Types and treatment of cerebral palsy

One classification method for cerebral palsy is to explain the predominant motor features,
which involve spastic, hypotonic, athetotic, dystonic, and ataxic, with topographical involvement
of limbs such as monoplegia, diplegia, triplegia, hemiplegia, or quadriplegia. And the second
method of classification is a physiological classification which includes pyramidal(spastic) and
extra pyramidal (non-spastic). It shows which area of the brain is affected and the resulting
motor disorders.

Types of cerebral palsy:

Spastic cerebral palsy:

Spastic cerebral palsy is the most frequently occurring type of cerebral palsy. Caused by damage
to the motor cortex. Key features are muscle stiffness, contractures, awkward reflexes, difficulty
with coordination, and abnormal gait patterns. Spastic cerebral palsy is further divided into
spastic diplegic, spastic hemiplegic, and spastic quadriplegic.

● Spastic diplegic:
30 to 40 percent CP cases are spastic diplegic. Lower extremities are more affected than
upper extremities. Cognitive functions are normal. Usually, history reveals premature
birth.
● Spastic hemiplegic:
20 to 30 percent of CP is spastic hemiplegic. Symptoms of spasticity and motor
difficulties are more prominent on one side of the body and the arms are more affected
than the legs. High risk of seizure disorders, communication disorders, and visual field
defects are present.
● Spastic quadriplegic:
10 to 15 percent of Spastic CP are quadriplegic. Both upper and lower extremities are
involved. Upper extremities involvement is more than lower extremities. The trunk and
muscles of the mouth, tongue, and pharynx are also affected. Cognitive defects, epilepsy,
and visual impairment are correlated conditions.
Dyskinetic/Athetoid Cerebral palsy:
10 to 15 percent CP is dyskinesia CP. It is caused by damage to basal ganglia or
thalamus. Dyskinesia marked by excessive motor activity which leads to abnormal
movement control. Involuntary sustained muscle contraction results in twisted and
repetitive movements. Speaking, swallowing problems and drooling is also present with
movement disorder.
Main symptoms:
● Slow, involuntarily movements of hands, arms and face

● Involuntary facial grimace

● Drooling

● Difficulty in sitting and straight walking.

Dyskinetic may be Athetosis, chorea, choreoathetosis and hypotonia.

Athetosis: Slow, involuntary writhing movements of arm, hand, face which prevent
proper stable posture.
Chorea: Slow, irregular, uncertain, involuntary jerky movements
Choreoathetosis: Mixed symptoms of athetosis and chorea.
 Hypotonia: floppy, low muscle tone with little to no movement.

Ataxic cerebral palsy:

Ataxic CP is caused by damage to the neurons of cerebellum. Difficulty with normal
movements, balance and coordination and proprioception is present. Ataxic and spastic
diplegia often present in combination.
Main symptoms:
● loss of balance and coordination

● wide based gait

● intentional tremors

● Difficulty with fine motor movements

Mixed Cerebral palsy:

When symptoms of other three types of CP are present it called mixed cerebral palsy.
spasticity and ataxia often together. More than one part of motor cortex is damaged
which shows combined symptoms.

Treatment of cerebral palsy:

Management of CP begins with early assessment, diagnosis, and treatment.

Treatment should be individualized based according to clinical presentation. As CP is associated
with other medical comorbidities, management includes a multidisciplinary approach.
 Audiologist,
Nutritionist

Pediatric
gastroenterologist
physiatrist,
,
psychologist
Pediatric
pulmonologist

CP managment

Physiotherapist,
Pediatric surgeon, Pediatric
nursing orthopedic
surgeon

Speech-language
therapist,
Occupational
therapist

Management to treat spasticity:

Pharmacological management:

● Baclofen: oral and intrathecal pump

● Botulinum toxin intramuscular injection
Non-pharmacologic management:
● Physiotherapy

● Occupational therapy
● Use of adaptive equipment and orthoses
● Orthopedic surgical procedures

PHYSIOTHERAPY MANAGEMENT OF CHILDREN WITH CP

Physiotherapists are specialists in managing the impairments present in CP patients. Some
approaches used by a physiotherapist are:
● The neurodevelopmental technique (NDT),

● Neuromuscular electrical stimulation,

● Exercise therapy,
● constraints-induced movement therapy (CIMT).
NDT approach:
It involves moving through normal movement patterns to experience normal movement. It
focuses on inhibiting abnormal movement patterns and facilitates normal movements. It helps in
normalizing muscle tone, attaining motor skills, and improving functional motor skills.
Exercise therapy:
The treatment protocol involves a passive range of movements, passive stretching, progressive
resisted exercises, and weight-bearing exercises.

Constraints-induced movement therapy (CIMT).

Specifically used for improving upper limb function in the hemiplegic type of CP. The main aim
of this method is to increase the spontaneous use of impaired limbs by constraining non-affected
limbs.

Orthotics, adaptive equipment, and assistive technology

Long-term management of CP requires knowledge of the assistance, patient requires in daily
life. Orthoses, adaptive equipment, and assistive technology devices are used for improving a
child’s functional abilities and facilitating activities of daily living.
Some surgical management includes selective dorsal rhizotomy, tendon release, and spinal
fixation.

Conclusion:
There are many different types of CP. Mostly Cp shows symptoms of more than one type of
Cerebral palsy. The most prominent sign of CP is delayed milestone and motor disability.
Management of CP requires a multidisciplinary team approach. Physiotherapy plays the most
important role in the rehabilitation of cerebral palsy.