Aetiology Antenatal 80%.

Dysgenesis/malformation, congenital infections (rubella, CMV, toxplasmosis)

Spastic (70%) Affected lower limbs show increased tone (clasp knife), brisk reflexes, and extensor plantar responses Hemiplegia unilateral and arises from damage to middle cerebral artery territory. Results in delayed but eventually normal gait. Diplegia Results from IVH, ventricular dilation or periventricular lesion. Can results in a characteristic gait (toes turned in, knees bent) Quadriplegia affects all four limbs, head control and gives abnormal primitive reflexes. Results from widespread bilateral lesions. There is a poor prognosis related to feeding and mobility and there is a high mortality from chest infections secondary to muscular weakness and poor chest dynamics secondary to kyphoscoliosis.

Perinatal 10%. Hypoxic ischaemic encephalopathy. Birth trauma.

Postnatal 10%. Meningitis, encephalitis, extradural haemorrhage, IVH, head injury, NAI, hyperbilirubinaemia, prolonged hypoglycaemia.

Associated Features - Epilepsy, learning difficulties, visual impairment, squints, hearing loss, behavioural disorders. Risk factors preterm delivery, low birth weight.

Non-progressive disorder of movement and posture. History Delayed milestones, poor feeding, abnormalities of tone/posture/gait, language difficulties and impaired social skills.

Cerebral Palsy
Dyskinetic (10%)

Mixed (10%)

Ataxic (10%) Hypotonia, ataxia or trunk and limbs, postural imbalance, intention tremor Abnormal development of the cerebellum Most children walk (delayed) with aids (crutches)

Normal progress until 6-9 months, followed by progressive dystonia of lower limbs, trunk and mouth exaggerated by involuntary movements; athetoid (writhing) and choreographic movements (jerking) Abnormality of extrapyramidal pathways. Usually unable to walk independently, QOL can be poor.

Management Through an MDT approach:

,

Physiotherapy School support Occupational therapy SALT assessments/ feeding needs assessment Orthopaedic and neurosurgical interventions