Cerebral Palsy

Cerebral palsy describes a group of permanent disorders of the development of movement

and posture, causing activity limitation, that are attributed to non-progressive disturbances
that occurred in the developing fetal or infant brain. The motor disorders of CP are often
accompanied by disturbances of sensation, perception, cognition, communication, behavior,
by epilepsy and by secondary musculoskeletal problems. - Peter Rosenbaum
Types of Cerebral Palsy
There are four types of cerebral palsy, which are classified by location of brain damage, the
type of movement impairment, and other symptoms the condition causes. These four main
types of cerebral palsy, which are discussed in detail below include:
Hypotonic cerebral palsy
Hypertonic cerebral palsy
Ataxic cerebral palsy
Athetoid cerebral palsy

Hypotonic cerebral palsy

Children with hypotonic cerebral palsy have floppy muscles and no control
of their head.

The arms and legs hang down like a rag doll. Joints may be lax. Reflexes
may be poor, and walking is usually difficult.

posture problems and breathing and swallowing difficulties.

Speech may also be difficult

intelligence is usually unaffected.

Hypertonic Cerebral Palsy
Hypertonic cerebral palsy is the most common type,
accounting for 70 to 80 percent of all cases of
cerebral palsy in the United States. This type of
cerebral palsy occurs when brain damage affects
the cerebral cortex, or the outer layer of the brain, either at birth or a very young age.
Hypertonic cerebral palsy has a number of sub-forms, classified by the areas of the
body affected by brain damage, such as just one side of the body or just the lower
limbs (e.g. hemiplegic, diplegic) and the severity of the condition (i.e. mild, moderate,
or severe).

Athetoid Cerebral
Palsy
Athetoid cerebral palsy,
also called dyskinetic
cerebral palsy, affects
10 to 25 percent of all
people with this
condition. This type
of cerebral palsy is the
result of brain damage to the basal ganglia, located in the midbrain region.
 Ataxic Cerebral Palsy
This affects only between 5 and 10 percent of those with this condition. This is
caused by brain damage to the cerebellum, located towards the base of the brain.
The cerebellum is responsible for orchestrating muscle movement for balance and
coordination. When this part of the brain is damaged it can lead to ataxic cerebral
palsy, characterized by difficulty with balance and coordination of movements.
Moreover, patients with ataxic cerebral palsy may experience some or all of the
following symptoms:
Hypotoniapoor or low muscle tone
Gait problemssuch as a wide gait (walk)
Tremorsparticularly when attempting fine motor movements such as writing or
tying a shoe; these are also called intention tremors because they often occur when
a person tries to execute a voluntary, or intentional muscle movement.
Ataxic cerebral palsy is often whole body, affecting all four limbs and the trunk.
Epidemiologic and genetic risk factors for cerebral palsy
Following are the major risk factors for cerebral palsy :
Preterm delivery
Coexisting congenital anomaly (maldevelopment)
Probable genetic causes
Bacterial and viral intrauterine infection
Altered fetal inflammatory or thrombophilic response (perinatal stroke)
Fetal growth restriction
Higher-order pregnancy, risk greater with monozygosity and in vitro fertilization
Tight nuchal umbilical cord
Prolonged shoulder dystocia
Placental pathology, eg, chorioamnionitis, funisitis, villitis
Inborn errors of metabolism
Male:female ratio 1.3:1

Oral-Motor Feeding Difficulties

Discoordination of suck swallow
Structural abnormalities (cleft lip/palate; dentition)
Poor oral containment (food/fluid loss)
Tone abnormalities (hypo/hypertonic)
Altered oral sensory response (hypo/hyper-responsive)
Delayed oral motor skill development
Aspiration

Hypotonia
Open Mouth posture with tongue forward

Ribcage is weighted : Mostly a belly breather

Loud bursts but vocalizations tend to be short

Deeper voice
Hypertonia
Ungraded extension with asymmetrical head alignment

Active forces inhabit thoracic expansion

Voice quite and strained

Difficulty with visual focus for communication devices

Dyskinesia or Athetosis
Very stable head and jaw : hold with SCM
Difficulty coordinating breath with voice
Poor isolated control may compromise
visual regard when attempting to reach
Seek external stability for functional task

Ataxia
Poor orals sensory awareness
Challenging behaviours
Create risk for eating