Types and Forms of Cerebral Palsy

What Form of Cerebral Palsy Does My Child Have? Why Does One Doctor Classify Cerebral Palsy in this Manner, While the Other Doctor Labels it in Another? Why Does Classifying Cerebral Palsy Seem So Confusing?
Cerebral palsy is caused by an injury to the brain or by abnormal brain development. Although the injury is neurological in nature, it produces affects to the body that impair movement, coordination, balance and posture, which are mostly orthopedic in nature. There are various types of cerebral palsy. To complicate matters, there are secondary conditions caused by the motor impairment, as well as other co-mitigating factors which contribute to the child’s impairment. Every child is unique with varying degrees of impairment. Classification is important in understanding the individual child’s impairment, and for coordinating management of care.

The Classification Preference Changes Based on Intended Use
Professionals who specialize in treatment of cerebral palsy approach the condition from a number of different vantage points. An orthopedic surgeon requires a definition of the limbs affected and the extent of impairment in order to direct treatment. Neurosurgeons and neuroradiologists, on the other hand, are more concerned with the cause of the brain abnormality and descriptors for imposing white and gray matter in an effort to determine the type of brain injury or brain malformation. They are also concerned with diagnosing the extent and severity level of the child’s cerebral palsy. At first, a parent may be concerned with the severity level classification – mild, moderate or severe – in order to better understand the child’s impairment or disability. When meeting with the child’s pediatrician or physical therapist, it is useful to understand the topographical distribution of the impairment – the limbs and the sides of the body affected by brain damage. It also clarifies plegia (paralysis) or paresis (weakened) condition. Government agencies and school administrators may be more concerned with classification systems that gauge the level of impairment against the level of severity in order to plan and administer benefit programs and educational resources for the child. Researchers are interested in utilizing a universally accepted classification system, such as the Gross Motor Function Classification System (GMFCS), to increase consistency in studies and expand the ability to trend prevalence, life expectancy, societal impact, and prevention measures.

The Move to a Universal Classification System
For these reasons, many cerebral palsy classification systems are used today. Over the last 150 years, the definition of cerebral palsy has evolved and changed as new medical discoveries contributed to growing knowledge of the condition. Although a myriad of classifications – used differently and for many

 Double hemiplegia/double hemiparesis indicates all four limbs are involved. Two terms are at the heart of this classification method. It is believed this may be a form of hemiplegia/hemiparesis where one limb is significantly impaired. his or her daily activities are not limited. and adaptive technology to accomplish daily activities. it provides a description of how and where a child is affected by cerebral palsy. When used with Motor Function classification.  Triplegia/triparesis indicates three limbs are affected. Even when doctors agree on the level of severity. or no CP. but one side of the body is more affected than the other. but the impairment was acquired after completion of brain development and is therefore classified under the incident that caused the cerebral palsy. this method is common and offers a simple method of communicating the scope of impairment. This is useful in ascertaining treatment protocol.  No CP . including both legs. These are broad generalizations that lack a specific set of criteria. Still. such as traumatic brain injury or encephalopathy. those involved in cerebral palsy research are working toward a universally accepted classification system. .  Classification Based on Severity Level  Classification Based on Topographical Distribution  Classification Based on Motor Function  Classification Based on Gross Motor Function Classification System CLASSIFICATION OF CEREBRAL PALSY BASED ONSeverity Level Cerebral palsy is often classified by severity level as mild. anatomic and radiation findings. Below are the most commonly used classification systems understood and used by qualified medical practitioners involved in a child’s management team. primarily affects the lower body. CLASSIFICATION OF CEREBRAL PALSY BASED ONTopographical Distribution Topographical classification describes body parts affected.Moderate cerebral palsy means a child will need braces. medications. severe. moderate.  Hemiplegia/hemiparesis indicates the arm and leg on one side of the body is affected. are affected. it could refer to one upper and one lower extremity and the face.  Monoplegia/monoparesis means only one limb is affected. as well as causation and timing. MyChild™ has developed the MyChild™ Diagnosis Checklist and theMyChild™ Risk Factor Checklist for this purpose.Severe cerebral palsy means a child will require a wheelchair and will have significant challenges in accomplishing daily activities.Mild cerebral palsy means a child can move without assistance. This could be both arms and a leg. Because of the diversity of classification systems.  Moderate . The words are a combination of phrases combined for one single meaning. especially when compared to the GMFCS. In addition. which can be useful when accuracy is not necessary. Or. parents should also maintain home health records documenting associated impairments.  Paresis means weakened  Plegia/Plegic means paralyzed The prefixes and root words are combined to yield the topographical classifications commonly used in practice today.  Diplegia/diparesis usually indicates the legs are affected more than the arms.  Paraplegia/paraparesis means the lower half of the body.  Mild . the classification provides little specific information. parents may want to document different terms doctors use in cerebral palsy diagnosis.No CP means the child has cerebral palsy signs. or both legs and an arm.purposes – exists today.  Severe .

