What are the symptoms of cerebral palsy?
Cerebral palsy can range in severity from mild to severe. For example, a person with mild spastic hemiplegia is likely to be fully mobile, active and independent but have a slightly abnormal walking movement (gait). He or she may have some difficulty in using one hand and one foot may drop or drag. At the other extreme, someone with severe quadriplegia will be wheelchair-bound and need help with daily living tasks. Many people are in between these two extremes. Everyone is different and needs assessing by a specialised team.
Depending on the type of cerebral palsy and the area of brain affected, a child with cerebral palsy may have difficulty with moving, talking, eating or playing in the same ways as other children. The symptoms of cerebral palsy depend on the exact part of the brain that is affected.
The stiffness of the muscles in spastic cerebral palsy can gradually lead to permanent fixed contractures of joints in arms and legs. Some joints may eventually become fixed in a flexed position as a child becomes older. A main aim of treatment for spastic cerebral palsy is to keep to a minimum the effects of the muscle stiffness.
There are lots of different ways of classifying cerebral palsy - for example, by cause or distribution of movement disorder. One of the most common ways is by type of movement disorder - spastic, athetoid, ataxic and mixed.
Spastic cerebral palsy
This type of cerebral palsy occurs in about 7 in 10 cases. Spastic means that the affected muscles are more stiff than normal. How stiff an affected arm or leg is, can vary greatly from case to case. Movements of an affected arm or leg are stiff and jerky. Some muscles may become permanently shortened and stiff. This is called contracted.
There are different words that are used to describe types of spastic cerebral palsy. For example:
- Hemiplegia - means that the leg and arm of one side of the body are affected.
- Diplegia - means that both legs are affected. Arms are not affected or are only mildly affected.
- Quadriplegia - means that both arms and legs are affected. Arms are equally or more affected than legs.
Athetoid, or dyskinetic, cerebral palsy
This type occurs in about 2 in 10 cases. Some people with this type of cerebral palsy have slow, writhing movements of the hands, arms, feet, or legs. Some people have sudden muscle spasms. These movements cannot be controlled and so are involuntary. Sometimes the tongue or facial muscles are affected. The stiffness (tone) of the muscles can vary from too high to too low. As a result, people with athetoid cerebral palsy have difficulty in staying in one position. They may also be unable to use their arms or hands properly - for example, to hold objects.
Ataxic cerebral palsy
This type occurs in less than 1 in 10 cases. People with ataxic cerebral palsy have difficulties with balance and fine movement. This can mean loss of balance or being unsteady when walking. It could also make doing fine tasks with their hands difficult, such as writing. The muscle tone is usually decreased. That is, they do not tend to be stiff.
Mixed cerebral palsy
People with mixed cerebral palsy have a combination of two or three of the above types. It is most often a combination of spastic and athetoid cerebral palsy, which results in stiff muscle tone and involuntary movements.
What other problems are associated with cerebral palsy?
Sometimes the damage to the brain affects other aspects of brain function, as well as problems with muscles.
About half of children with cerebral palsy have some degree of learning difficulty. The severity can vary. The other half will have normal intelligence or above. About half of children will have some degree of speech problems. Sometimes a child with difficulty in speaking may be thought of as having low intelligence, whereas in fact they have normal or high intelligence. About 1 in 3 people with cerebral palsy will also have epilepsy. Some children also have problems with hearing, vision, eating and drinking.
Further reading and references
Cerebral palsy in under 25s: assessment and management; NICE Guidance (January 2017)
Spasticity in children and young people; NICE Clinical Guideline (July 2012, updated Nov 2016)
Hadders-Algra M; Early diagnosis and early intervention in cerebral palsy. Front Neurol. 2014 Sep 245:185. doi: 10.3389/fneur.2014.00185. eCollection 2014.
Fairhurst C; Cerebral palsy: the whys and hows. Arch Dis Child Educ Pract Ed. 2012 Aug97(4):122-31. doi: 10.1136/edpract-2011-300593.
Surman G, Hemming K, Platt MJ, et al; Children with cerebral palsy: severity and trends over time. Paediatr Perinat Epidemiol. 2009 Nov23(6):513-21. doi: 10.1111/j.1365-3016.2009.01060.x.
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