CP

What is CP?
• A non progressive neurological disorders that appear in infancy or early
childhood and permanently affect body movement and muscle coordination.
• CP is caused by damage to or abnormalities inside the developing brain that
disrupt the brain's ability to control movement and maintain posture and
balance. The term cerebral refers to the brain; palsy refers to the loss or
impairment of motor function.
• Early diagnostic features:
1. Abnormally persistent neonatal reflexes
2. Feeding difficulties
3. Persistent cortical thumb aafter months of age
https://pubmed.ncbi.nlm.nih.gov/23622161/
• Interruption of oxygen supply to the fetus or brain asphyxia was classically considered to be
the main causal factor explaining later CP. However several ante-, peri-, and postnatal factors
could be involved in the origins of CP syndromes. Congenital malformations are rarely
identified. CP is most often the result of environmental factors, which might interact with
genetic vulnerabilities, and could be severe enough to cause the destructive injuries visible
with standard imaging (i.e., ultrasonographic study or MRI), predominantly in the white
matter in preterm infants and in the gray matter and the brainstem nuclei in full-term
newborns. Moreover they act on an immature brain and could alter the remarkable series of
developmental events. Biochemical key factors originating in cell death or cell process loss,
observed in hypoxic-ischemic as well as inflammatory conditions, are excessive production of
proinflammatory cytokines, oxidative stress, maternal growth factor deprivation, extracellular
matrix modifications, and excessive release of glutamate, triggering the excitotoxic cascade. 

• ^etipathogenesis
Tpes of cp by body part
• Quadriplegia- This type affects all four limbs — both arms and both
legs. A person’s torso, facial, and oral muscles are often affected, too.
• TRIPLEGIA- This type affects three limbs — one arm and both legs. A
person’s torso, facial, and oral muscles may be affected, too.
• DIPLEGIA- This type affects both legs. A person’s arms may be affected
to a lesser extent.
• HEMIPLEGIA- This type affects one side of the body. People can either
have right-side hemiplegia (affecting their right arm and leg), or left-side
hemiplegia (affecting their left arm and leg). Approximately 40% of
people with cerebral palsy have hemiplegia.
• MONOPLEGIA- This type affects only one limb
Types of CP by brain part involved
1. Spastic CP-
2. Hypotonic/Atonic cp-
3. Extrapyramidal CP-
4. Cerebellar Involvement-
5. Mixed type-
1. Spastic CP
• Most common type
• This type causes muscles to appear stiff and tight. On vertical suspension
infant goes into scissoring due to adductor spasm with extensor posture
and they don’t flex their knees.
• The stretch reflex tendon are always brisk
• Have variable degrees of mental and visual handicap, seizures an
behavioural problems.
• It is the result of damage to the motor cortex
• Spastic SP is classified into 3 namely;Spastic quadriparesis, diplegia and
hemiparesis
Spastic quadriparesis
• is more common in term babies
• exhibits signs including;
1. opisthotonic posture
2. pseudobulbar palsy
3. feeding difficulties
4. restricted voluntary movements and motor deficits.
Spastic diplegia
• is commoner in preterm babies
• is associated with periventricular leukomalacia(The condition involves
the death of small areas of brain tissue around fluid-filled areas called
ventricles).
The lower limbs are more severely affected with extension and
adduction posturing, brisk tendon jerks and contractures
Spastic hemiplegia

• is usually recognized after 4-6 months age.

• Presenting compliants include;
1. early hand preference
2. abnormal persistent fisting
3. abnormal posture or gait disturbance

Vascular insults, porencephaly(It is a neurological disorder of the central

nervous system characterized by cysts or cavities within the cerebral
hemisphere) or cerebral anomalies may be associated
2. Hypotonic (Atonic) Cerebral Palsy

• These patients are hypotonic despite the pyramidal involvement.

• Babies with this type is usually floppy due ti muscle and ligaments
laxity.
• They also have difficulty in moving ang have poor reflexes
• Often severely mentally retarted.
• Muscles may show fibre disproportion and delayed CNS maturation is
common
Extrapyramidal CP

• Clinical manifestation:
1. Athetosis
2. Choreiform movements
3. dystonia
4. tremor
5. Rigidity
Arms, trunk, leg and neck might be involved
4. Cerebellar Involvement

• This form is seen in less than 5% of the patients..

• There is hypotonia and hyporeflexia.
• Ataxia and intention tremors appear by the age of 2 yr.
• Nystagmus is unusual; mental status may be near normal in some of
these patients.
5. Mixed Type

• Mixed cerebral palsy occurs when a child exhibits symptoms of more

than one type of cerebral palsy
A proportion of the patients have features of diffuse neurological
involvement of the mixed type