and pharynx can be affected. and therapists a very specific.  Non-spastic cerebral palsy will exhibit decreased or fluctuating muscle tone. often resulting in loose. Muscle Tone Many motor function terms describe cerebral palsy’s effect on muscle tone and how muscles work together.  Spastic cerebral palsy is characterized by increased muscle tone. The pyramidal tract consists of two groups of nerve fibers responsible for voluntary movements. Need more information on conditions commonly associated with cerebral palsy? Call 800-692-4453. muscles do not work together and can even work in opposition to one another. 324 Conditions Often Associated with Cerebral Palsy MyChild™ Learn more! CLASSIFICATION OF CEREBRAL PALSY BASED ONMotor Function The brain injury that causes cerebral palsy affects motor function. while movements tend to be jerky and awkward. When muscle tone is impaired.   Tetraplegia/tetraparesis indicates that all four limbs are involved. as well. thalamus. doctors. spastic and non-spastic cerebral palsy is referred to in the medical community as pyramidal (spastic) and extrapyramidal (non-spastic) cerebral palsy. and cerebellum. Pyramidal cerebral palsy would indicate that the pyramidal tract is damaged or not functioning properly. Two terms used to describe muscle tone are:  Hypertonia/Hypertonic — increased muscle tone. rigid. Two main groupings include spastic and non-spastic. Reflexes can be exaggerated. yet broad. making limbs stiff. mouth. but three limbs are more affected than the fourth. Proper muscle tone when bending an arm requires the bicep to contract and the triceps to relax. and swallowing. They descend from the cortex into the brain stem. with neck and head paralysis often accompanied by eating and breathing complications. the arms and legs are affected. often resulting in very stiff limbs. Request MyChild™ Kit No. The tongue. Extrapyramidal cerebral palsy indicates the injury is outside the tract in areas such as the basal ganglia. Hypertonia is associated with spastic cerebral palsy  Hypotonia/Hypotonic — decreased muscle tone. Hypotonia is associated with non-spastic cerebral palsy Two Classifications by Motor Function: Pyramidal and Extrapyramidal When referring to location of the brain injury. Motor function classification provides both a description of how a child’s body is affected and the area of the brain injury. Quadriplegia/quadriparesis means that all four limbs are involved. In essence. floppy limbs. which helps doctors choose treatments with the best chance for success. Pyramidal and extrapyramidal are key components to movement impairments. eating. Muscles continually contract. and resistant to flexing or relaxing. Pentaplegia/pentaparesis means all four limbs are involved. description of a child’s symptoms. Spastic (Pyramidal) – Spasticity implies increased muscle tone. the ability to control the body in a desired matter. . impairing speech. Using motor function gives parents. breathing. Often. they are responsible for communicating the brain’s movement intent to the nerves in the spinal cord that will stimulate the event. Each has multiple variations and it is possible to have a mixture of both types.

