonest type of cerebral palsy and has much better prognosis than other varieties.

Dyskinesia - Dyskinesia is defined as abnormal motor movements that become obvious when the patient initiates a movement. When the patient is totally relaxed, usually in the supine position, a full range of motion and decreased muscle tone may be found.

 Dyskinetic patients are divided into two subgroups.

The hyperkinetic or choreo-athetoid children show purposeless, often massive involuntary movements with motor overflow, that is, the initiation of a movement of one extremity leads to movement of other muscle groups. b, The dystonic group manifest abnormal shifts of general muscle tone induced by movement. Typically, these children assume and retain abnormal and distorted postures in a stereotyped pattern.

Both types of dyskinesia may occur in the same patient. Simply stated, spasticity you feel; dystonia you see. Ataxias -Patients with ataxia have a disturbance of the coordination of voluntary movements due to muscle dys-synergia. These patients may be hypotonic during the first two or three years of life. They commonly walk with a wide-based gait and have a mild intentional tremor (dysmetria). Mixed Group-- Patients in this category commonly have mild Spasticity, dystonia, and / or athetoid movements. Ataxia may also be a component of the motor dysfunction in patients placed in this group.

Hypotonic – Decrease tone in whole body. This type of cerebral palsy usually converts in athetoid or mixed cerebral palsy as time passes.

Anatomical Grouping depending upon no. and extend of limbs affected

Diplegia-  Diplegia refers to involvement predominantly of the legs. Quadriplegic refers to dysfunction of all four extremities; in some children one upper extremity might be less involved; the term triplegia then would be substituted.

Hemiplegia - Hemiplegia refers to individuals with unilateral motor dysfunction; and in most children the upper extremity is more severely involved than the lower. Finally, an unusual situation may occur, where the upper extremities are much more involved than the lowers; the term Double Hemiplegia is applied to this group of patients.

Functional Classifications of Cerebral palsy Depending upon the degree of functional independence.

• Clumsy Child. Uses no resistive devices (such as crutches), Can walk indoors and outdoors and climb stairs , Can perform usual activities such as running and jumping, Only has decreased speed, balance and coordination.

• Walks Independently. Limited in outdoor activities, Has the ability to walk indoors and outdoors and climb stairs with support of railing, has difficulty with uneven surfaces, inclines or in crowds, has minimal ability to run or jump.

• Uses Assistive Mobility Devices Walks with assistive mobility devices indoors and outdoors on level surfaces May be able to climb stairs using a railing, may propel a manual wheelchair (with assistance needed for long distances or uneven surfaces).

• Severely Limited, Self-mobility severely limited even with assistive devices, uses wheelchairs most of the time and may propel their own power wheelchair.

• No Self-Mobility.  They have physical impairments that restrict voluntary control of movement.

The ability to maintain head and neck position against gravity is impaired in all areas of motor function, children cannot sit or stand on their own even with equipment, cannot do independent mobility; though may be able to use a powered Wheel chair.

I am Jitendra Jain King George's Medical University, for a while known as Chhatrapati Shahuji Maharaj Medical University, is a medical university located in Lucknow, Uttar Pradesh, India. It came into being after the upgrade of King George's Medical College into a university by an act passed by government of Uttar Pradesh.