Cerebral palsy is a motor control disorder that is caused by injury or abnormalities in an immature brain. This is a permanent disorder that is non-progressing and occurs during fetal or infant brain development (Hockenberry & Wilson, 2014). Motor disorders can include sensory, perception, communication, cognition, behavioral, musculoskeletal, seizures, and epilepsy. Symptoms vary by which part of the brain is affected. Abnormal muscle tone and coordination are the primary problems seen (Hockenberry & Wilson, 2014). The patient often presents with problems affecting muscle control, coordination, muscle tone, reflex, posture, and balance as well as fine motor skills, gross motor skills and oral motor functioning (“Types of cerebral palsy,” 2016).
There are different types of cerebral palsy that describe affected body parts and severity of symptoms. Spastic cerebral palsy is characterized by increase muscle tone. Non-spastic cerebral palsy is identified by a lack of muscle tone. Furthermore, muscle tone is described as being either hypertonic, which is increased muscle tone resulting in stiff limbs or hypotonic which is decreased muscle tone resulting in the loose, floppy limbs (“Types of cerebral palsy,” 2016).
Symptoms or brain injuries occurring before birth or during birth are called congenital cerebral palsy. Approximately 85% to 90% of cerebral palsy cases are congenital. However, injury can occur post birth up to two years of age (Sorrentino & Remmert, 2016). There are different types of cerebral palsy. Each form describes the various symptoms. Spastic cerebral palsy represents approximately 70% of all cases and can be corrected most times with surgery (Sorrentino & Remmert, 2016). Spastic cerebral palsy is characterized by increased muscle tone and hyperreflexia resulting in awkward and restrictive movements. Spastic cerebral palsy can be broken down further to describe which parts of the body is affected. These are hemiplegia, diplegia, and quadriplegia.
Spastic hemiplegia describes limited movement on one side of the body. One hemisphere or side of the brain controls the opposite side of the body (“Spastic diplegia cerebral palsy,”2014). If the right side of the brain experiences damage the symptoms will appear on the left side of the body and vice versa. The affected side is usually shorter and thinner than the other side, and an abnormal curvature of the spine can also develop called scoliosis (Cerebral palsy: Hope through research,” 2016).
Those affected with spastic cerebral palsy can have a wide range of difficulties (“Spastic cerebral palsy”, 2016). But, not all patients experience every problem. Symptoms may be mild and others severe. Furthermore, some symptoms may be temporary (Cerebral palsy: Hope through research,” 2016). For example, a patient may have trouble walking due to difficulty with their balance. Once they are given aids to help with their balance, walking becomes much easier.
Children with spastic hemiplegia may also have developmental delays (“Spastic diplegia cerebral palsy,”2014). This is usually seen as not being able to sit up, crawl, walk, or talk the same time as other children. Some of these patients may experience seizures as well. This form of cerebral palsy may affect intelligence. However, only about a quarter of all children with this type of cerebral palsy have an IQ below 70 (Brainandspinalcord, 2016). This type of cerebral palsy can lead to limb deformities. There can be problems with normal flexing of affected body parts such as the foot not flexing normally causing toe walking. Children do not outgrow this problem. Therefore, it can lead to difficulty walking as well as problems with hip joints and falling. Another related problem is foot drop which can also lead to problems with walking. Foot drop is when the individual has difficulty lifting the front part of the foot when walking (Brainandspinalcord, 2016). However, surgery, orthopedic devices, and therapy can help this problem. Typically, these patients get physical therapy which is a standard treatment.
Another type of spastic cerebral palsy is diplegia. This type of cerebral palsy tends to affect the legs more than arms (“Cerebral palsy: Hope through research,” 2016) Therefore, this patient may have difficulty walking. The gait may appear as crouched, toe walking, and flexed knees. However, this can be corrected with proper treatments. In most cases the patient with spastic diplegia has a normal IQ. However, may have other problems such as the turning in or out of one eye commonly called cross-eye or strabismus (“Cerebral Palsy: Hope through research,” 2016). This is due to weakness of the eye muscles. Furthermore, this patient may be nearsighted. Often, this too can be corrected with aids such as glasses. The patient may also use leg braces to help with their gait. In the infant, developmental milestones are often delayed. These include rolling over, sitting, or standing. Also, a scissor leg often occurs due to leg muscles being stiff and tight (“Spastic diplegia cerebral palsy,” 2014).
The last type of spastic cerebral palsy is quadriplegia. This is the most severe form of spastic cerebral palsy and is usually associated with moderate to severe intellectual disabilities (“Cerebral Palsy: Hope through research,” 2016). The cause is widespread brain damage or malformations of the brain. These children often have severe stiffness in their muscles but a floppy neck (“Types of cerebral palsy,” 2016). All limbs are affected as well as the body trunk. They are usually not able to walk. Speaking and being understood is difficult and seizures are often hard to control (“Types of cerebral palsy,” 2016).
Other forms of cerebral palsy include Anthenoid or Dyskinetic and Ataxic types. Anthenoid and Dyskinetic forms are more difficult to correct with surgery. Each is characterized by slow uncontrollable writhing or jerking movements of the hands, arms, feet, or legs. Hyperactivity in the muscles of the face and tongue may make the patient appear to be grimacing or cause drooling. The patient is usually not able to sit straight or walk. Comorbidities include hearing problems, breathing problems, speaking problems. Intellectual abilities are usually normal.
Ataxic cerebral palsy represents approximately 10% of all cases (Bochek, 2016). Again, surgery does not correct this type of cerebral palsy. Typically balance and depth perception are affected as well as coordination in the walk. These patients will typically have a wide base gait and have difficulty with writing or buttoning a shirt.
Dyskinetic cerebral palsy is characterized by involuntary muscle movements. The spasms that result in the unwanted movement are typically difficulty to control and painful for the patient (Dystonia Society, 2014). This type of cerebral palsy will often be seen in combination with other types of cerebral palsy. The patient with dyskinetic cerebral palsy presents with uncontrollable movements of the face, tongue, lips, jaw, throat, and even respiration (Dystonia Society, 2014). This can often lead to problems with eating, drinking and speech.
Additional impairments typically associated with cerebral palsy are intellectual dysfunction, delayed development, impaired vision, hearing loss, language disorders, incontinence, abnormal sensations and perceptions, muscle contractions, swallowing issues, emotional problems, and dental problems (Hegnar & Acello, 2014). Medical comorbidities can include seizures, hydrocephalus, GERD, pneumonia, dental problems, muscle spasms and urinary tract infections as well as constipation (Hegnar & Acello, 2014).