Balance and posture are involved. and spastic quadriplegia. especially in the arms. CLASSIFICATION OF CEREBRAL PALSY BASED ONGross Motor Function Classification System Gross Motor Function Classification System (GMFCS) uses a five-level system that corresponds to the extent of ability and impairment limitation. Stress can also worsen the involuntary movements. An injury in the brain outside the pyramidal tract causes non-spastic cerebral palsy. such as spastic diplegia. often repetitive. The injury to the brain occurs in the pyramidal tract and is referred to as upper motor neuron damage. mental impairment and seizures are less likely. Non-Spastic (Extrapyramidal) – Non-spastic cerebral palsy is decreased and/or fluctuating muscle tone. and ataxic comprises 5%.Spastic cerebral palsy is hypertonic and accounts for 70% to 80% of cerebral palsy cases. Movement can be slow or fast. the constant contracting of muscles that results in painful joint deformities. Each level is determined by an age range and a set of activities the child can achieve on his or her own. spastic hemiparesis. Often. . and hands. The most common form of mixed cerebral palsy involves some limbs affected by spasticity and others by athetosis. Walking gait is often very wide and sometimes irregular. legs. fine motor skills requiring coordination of the eyes and hands. not intellectual. and tend to be more jerky and shaky  Choreoathetoid — a combination of chorea and athetosis. some may classify cerebral palsy by the specific movement dysfunction. spastic and non-spastic. and rhythmic  Chorea — irregular movements that are not repetitive or rhythmic. A higher number indicates a higher degree of severity. twisted posture. ataxic and dyskinetic. athetoid and dystonic. impairment.  Athetoid cerebral palsy includes cases with involuntary movement. but twisting and curving  Dystonia — involuntary movements accompanied by an abnormal. sinuous. whereas sleeping often eliminates them. are difficult. The stress on the body created by spasticity can result in associated conditions such as hip dislocation. Non-spastic cerebral palsy lowers the likelihood of joint and limb deformities. Due to the location of the injury. Dyskinetic Dyskinetic cerebral palsy is separated further into two different groups. such as writing. and sometimes rhythmic. Control of eye movements and depth perception can be impaired. one of the main characteristics of non-spastic cerebral palsy is involuntary movement. Together they make up 20% of cerebral palsy cases. but instead indicates impaired balance and coordination Mixed A child’s impairments can fall into both categories. and limb deformities. Ataxic/Ataxia Ataxic cerebral palsy affects coordinated movements. Because non-spastic cerebral palsy is predominantly associated with involuntary movements. Spastic cerebral palsy is often named in combination with a topographical method that describes which limbs are affected. Multiple forms of non-spastic cerebral palsy are each characterized by particular impairments. movements are irregular. Planned movements can exaggerate the effect – a condition known as intention tremors. such as:  Athetosis — slow.  Dystonia/Dystonic cerebral palsy encompasses cases that affect the trunk muscles more than the limbs and results in fixed. writhing movements that are often repetitive. scoliosis. One particular concern is contracture. The ability to speak may be impaired as a result of physical. Non-spastic cerebral palsy is divided into two groups. sustained posture  Ataxia/Ataxic — does not produce involuntary movements. referred to as mixed cerebral palsy. Broken down. dyskinetic makes up 15% of all cerebral palsy cases.

