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Clinical features and classification of cerebral palsy

Authors
Laurie Glader, MD
Elizabeth Barkoudah, MD
Section Editors
Marc C Patterson, MD, FRACP
Carolyn Bridgemohan, MD
Deputy Editor
Carrie Armsby, MD, MPH

INTRODUCTION

Cerebral palsy (CP) refers to a heterogeneous group of conditions involving permanent nonprogressive central motor dysfunction that affect muscle tone, posture, and movement [1,2]. These conditions are due to abnormalities of the developing fetal or infantile brain resulting from a variety of causes. The motor impairment generally results in limitations in functional abilities and activity which can range in severity. Multiple additional symptoms often accompany the primary motor abnormalities, including altered sensation or perception, intellectual disability, communication and behavioral difficulties, seizure disorders, and musculoskeletal complications. Although the underlying etiology itself is not progressive, the clinical expression may change over time as the brain matures.

The clinical features and classification of CP are reviewed here. The epidemiology, etiology, prevention, evaluation, diagnosis, management, and prognosis are discussed separately:

(See "Epidemiology, etiology, and prevention of cerebral palsy".)

(See "Evaluation and diagnosis of cerebral palsy".)

(See "Management and prognosis of cerebral palsy".)

                                   
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Literature review current through: Sep 2017. | This topic last updated: May 31, 2017.
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References
Top
  1. Rosenbloom L. Definition and classification of cerebral palsy. Definition, classification, and the clinician. Dev Med Child Neurol Suppl 2007; 109:43.
  2. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007; 109:8.
  3. Crothers B, Paine S. The Natural History of Cerebral Palsy, Harvard University Press, Cambridge 1959.
  4. Surveillance of Cerebral Palsy in Europe. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE). Dev Med Child Neurol 2000; 42:816.
  5. Foley J. Physical aspects. In: Cerebral Palsy and the Young Child, Blencowe SM (Ed), E&S Livingstone, London 1969. p.15.
  6. Capute AJ. Identifying cerebral palsy in infancy through study of primitive-reflex profiles. Pediatr Ann 1979; 8:589.
  7. Zafeiriou DI, Tsikoulas IG, Kremenopoulos GM. Prospective follow-up of primitive reflex profiles in high-risk infants: clues to an early diagnosis of cerebral palsy. Pediatr Neurol 1995; 13:148.
  8. Noritz GH, Murphy NA, Neuromotor Screening Expert Panel. Motor delays: early identification and evaluation. Pediatrics 2013; 131:e2016.
  9. NICE guideline: Cerebral palsy in under 25s: assessment and management, 2017. Available at: https://www.nice.org.uk/guidance/ng62/resources/cerebral-palsy-in-under-25s-assessment-and-management-1837570402501 (Accessed on January 30, 2017).
  10. Allen MC, Alexander GR. Using motor milestones as a multistep process to screen preterm infants for cerebral palsy. Dev Med Child Neurol 1997; 39:12.
  11. Myklebust BM. A review of myotatic reflexes and the development of motor control and gait in infants and children: a special communication. Phys Ther 1990; 70:188.
  12. Burke D. Spasticity as an adaptation to pyramidal tract injury. Adv Neurol 1988; 47:401.
  13. Landau WM. Clinical neuromythology II. Parables of palsy pills and PT pedagogy: a spastic dialectic. Neurology 1988; 38:1496.
  14. Lesný I, Stehlík A, Tomásek J, et al. Sensory disorders in cerebral palsy: two-point discrimination. Dev Med Child Neurol 1993; 35:402.
  15. Freud S. Die Infantile Cerebrallahmung. In: Specielle Pathologie und Therapie, Nothnagel S (Ed), Holder, Vienna 1897. p.1.
  16. Cazauvieilh JB. Recherches sur l'agenesie cerebrale et le paralysie congenitale. Arch Gen Med 1827; 14:5.
  17. Cooper J, Majnemer A, Rosenblatt B, Birnbaum R. The determination of sensory deficits in children with hemiplegic cerebral palsy. J Child Neurol 1995; 10:300.
  18. Himmelmann K, Beckung E, Hagberg G, Uvebrant P. Gross and fine motor function and accompanying impairments in cerebral palsy. Dev Med Child Neurol 2006; 48:417.
