We are talking about a neurological disorder that affects a person’s movements, muscle tone and coordination.
These effects can differ from one child with cerebral palsy to another, and are generally due to the type and extent of the disorder each person has.
Importance of the classification of cerebral palsy
Currently there are several classification systems for cerebral palsy to define the type and form of cerebral palsy that an individual has.
The classification is complicated by the wide range of clinical presentations and the degrees of activity limitation that the condition presents.
Knowing the severity, location, and type of cerebral palsy a child has will help coordinate the type of therapy they need to carry out their daily activities.
Professionals who specialize in the treatment of cerebral palsy approach the disease from several different points of view.
For example, an orthopedic surgeon requires a definition of the affected limbs and the degree of impairment to prescribe treatment.
Neurosurgeons and neuroradiologists, on the other hand, are more concerned with the cause of brain damage and the descriptors for studying white and gray matter to determine the type of brain injury or brain malformation.
They are also concerned with diagnosing the extent and severity of the child’s cerebral palsy.
At first, parents may be concerned with the classification of the severity level: mild, moderate or severe, to better understand the severity of the child’s disability.
When parents meet with the child’s pediatrician or physical therapist, it is helpful to understand the topographic distribution of the impairment, limbs, and sides of the body affected by brain damage.
It is also important to clarify whether the child has a condition of plegia (paralysis) or paresis (weakened).
Teachers need to know the classification systems that describe disability to rate a child, and to assign educational supports to the child and necessary special education services.
Researchers are interested in using a universally accepted classification system, to increase consistency in studies from around the world and expand the capacity to generate knowledge about prevalence, life expectancy, social impact, prevention measures and education.
Universal classification system
Many classification systems for cerebral palsy are used today. In the last 150 years, the definition of cerebral palsy has evolved and changed as new medical discoveries contributed to a greater understanding of the disease.
Although a large number of classifications exist today, used differently and for many purposes, people involved in cerebral palsy research are working towards a universally accepted classification system.
Currently the gross motor classification system is the most widely used.
Diagnosis of the types of cerebral palsy
Doctors can diagnose the type of cerebral palsy a patient has by reviewing the medical history, performing a physical exam, and sometimes obtaining images or other tests.
The gross motor classification system is used as a measure of severity and one of the ways in which symptoms can be characterized.
It consists of an in-depth checklist of the child’s physical abilities and weaknesses.
Cerebral palsy is a disorder that affects your movement and muscle tone. The condition is caused by problems in the brain.
Types of cerebral palsy
The most used classification systems are:
Classification based on severity level
Cerebral palsy is often classified based on the level of severity as mild, moderate, severe, or no cerebral palsy. These are broad generalizations that lack a specific set of criteria.
Even when clinicians agree on the level of severity, the classification provides little specific information, especially compared to the Gross Motor Function Classification System.
Still, this method is common and offers a simple method of communicating the extent of deterioration, which can be useful when precision is not required.
Mild cerebral palsy
It means that a child can move without help, their daily activities are not limited.
Moderate cerebral palsy
Moderate cerebral palsy means that a child will need braces, medications, and adaptive technology to perform daily activities.
Severe cerebral palsy
Severe cerebral palsy means that a child will need a wheelchair and will have significant challenges in performing daily activities.
No cerebral palsy
No cerebral palsy means that the child has signs of cerebral palsy, but the impairment was acquired after the completion of brain development and is therefore classified according to the incident that caused the cerebral palsy, such as traumatic brain injury or encephalopathy.
Classification based on topographic distribution
Topographic classification describes the parts of the body affected. Words are a combination of phrases combined for a single meaning.
When used with the motor function classification system, it provides a description of where and to what extent a child is affected by cerebral palsy. This method is useful in determining the treatment protocol.
The prefixes and the root words are combined to produce the topographic classifications commonly used in practice today. Parasis means weakened and plegia means paralyzed.
- Monoplegia / monoparesis: means that only one limb is affected. This is believed to be a form of hemiplegia / hemiparesis in which a limb is significantly impaired.