CanChild Centre for Childhood Disability Research. Using GMFCS helps determine the surgeries.walks with limitations.walks without limitations. treatments. It is also recommended to document upper extremity function and speech impairments. Usually supported when sitting. charting independence and reliance on adaptive technology. It emphasizes sitting. it is often combined with other classification systems that define the extent. and gross motor skills such as running. and likely to be transported in manual wheelchair or powered mobility. 6-12. Apa itu cerebral palsy? DEFINISI . Limitations include walking long distances and balancing. but not as able as Level I to run or jump. as the child progresses in age. 4-6.self-mobility with use of powered mobility assistance. walking. Michael Livingston. while utilizing wheeled mobility outdoors. The goal is to present an idea of how self-sufficient a child can be at home. The GMFCS classification system recognizes that children with impairments have age-appropriate developmental factors. The parent is then able to understand motor impairment abilities over time. as opposed to the limitations imposed by his or her impairments. How is GMFCS Used? The GMFCS uses head control. and may rely on wheeled mobility equipment when outside of home for traveling long distances.walks with adaptive equipment assistance. McMaster University. the lower of the two classification levels is chosen. can sit on own or with limited external support. GMFCS Level II. unless self-mobility can be achieved by learning to operate a powered wheelchair. Peter Rosenbaum. 2-4. the GMFCS is a powerful system for researchers. usually prior to age 4. and assistive technology likely to result in the best outcome for a child. it improves data collection and analysis and hence result in better understanding and treatment of cerebral palsy. This system is useful to parents and caretakers as a developmental guideline which takes into consideration the child’s motor impairment. and navigating inclined or uneven surfaces to define a child’s accomplishment level. To best utilize the GMFCS. GMFCS Level V. Requires extensive use of assisted technology and physical assistance. The GMFCS addresses the goal set by organizations such as the World Health Organization (WHO) and the Surveillance of Cerebral Palsy in Europe (SCPE) which advocate for a universal classification system that focuses on what a child can accomplish.The GMFCS is a universal classification system applicable to all forms of cerebral palsy. and 12-18) a developmental guideline appropriate for the assigned GMFCS level. GMFCS Classification Levels   GMFCS Level I. GMFCS Level IV.    How Can I Obtain a Copy of the Expanded and Revised GMFCS Classification System? More information about the GMFCS Classification System is available at: CanChild Centre for Childhood Disability Research website at McMaster University A pdf of the GMFCS Classification System is made available at: GMFCS Classification The GMFCS Classification System is provided by: GMFCS – E & R © Robert Palisano.severe head and trunk control limitations. and at outdoor and indoor venues. 2007. and severity of impairment. and has some independence in standing transfers. therapies. Additionally. at school. Doreen Bartlett. jumping. It assigns a classification leve l (GMFCS Level 1 – 5). GMFCS Level III. movement transition. and transported in a manual wheelchair. self-mobility is limited. in the community and at school. Requires hand-held mobility assistance to walk indoors. When the child fits in multiple levels. GMFCS is able to chart by age group (0-2. movement transfers and mobility. location. may require use of mobility devices when first learning to walk.

CP bukanlah merupakan suatu penyakit dan tidak bersifat progresif (penderita tidak semakin memburuk dan juga tidak semakin baik). Karena cedera otak ini. kemungkinan karena pembuluh darah ke otak bayi prematur belum berkembang secara sempurna dan mudah mengalami perdarahan karena tidak dapat mengalirkan oksigen ke otak dalam jumlah yang memadai. kelumpuhan serta mengalami gangguan fungsi saraf lainnya.CP (Cerebral Palsy/ kelumpuhan otak besar) adalah suatu keadaan dimana penderitanya mengalami buruknya pengendalian otot.Menurut penelitian lebih banyak penyebabnya tidak diketahui.Cedera kepala karena . Gejala lain yang juga bisa ditemukan pada CP: . GEJALA Gejala biasanya timbul sebelum anak berumur 2 tahun dan pada kasus yang berat. Cedera otak bisa disebabkan oleh: . Bayi yang lahir prematur sangat rentan terhadap CP. bisa muncul pada saat anak berumur 3 bulan. yang menyebabkan perubahan bentuk lengan dan tungkai sehingga anak harus memakai kursi roda. Akibatnya mempengaruhi kemampuan otak untuk menyerap informasi (sensorik) atau kemampuan otak untuk merespons informasi (motorik). selama dan segera setelah bayi lahir.Saat proses persalinan berlangsung . radang. . CP bisa disebabkan karena cedera otak yang terjadi pada saat . serta penyakit yang merusak otak secara progresif.Kecerdasan di bawah normal . Gejalanya bervariasi. mulai dari kejanggalan yang tidak tampak nyata sampai kekakuan yang berat. indera jadi bermasalah.Anak yang berumur kurang dari 5 tahun. .Kadar bilirubin yang tinggi di dalam darah .Penyakit berat pada tahun pertama kehidupan bayi .Bayi masih berada dalam kandungan . kekakuan.Bayi yang baru lahir . PENYEBAB Anak yang mengalami cerebral palsy biasanya disebabkan karena adanya masalah yang terjadi dalam otak yang dapat berasal dari trauma kepala. 10-15% kasus CP terjadi akibat otak cedera pada saat lahir dan berkurangnya aliran darah ke otak sebelum. perdarahan otak karena adanya kelainan kromosom (seperti pada Down Syndrome).Keterbelakangan mental .Cedera pembuluh darah.

