Types and Symptoms of Cerebral Palsy

Cerebral palsy occurs when a baby suffers hypoxia or lack of oxygen to the brain during delivery. Causes of birth injury vary and may be the result of negligence and/or medical malpractice. They include the following: nuchal cord injury, where an umbilical cord is wrapped around the baby’s neck, cutting off oxygen during or before delivery; a prolonged labor where the baby is in distress; the failure of the physician and nurses to perform a timely Caesarean Section when the baby is in distress, and negligence in timely monitoring or failure to monitor the mother’s and the baby’s vital signs during delivery resulting in a failure to take action to avoid a birth injury.

Injury to a baby’s brain from hypoxia interferes with the normal development of the child’s brain, which leads to the child’s inability to develop and grow normally. The child may miss developmental milestones.

The main distinction of cerebral palsy types depends on the movement disorder involved. Individuals can also experience symptoms of more than one type of CP, or “mixed CP.” The most common type of mixed CP is a combination of spastic (stiff muscles) and dyskinetic (uncontrollable muscle movement) CP. The following lists the variation of disorders caused by CP.

Types of Cerebral Palsy

1. Spastic Cerebral Palsy. This is the most common type of CP, affecting roughly 80 percent of persons with CP. Spastic CP is characterized by increased muscle tone, which results in stiff muscles and awkward movements. Spastic CP types are classified by affected body parts.
2. Spastic Diplegia/Diparesis. Plegia and paresis means paralyzed and/or weak. This type of spastic CP primarily affects the legs, with arms being either less affected or not affected. This condition can inhibit a person’s ability to walk because the legs are being pulled together, turned inward, and/or crossed at the knees or scissoring.
3. Spastic Hemiplegia/Hemiparesis. Hemi, meaning half, is a type of spastic CP that affects just one side of a person’s body, usually the arm more than the leg.
4. Spastic Quadriplegia/Quadriparesis. This is the most severe form of spastic CP. It affects all four limbs, the face, and the trunk of the body. Persons with this condition are usually unable to walk and often have other developmental or intellectual disabilities including vision, hearing, or speech impairments or seizures.
5. Ataxic Cerebral Palsy. This most rare and least diagnosed form of Cerebral Palsy is characterized by low muscle tone and poor coordination of movements. It results in balance and coordination impairments while standing and/or walking. Children with ataxic CP may sway, have an unsteady gait, walk with their feet spread wide apart to avoid falling, and may have a difficult time with quick or controlled movements.
6. Dyskinetic Cerebral Palsy. Dyskinetic means bad or difficult motion or movement. This type of CP is characterized by uncontrollable movements of an individual’s hands, arms, feet, and legs. It usually causes difficulty with walking and sitting. Movements can be slow or fast and twisting or spasmodic. If the face and tongue are affected, the individual may have trouble swallowing, sucking, and talking. Muscle tone is constantly changing from too tight to too loose. This type of CP includes subtypes of the following forms of cerebral palsies:
   
   1. Athetoid: Involuntary movements which are both slow and writhing
   2. Choreoathetoid: A combination of involuntary movements, including both irregular contractions and writhing.
   3. Dystonic: Involuntary repetitive muscle contractions resulting in twisting and abnormal postures.
7. Brachial Plexus. This type of CP involves a group of shoulder nerves that can become damaged as a result of a difficult labor and/or birth. This injury can result in the loss of movement or weakness in the newborn’s arm and/or hand on the side affected. Other symptoms may include loss of the Moro reflex (an involuntary startled response in newborns), a bent arm at the elbow and held against the body, and a decreased grip.
8. Erb’s Palsy. Erb’s palsy is a form of brachial plexus palsy. In cases where brachial plexus palsy affects the upper nerves of the arm, the condition is diagnosed as Erb’s palsy. It includes four main types of nerve injuries:
   
   1. Neurapraxia – a stretch injury that usually heals within three months.
   2. Neuroma – an injury that damages some of the nerve fibers and may result in scar tissue; this does not result in a total recovery.
   3. Rupture – an injury resulting in the tearing (rupture) of the nerve itself that will not heal on its own.
   4. Avulsion – a condition where the nerve is torn from the spinal cord. It is the most serious type of nerve injury and is generally permanent.
      
      

Symptoms of Cerebral Palsy

Signs and symptoms of cerebral palsy appear in infancy or preschool years. The most common ones can be summarized as follows:

1. Low muscle tone (baby feels ‘floppy’ when picked up)
2. Unable to hold up his or her own head while lying on their stomach or in a supported sitting position
3. Muscle spasms, feeling stiff, tremors, or involuntary movements
4. Poor muscle control and coordination, poor reflexes, and poor posture
5. Delayed development (can’t sit up or independently roll over by six months)
6. Prefers to use one side of the body  
7. Slow writhing movements
8. Eye muscle imbalance
9. Epilepsy, blindness, deafness, or seizures
10. Learning difficulties
11. Feeding or swallowing difficulties. Children with CP in this area are also at risk for choking, aspirating, malnutrition, recurrent lung infections, and progressive lung disease.
12. Urinary incontinence
13. Abnormal touch or pain perceptions
14. Emotional problems associated with experiencing specific and sometimes multiple chronic disabilities
    
    

Any or all of these symptoms may require various types of therapy for an undetermined period of time or even over a lifetime. Examples of such therapies are: physical, occupational, recreational, speech and language, psychological/emotional, and therapy dealing with breathing, eating, drinking, and drooling issues.