- Diplegia / diparesis: generally indicates that the legs are more affected than the arms; It mainly affects the lower body.
- Hemiplegia / Hemiparesis : indicates that the arm and leg on one side of the body are affected.
- Paraplegia / Paraparesis: The lower half of the body, including both legs, is affected.
- Triplegia / tryparesis: indicates that three limbs are affected. This could be both arms and one leg, or both legs and one arm. Or, it could refer to an upper and lower limb and the face.
- Double Hemiplegia / Hemiparesis: Double indicates that all four limbs are affected, but one side of the body is more affected than the other.
- Quadriplegia / tetraparesis: indicates that all four extremities are involved, but three extremities are more affected than the fourth.
- Quadriplegia / Quadriparesis: means that all four limbs are involved.
- Pentaplegia / pentaparesis: means that all four limbs are involved, with paralysis of the neck and head, often accompanied by complications with eating and breathing.
Classification based on motor function
The brain injury that causes cerebral palsy affects motor function, the ability to control the body in a desired matter.
Two main groupings include spastic and nonspastic. Each has multiple variations and it is possible to have a mix of both types.
Spastic cerebral palsy is characterized by increased muscle tone.
Non-spastic cerebral palsy will exhibit decreased or fluctuating muscle tone.
Classification of motor function provides a description of how a child’s body and the area of brain injury are affected.
The use of motor function provides parents, physicians, and therapists with a very specific, but comprehensive, description of a child’s symptoms, helping physicians choose the treatments with the best chance of success.
Many terms in motor function describe the effect of cerebral palsy on muscle tone and how the muscles work together.
Proper muscle tone when bending an arm requires the biceps to contract and the triceps to relax.
When muscle tone is impaired, the muscles do not work together and may even work in opposition to each other.
Two terms used to describe muscle tone are:
- Hypertonia / hypertonicity: This is an increase in muscle tone, often resulting in very stiff limbs. Hypertonia is associated with spastic cerebral palsy
- Hypotonia / Hypotonic – Decreased muscle tone, often resulting in limp and limp limbs. Hypotonia is associated with nonspastic cerebral palsy
When it comes to the location of the brain injury, spastic and nonspastic cerebral palsy is known in the medical community as pyramidal and extrapyramidal cerebral palsy.
Pyramidal or spastic cerebral palsy
The pyramidal tract consists of two groups of nerve fibers responsible for voluntary movements.
They descend from the cortex to the brain stem, in essence, they are responsible for communicating the intention of the brain movement to the nerves of the spinal cord that stimulate the event.
Pyramidal cerebral palsy would indicate that the pyramidal tract is damaged or not working properly.
Extrapyramidal cerebral palsy indicates that the lesion is outside the tract in areas such as the basal ganglia, the thalamus, and the cerebellum.
Pyramidal and extrapyramidal are key components for movement impairments.
Spasticity implies increased muscle tone. The muscles continually contract, making the limbs stiff, rigid, and resistant to flexion or relaxation.
The reflections can be exaggerated, while the movements tend to be jerky and uncomfortable.
Often the arms and legs are affected. The tongue, mouth, and pharynx can also be affected, making it difficult to speak, eat, breathe, and swallow.
Spastic cerebral palsy is hypertonic and accounts for 70% to 80% of cases of cerebral palsy. The brain injury occurs in the pyramidal tract and is known as upper motor neuron damage.
The stress on the body created by spasticity can result in associated conditions, such as hip dislocation, scoliosis, and limb deformities.
Of particular concern is contracture, the constant contraction of muscles that produces painful joint deformities.
Spastic cerebral palsy is often called in combination with a topographical method that describes which limbs are affected, such as spastic diplegia, spastic hemiparesis, and spastic quadriplegia.
Spastic cerebral palsy is divided into three different subtypes, including:
It involves muscle stiffness, usually in the leg area, but the arms can also be slightly affected.
In this type of cerebral palsy, the muscles are tight in the legs and hips and can cause walking problems because the legs bend toward the knees.
