Classification Of Cerebral Palsy

Cla ss ifi ca tion O f Cer ebr al P al sy Dhruv Mehta

Ph ysio lo gic al     

SPASTICITY HYPOTONIA ATAXIA DYKINESIA MIXED

Sp astic c erebral pals y  Increased Stretch Reflex,clonus,positive Babinski Sign,  Esotropia/Exotropia,exaggera ted Co-contraction,  Repetitive Stereotyped Patterns,small Inner Range Movts,lack Of Selective Control,  Associated Movts,associated Reactions,  Poor Equilibrium.Spasticity Increases With Stress.,  Visual Problems+

Hyp oto nic cerebral palsy.  Muscle Weakness+  Floppiness May Be Transient,may Develop pasticity/Athetosis/Dystonia  Can’t Generate Muscle Force Against Gravity,respiration Shallow,flaring Of Ribs,  Increased Base Of Support,poor Co-contraction,  Increased Rom,  Joint Laxity,processing Of Proprioceptors,tactile Systems Affected,  Strabismus  Visual Field Defects,refractive Errors May Be Present.

Dysk in etic c erebral palsy.  Athetosis,chorea,choreoathetosis,dystonia.  No Fixed Posture,lack Stability,fluctuating Tone.Insufficient Grading,poor Head Control,total Patterns,speech And Breathing Difficulties,,hearing Loss,visual Disturbances,fleeting Irregular Contractions,wind-swept Hips,mobile Spasms,alt Flexion/Extension,pronation/Supi nation.  10-15% Of Cp Hyper Bilirubinemia, Severe Hypoxia  Basal Ganglia Disfunction

At axic c erebral p alsy  Less Incidence,associated With Cerebellar Lesions,hydrocephalus,head Injury,encephalitis.Loss Of Balance,co-ordination,fine Motor Control,hypotonia+,widebased Gait,dysmetria,intention Tremor,titubation Of Head,trunkal Sway,nystagmus,cocontraction Poor,poor Proximal Fixation,inadequate Balance Reactions,slow,delayed Protective Responses.  Less Than 5% Of C.P.

Mix ed cerebral p alsy.  Mixed Spasticity  Dystonia And /Or Athetoid Movements.  Ataxia May Be A Component Of The.Motor Dysfunction

Topographi cal cl ass if icatio n MONOPLEGIA HEMIPLEGIA PARAPLEGIA DIPLEGIA TRIPLEGIA TOTAL BODY INVOLVED/QUADRIPLEGIA/TETRAPLEGIA  DOUBLE HEMIPLEGIA      

Mo noplegia   

One Limb Involved Spasticity(usually) Patient Should Run To Exclude Hemiplegic Pattern

He mip le gia  Spastic Upper & Lower Limb On Same Side  Hemidystonia Also Occurs  35 - 45% Of Spastic C.P.  Focal Traumatic, Vascular Or Infectious Lesion, Seizure, Visual Field Defects, Astereognosis, Proprioceptive Loss Likely

Pa raplegia .  Lower Limb Involvement Only  Rare In Spastic Type Of C.P.  Common In Familial Type

Dip le gia.  Minor Involvement Of Upper Limbs (Slight Inco-ordination Of Finger Movement)  Major Involvement Of Lower Limbs  Spasticity  25-35% Of Spastic C.P. Prematurity Usual, Also Low Birth Wieght Babies, Periventricular Leuco Malacia, Intelligence Normal, Epilepsy Less Common

Tr iplegia.  Three Limbs Involved  The Limb On The Hand Side May Be More Effected  Spasticity Present

Quadri pl egi a/ Tetr ap legi a

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Total body i nv olved . e Hemi pl egia . AllDoubl Four Limbs, Head, Neck & Trunk Involved Spastic, Athetoid & Mixed Types Double Hemiplegia Upper Limbs More Than Lower Limbs 40-50% Of Spastic C.P. Premature Babies, Perinatal Hypoxic Ischemic Encephalopathy