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What is Cerebral Palsy
Cerebral Palsy (CP) describes a group of 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 cerebral palsy are often accompanied by disturbances of sensation, cognition, communication, perception, and/or behaviour, and/or by a seizure disorder.
(Bax et al., 2005)
The prevalence of CP depends on the age of the child at the moment the diagnose is made. Especially in children with CP without a burdened medical previous history there often is a delay in making the diagnosis. In the Western world the prevalence of CP is around 2 children in every 1000 live born children.
The presence of a movement disorder, caused by dysfunction of the central nerve system is therefore obligatory for the diagnosis. The types of movement disorders are subdivided in 3 main groups:
Spastic Cerebral Palsy. Here at least two of the next three symptoms are obligatory:
o abnormal posture and / or movement
o increased muscle strain (which can be variably present)
o pathological reflexes (hyperreflexion and / or reflex according to Babinski)
Atactic Cerebral Palsy:
o abnormal posture and / or movement
o loss of normal muscle co ordination, so movement with abnormal strength, rhythm and precision like hypermetrics (missing of an object of the intended movement) and dysdiadochokinetics (not being able to quickly alternating a direction of movement)
Dyskinetic Cerebral Palsy:
o abnormal posture and / or movement, involuntary movements – also in rest
o involuntary, uncontrolled, repetitive and sometimes stereotype movements
§ dystonic Cerebral Palsy:
· hypokinesia, slow movements
· hypertonia: non speed dependent increased muscle tonus in passive movement
§ hyperkinetic Cerebral Palsy (earlier also called chorea - athetoid Cerebral Palsy)
· hyperkinesia (fierce movements)
Dystonic and hyper kinetic movement characteristics also can manifest themselves at the same time, during which the contribution of the two components can change and exchange in time. For that reason it is preferred to speak of a dyskinetic movement disorder, possibly considering the addition of the dystonic or hyperkinetic type.
The localisation of the spastic movement disorders can be unilateral or bilateral. A further subdividing of the localisation decreases the reliability. In the description of the diagnosis unilateral or bilateral CP will suffice. The unilateral CP consists of hemiparesis or monoparesis, the bilateral of diplegia (legs are more affected than arms) and tetraparesis (arms are equally or more affected than legs). The term “plegia” means complete paralysis. However, in an upper motor neuron syndrome this can never be the case: there is always some muscle activity present. For that reason the term “plegia” is not adequate, although internationally this term is still being used here and there.
Gross Motor Classification System
The severity of the motor disorders regarding the mobility can be classified according to the Gross Motor Classification System (GMFCS). All children with CP can be classified in five different classifications:
Level 1: only limitations in higher gross motor skills (running, jumping, hopping)
Level 2: walking without aid; limitation in walking outside and in direct surroundings of house environment
Level 3: walking with aid, limitations in walking outside and in direct surroundings of house environment
Level 4: moving independently with limitations: children are being transported or use hand pushed wheel chair or electric wheel chair
Level 5: moving independently is severely limited, even with the use of aids