3.. dan menolong dirinya sendiri. Deng pertolongan secara khusus. misalnya tangan kanan dan kedua kaki lumpuh. cerebral palsy dapat digolongkan menjadi 6 (enam) golongan. berbicara tegas.Gangguan pendengaran KLASIFIKASI Cerebral Palsy dapat diklasifikasikan menurut : (a) Derajat kecacatan (b) Tipografi anggota badan yang cacat dan (c) Fisiologi kelainan geraknya. (a) Penggolongan menurut derajat kecacatan cerebal palsy dapat digolongkan atas : 1. kruk/ tongkat sebagai penopang dalam berjalan. Mereka dapat hidup bersama-sama dengan a normal lainnya. berja dan mengurus dirinya sendiri. (b) Penggolongan menurut tipografi. Diplegia. lumpuh anggota gerak atas dan bawah pada sisi yang sama. sedangkan kaki kanan d keduanya tangannya normal.Kontraktur persendian . 2. kedua tangan kanan dan kiri atau kedua kaki kanan dan kiri (paraple-gia) 5. Golongan sedang : mereka yang membutuhkan treatment/latihan khusus untuk bicara. anak-anak kelompok ini diharapkan dapat mengurus dirinya sendiri. Paraplegia. Golongan ringan : mereka yang dapat berjalan tanpa menggunakan alat. dilihat dari tipografi yaitu banyaknya anggota tubuh yang lumpuh. . bicara. mereka tidak dapat hidup mandiri ditengah-teng masyarakat. Mereka cacat pa kedua tangan dan kakinya. anak jenis ini mengalami kelumpuhan seluruh anggota geraknya. 6. golongan ini memerlukan alat-lat khusus untuk membantu gerakann seperti brace untuk membantu penyangga kaki. misalnya tangan dan k kanan .Gangguan menelan atau mengunyah makanan . 3. atau tangan kiri dan kaki kiri. . hanya satu anggota gerak yang lumpuh misalnya kaki kiri.Pernafasan yang tidak teratur .Gangguan penglihatan .Kejang/ epilepsi (terutama pada tipe spastik) . da menolong dirinya sendiri dalam kehidupan sehari-hari. 4. Monoplegia. Quadriplegia bisa juga disebut triplegia. atau tangan kiri dan kedua kakinya lumpuh.Gangguan berbicara (disartria) . 2. tiga anggota gerak mengalami kelumpuhan. meskipun cacat tetapi tidak mengganggu kehidupan dan pendidikannya. lumpuh pada kedua tungkai kakinya.Gangguan perkembangan kemampuan motorik . Hemiplegia.Gangguan menghisap atau . yaitu: 1.Gerakan menjadi terbatas. Quadriplegia. Golongan berat : anak cerebral palsy golongan ini yang tetap membutuhkan perawatan da ambulasi. Triplegia.