  19. Odding E, Roebroeck ME, Stam HJ. The epidemiology of cerebral palsy: incidence, impairments and risk factors. Disabil Rehabil 2006; 28:183.
  20. Harbord MG, Kobayashi JS. Fever producing ballismus in patients with choreoathetosis. J Child Neurol 1991; 6:49.
  21. Sanger TD, Chen D, Fehlings DL, et al. Definition and classification of hyperkinetic movements in childhood. Mov Disord 2010; 25:1538.
  22. Miller G, Cala LA. Ataxic cerebral palsy--clinico-radiologic correlations. Neuropediatrics 1989; 20:84.
  23. Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics 2012; 130:e1285.
  24. Ashwal S, Russman BS, Blasco PA, et al. Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2004; 62:851.
  25. Bagnato SJ, Campbell TF. Comprehensive neurodevelopmental evaluation of children with brain insults. In: Static Encephalopathies of Infancy and Childhood, Miller G, Ranier JC (Eds), Raven, New York 1992. p.27.
  26. Bjorgaas HM, Hysing M, Elgen I. Psychiatric disorders among children with cerebral palsy at school starting age. Res Dev Disabil 2012; 33:1287.
  27. Gabis LV, Tsubary NM, Leon O, et al. Assessment of Abilities and Comorbidities in Children With Cerebral Palsy. J Child Neurol 2015; 30:1640.
  28. Christensen D, Van Naarden Braun K, Doernberg NS, et al. Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning - Autism and Developmental Disabilities Monitoring Network, USA, 2008. Dev Med Child Neurol 2014; 56:59.
  29. Wilmshurst JM, Ibekwe RC, O'Callaghan FJ. Epileptic spasms - 175 years on: Trying to teach an old dog new tricks. Seizure 2017; 44:81.
  30. Black P. Visual disorders associated with cerebral palsy. Br J Ophthalmol 1982; 66:46.
  31. Jan JE, Groenveld M, Sykanda AM, Hoyt CS. Behavioural characteristics of children with permanent cortical visual impairment. Dev Med Child Neurol 1987; 29:571.
  32. Thurston SE, Leigh RJ, Crawford T, et al. Two distinct deficits of visual tracking caused by unilateral lesions of cerebral cortex in humans. Ann Neurol 1988; 23:266.
  33. Schenk-Rootlieb AJ, van Nieuwenhuizen O, van der Graaf Y, et al. The prevalence of cerebral visual disturbance in children with cerebral palsy. Dev Med Child Neurol 1992; 34:473.
  34. Buckley E, Seaber JH. Dyskinetic strabismus as a sign of cerebral palsy. Am J Ophthalmol 1981; 91:652.
  35. Katayama M, Tamas LB. Saccadic eye-movements of children with cerebral palsy. Dev Med Child Neurol 1987; 29:36.
  36. Lew H, Lee HS, Lee JY, et al. Possible linkage between visual and motor development in children with cerebral palsy. Pediatr Neurol 2015; 52:338.
  37. Ego A, Lidzba K, Brovedani P, et al. Visual-perceptual impairment in children with cerebral palsy: a systematic review. Dev Med Child Neurol 2015; 57 Suppl 2:46.
  38. Jan JE, Lyons CJ, Heaven RK, Matsuba C. Visual impairment due to a dyskinetic eye movement disorder in children with dyskinetic cerebral palsy. Dev Med Child Neurol 2001; 43:108.
  39. Pennefather PM, Tin W. Ocular abnormalities associated with cerebral palsy after preterm birth. Eye (Lond) 2000; 14 ( Pt 1):78.
  40. Nordberg A, Miniscalco C, Lohmander A, Himmelmann K. Speech problems affect more than one in two children with cerebral palsy: Swedish population-based study. Acta Paediatr 2013; 102:161.
  41. Zhang JY, Oskoui M, Shevell M. A population-based study of communication impairment in cerebral palsy. J Child Neurol 2015; 30:277.
  42. Mei C, Reilly S, Reddihough D, et al. Language outcomes of children with cerebral palsy aged 5 years and 6 years: a population-based study. Dev Med Child Neurol 2016; 58:605.
  43. Brooks J, Day S, Shavelle R, Strauss D. Low weight, morbidity, and mortality in children with cerebral palsy: new clinical growth charts. Pediatrics 2011; 128:e299.
  44. Stallings VA, Charney EB, Davies JC, Cronk CE. Nutritional status and growth of children with diplegic or hemiplegic cerebral palsy. Dev Med Child Neurol 1993; 35:997.
  45. Stallings VA, Charney EB, Davies JC, Cronk CE. Nutrition-related growth failure of children with quadriplegic cerebral palsy. Dev Med Child Neurol 1993; 35:126.
  46. Sondheimer JM, Morris BA. Gastroesophageal reflux among severely retarded children. J Pediatr 1979; 94:710.