It is when one side of the body is mainly involved, with movement difficulties mainly in the arm of the affected side.
The arm and leg on that side may be shorter and thinner, which could cause you to walk on your toes.
Some people with this type have a curved spine, called scoliosis.
Seizures and speech problems can also be part of spastic hemiplegia.
It is characterized by motor dysfunction throughout the body, is the most severe type of spastic cerebral palsy, and usually occurs with other associated disorders.
Non-spastic or extrapyramidal cerebral palsy
Non-spastic cerebral palsy decreases or muscle tone fluctuates.
The multiple forms of non-spastic cerebral palsy are characterized by particular disabilities.
One of the main characteristics of non-spastic cerebral palsy is involuntary movement.
Movement can be slow or fast, often repetitive, and sometimes rhythmic. Planned movements can exaggerate the effect, a condition known as tremors of intention.
Stress can also make involuntary movements worse, while sleeping often eliminates them.
An injury to the brain outside the pyramidal tract causes nonspastic cerebral palsy.
Due to the location of the injury, mental decline and seizures are less likely.
Non-spastic cerebral palsy reduces the likelihood of joint and limb deformities.
The ability to speak can be impaired as a result of a physical disability, not an intellectual one.
Nonspastic cerebral palsy is divided into two groups, ataxic and dysynthetic. Together they make up 20% of cerebral palsy cases.
Dyskinetics constitutes 15% of all cases of cerebral palsy, and ataxia comprises 5%.
This is the least common type of cerebral palsy. Ataxic cerebral palsy affects balance and posture.
Children with ataxic cerebral palsy exhibit jerky and uncoordinated movements.
The movements are initiated by a voluntary effort, which is then interrupted and out of control, causing a lack of balance or coordination.
There may be difficulties in walking, the gait is often very irregular.
Control of eye movements and depth perception can be affected.
Fine motor skills that require eye and hand coordination, such as writing, are often difficult.
It can have effects on speech and swallowing.
It does not produce involuntary movements, but rather indicates impaired balance and coordination
Dyskinetic cerebral palsy is separated into two different groups: athetoid and dystonic.
Athetoid cerebral palsy includes cases with involuntary movements, especially in the arms, legs, and hands.
Dystonia or dystonic cerebral palsy encompasses cases that affect the muscles of the trunk more than the extremities and results in a fixed and twisted posture.
Because nonspastic cerebral palsy is predominantly associated with involuntary movements, some may classify cerebral palsy by specific movement dysfunction, such as:
- Athetosis: slow, twisting movements that are often repetitive, sinuous and rhythmic, with extreme fluctuations that cause difficulty in maintaining a posture.
- Chorea: Irregular movements that are not repetitive or rhythmic, and tend to be more jerky and shaky. These abrupt and unpredictable movements make the child appear uncoordinated and clumsy.
- Dystonia: when the movements are twisted and repetitive, they can be present in a part of the body or in the whole body and the movements are not planned and involuntary, they are generally stimulated by initiating a voluntary movement. These involuntary movements are accompanied by an abnormal and sustained posture.
These movement disorders can exist together in different combinations, presenting problems with fine motor skills, including grasping small objects, as well as gross motor dysfunction, such as walking.
Mixed cerebral palsy
A child’s disabilities can fall into both spastic and non-spastic categories called mixed cerebral palsy.
The most common form of mixed cerebral palsy involves some limbs affected by a combination of spastic and dyskinetic.
Mixed cerebral palsy can also lead to additional associated medical problems and conditions.
The biggest clue that a baby might have cerebral palsy is a delay in doing something that most babies can do by a certain age.
Doctors call these “milestones.” Examples include rolling, sitting, standing, and walking.
Certain movements and behaviors in babies at specific stages of development can be signs of cerebral palsy.
But your baby can have these problems without having cerebral palsy. So it is necessary to see a doctor to find out what is happening.
In babies younger than 6 months, those signs include:
- When the sleeping baby is lifted, his head falls back.
It feels very stiff or very loose.
- When cradled in the arms, he extends his back and neck, almost as if he is pulling away.