Pada tipe ini tidak terdapat kekejangan atau kekakuan. Spastik. tungkai. Otot-ototnya dapat digerak dengan mudah. Kekakuan itu timbul sewaktu akan digerakkan ses dengan kehendak. Akibatnya. Tipe Campuran. gejala itu menjadi berkurang. gerakan mekanik lebih tampak. dan anak cenderung melipat lengannya ke arah samping. Berbagai pemeriksaan laboratorium bisa dilakukan untuk menyingkirkan penyebab lainnya:  MRI kepala menunjukkan adanya kelainan struktur maupun kelainan bawaan  CT scan kepala menunjukkan adanya kelainan struktur maupun kelainan bawaan  Pemeriksaan pendengaran (untuk menentukan status fungsi pendengaran)  Pemeriksaan penglihatan (untuk menentukan status fungsi penglihatan)  EEG  Biopsi otot. Gera itu dapat terjadi pada kepala. 6. Kekakuan memang ti tampak tetapi mengalami kekakuan pada waktu berdiri atau berjalan. tetapi tidak seperti pada tipe spastik. Dalam keadaan ketergantungan emosional kekakuan atau kekejangan itu ma bertambah. anak tuna tipe mengalami gangguan dalam kehidupan sehari-hari. Tremor otot atau kekakuan tampak dengan jelas. Ciri khas tipe ini adalah seakan-akan kehilangan keseimbangan. Tipe ini (50% dari semua kasus CP). gerakannya tan tidak ada keluwesan. Pada tipe ini seorang anak menunjukan dua jenis ataupun lebih gejala tuna sehingga akibatnya lebih berat bila dibandingkan dengan anak yang hanya memiliki satu jenis/ kecacatan. DIAGNOSA Pada pemeriksaan akan ditemukan tertundanya perkembangan kemampuan motorik. 3. anak cerebral palsy dibedakan menjadi: 1. Ataxia. tungkainya bergerak seperti gunting atau gerakan abnormal lainnya. PENGOBATAN . Refleks infantil (misalnya menghisap dan terkejut) tetap ada meskipun seharusnya sudah menghilang.. 4. sebaliknya dalam keadaan tenang. mata.(c) Penggolongan menurut fisiologi dilihat dari kelainan gerak dilihat dari segi letak kelainan di otak dan fungsi geraknya(Motorik). Athetoid. 2. Ciri khas tipe ini terdapat pada sistem gerakan. Gejala yang tampak jelas pada tipe ini adalah senantiasa dijumpai adanya gerak gerakan kecil dan terus-menerus berlangsung sehingga tampak seperti bentuk getaran-getaran. Diantara mereka ada yang nor bahkan ada yang diatas normal. misalnya pada saat makan mulut terkatup terle dahulu sebelum sendok berisi makanan sampai ujung mulut. dan bibir. Pada umumnya anak jenis spastik ini memiliki tingkat kecerdasan yang tidak terlalu rendah. Pada tipe ini didapat kekakuan otot. 5. Gangguan utama pada tipe terletak pada sistem koordinasi dan pusat keseimbangan pada otak. Hampir semua gerakan terjadi dil kontrol dan koordinasi gerak. Rigid. Tremor. ditandai dengan adanya gejala kekejangan a kekakuan pada sebagian ataupun seluruh otot.

alat bantu dengar . Pengobatan yang dilakukan biasanya tergantung kepada gejala dan bisa berupa: .terapi fisik .kaca mata . .terapi okupasional . Pembedahan juga perlu dilakukan untuk memasang selang makanan dan untuk mengendalikan refluks gastroesofageal. Tetapi banyak hal yang dapat dilakukan agar anak bisa hidup semandiri mungkin.bedah ortopedik . Jika tidak terdapat gangguan fisik dan kecerdasan yang berat. Anak lainnya memerlukan terapi fisik yang luas.terapi wicara memperjelas bicara anak dan membantu atasi masalah makan . PROGNOSIS Prognosis biasanya tergantung kepada jenis dan beratnya CP. Pada beberapa kasus.braces (penyangga) . Lebih dari 90% anak dengan CP bisa bertahan hidup sampai dewasa.obat anti-kejang . banyak anak dengan CP yang tumbuh secara normal dan masuk ke sekolah biasa. mungkin perlu dilakukan pembedahan.CP tidak dapat disembuhkan dan merupakan kelainan yang berlangsung seumur hidup.perawatan (untuk kasus yang berat). untuk membebaskan kontraktur persendian yang semakin memburuk akibat kekakuan otot.pendidikan dan sekolah khusus . pendidikan khusus dan selalu memerlukan bantuan dalam menjalani aktivitasnya seharihari.obat pengendur otot (untuk mengurangi tremor dan kekakuan) .