- When loaded, his legs stiffen and cross over each other in a scissor fashion.
If the baby is over 6 months old, warning signs may include:
- The baby cannot crawl.
- The baby cannot put his hands together.
- He has trouble putting his hands to his mouth and when he does, it is with one hand. The other remains in a fist.
If the baby is more than 10 months old, watch out for these signs:
- He crawls by pushing himself with one hand and one leg while dragging the other side of the body.
- It does not crawl on all fours, but instead glides, or jumps on its knees.
If the baby is over a year old and cannot stand unsupported or crawl, those are also possible signs of cerebral palsy.
Classification based on the gross motor function classification system
The gross motor function classification system uses a five-level system that corresponds to the degree of capacity limitation and impairment.
A higher number indicates a greater degree of severity. Each level is determined by an age range and a set of activities that the child can do by himself.
The Gross Motor Function Classification System is a universal classification system applicable to all forms of cerebral palsy.
Using the Gross Motor Function Classification System helps determine the surgeries, treatments, therapies, and assistive technology that may result in the best outcome for a child.
Furthermore, the Gross Motor Function Classification System is a powerful system for researchers, improves data collection and analysis, and thus results in better understanding and treatment of cerebral palsy.
The Gross Motor Function Classification System addresses the goal set by organizations such as the World Health Organization, which advocates for a universal classification system that focuses on what a child can achieve, as opposed to the limitations imposed by his or her abilities. impediments.
This system is useful as a developmental guide that takes into consideration the child’s motor disability. Assign a rating level from 1 to 5.
Parents can then understand motor disability capabilities over time as the child progresses in age.
To better utilize the Gross Motor Function Classification System, it is often combined with other classification systems that define the extent, location, and severity of impairment.
Documenting upper limb function and speech impairments is also recommended.
Uses of the Gross Motor Function Classification System
The Gross Motor Function Classification System uses head control, movement transition, gait, and gross motor skills such as running, jumping, and navigating inclined or uneven surfaces to define a child’s level of achievement.
The goal is to present an idea of how self-sufficient a child can be at home, at school, and indoors and outdoors.
When the child adjusts at multiple levels, the lower of the two rating levels is chosen.
The classification system Gross Motor Function Classification System recognizes that children with disabilities have developmental factors appropriate for their age.
The Gross Motor Function Classification System can record by age group (0-2; 2-4; 4-6; 6-12; and 12-18) an appropriate developmental guide for the assigned level.
Emphasizes sitting, movement transfers, and mobility, tracing independence and reliance on adaptive technology.
Cerebral palsy is classified according to the level of severity as mild, moderate, severe, or without cerebral palsy.
These are broad generalizations that lack a specific set of criteria. Even when clinicians agree on the level of severity, the classification provides little specific information, especially compared to the System of
Gross Motor Function Classification
Still, this method is common and offers a simple method of communicating the extent of deterioration, which can be useful when precision is not required.
Classification levels of the Gross Motor Function Classification System
Gross Motor Function Classification System Level I
Regarding motor function, he walks without limitations.
Gross Motor Function Classification System Level II
At this level he walks with limitations. Limitations include walking long distances and maintaining balance, but not as capable as Level I in running or jumping.
You may require the use of mobility devices when you first learn to walk, usually before age 4, and you can rely on wheeled mobility equipment when you are away from home to travel long distances.
Gross Motor Function Classification System Level III
May take walks with the assistance of adaptive equipment. Requires manual mobility assistance to walk indoors, while using wheeled mobility outdoors, in the community, and at school.
You can sit alone or with limited external support and have some independence in permanent transfers.
Gross Motor Function Classification System Level IV
Own mobility with the use of motorized mobility assistance. Usually supported when sitting, own mobility is limited and is likely to be carried in a manual wheelchair or with electric mobility.
Gross Motor Function Classification System Level V
He has severe limitations in head and trunk control.
It requires extensive use of assistive technology and physical assistance and is transported in a manual wheelchair, unless self-mobility can be achieved by learning to operate an electric wheelchair.