  47. Stevenson RD, Hayes RP, Cater LV, Blackman JA. Clinical correlates of linear growth in children with cerebral palsy. Dev Med Child Neurol 1994; 36:135.
  48. Del Giudice E, Staiano A, Capano G, et al. Gastrointestinal manifestations in children with cerebral palsy. Brain Dev 1999; 21:307.
  49. Andrew MJ, Parr JR, Sullivan PB. Feeding difficulties in children with cerebral palsy. Arch Dis Child Educ Pract Ed 2012; 97:222.
  50. Stevenson RD, Roberts CD, Vogtle L. The effects of non-nutritional factors on growth in cerebral palsy. Dev Med Child Neurol 1995; 37:124.
  51. Erasmus CE, van Hulst K, Rotteveel JJ, et al. Clinical practice: swallowing problems in cerebral palsy. Eur J Pediatr 2012; 171:409.
  52. Erkin G, Culha C, Ozel S, Kirbiyik EG. Feeding and gastrointestinal problems in children with cerebral palsy. Int J Rehabil Res 2010; 33:218.
  53. Veugelers R, Benninga MA, Calis EA, et al. Prevalence and clinical presentation of constipation in children with severe generalized cerebral palsy. Dev Med Child Neurol 2010; 52:e216.
  54. Spiroglou K, Xinias I, Karatzas N, et al. Gastric emptying in children with cerebral palsy and gastroesophageal reflux. Pediatr Neurol 2004; 31:177.
  55. Parkes J, Hill N, Platt MJ, Donnelly C. Oromotor dysfunction and communication impairments in children with cerebral palsy: a register study. Dev Med Child Neurol 2010; 52:1113.
  56. Reddihough DS, Baikie G, Walstab JE. Cerebral palsy in Victoria, Australia: mortality and causes of death. J Paediatr Child Health 2001; 37:183.
  57. Flynn JM, Miller F. Management of hip disorders in patients with cerebral palsy. J Am Acad Orthop Surg 2002; 10:198.
  58. McCarthy JJ, D'Andrea LP, Betz RR, Clements DH. Scoliosis in the child with cerebral palsy. J Am Acad Orthop Surg 2006; 14:367.
  59. Chad KE, McKay HA, Zello GA, et al. Body composition in nutritionally adequate ambulatory and non-ambulatory children with cerebral palsy and a healthy reference group. Dev Med Child Neurol 2000; 42:334.
  60. Henderson RC, Lark RK, Gurka MJ, et al. Bone density and metabolism in children and adolescents with moderate to severe cerebral palsy. Pediatrics 2002; 110:e5.
  61. Cohen M, Lahat E, Bistritzer T, et al. Evidence-based review of bone strength in children and youth with cerebral palsy. J Child Neurol 2009; 24:959.
  62. Mergler S, Evenhuis HM, Boot AM, et al. Epidemiology of low bone mineral density and fractures in children with severe cerebral palsy: a systematic review. Dev Med Child Neurol 2009; 51:773.
  63. Henderson RC, Kairalla JA, Barrington JW, et al. Longitudinal changes in bone density in children and adolescents with moderate to severe cerebral palsy. J Pediatr 2005; 146:769.
  64. Decter RM, Bauer SB, Khoshbin S, et al. Urodynamic assessment of children with cerebral palsy. J Urol 1987; 138:1110.
  65. Silva JA, Gonsalves Mde C, Saverio AP, et al. Lower urinary tract dysfunction and ultrasound assessment of bladder wall thickness in children with cerebral palsy. Urology 2010; 76:942.
  66. Murphy KP, Boutin SA, Ide KR. Cerebral palsy, neurogenic bladder, and outcomes of lifetime care. Dev Med Child Neurol 2012; 54:945.
  67. Roijen LE, Postema K, Limbeek VJ, Kuppevelt VH. Development of bladder control in children and adolescents with cerebral palsy. Dev Med Child Neurol 2001; 43:103.
  68. Richardson I, Palmer LS. Clinical and urodynamic spectrum of bladder function in cerebral palsy. J Urol 2009; 182:1945.
  69. Borzyskowski M. Cerebral palsy and the bladder. Dev Med Child Neurol 1989; 31:687.
  70. Bauer SB. Neurogenic bladder: etiology and assessment. Pediatr Nephrol 2008; 23:541.
  71. Penner M, Xie WY, Binepal N, et al. Characteristics of pain in children and youth with cerebral palsy. Pediatrics 2013; 132:e407.
  72. Arnaud C, White-Koning M, Michelsen SI, et al. Parent-reported quality of life of children with cerebral palsy in Europe. Pediatrics 2008; 121:54.
  73. Colver A, Rapp M, Eisemann N, et al. Self-reported quality of life of adolescents with cerebral palsy: a cross-sectional and longitudinal analysis. Lancet 2015; 385:705.
  74. Findlay B, Switzer L, Narayanan U, et al. Investigating the impact of pain, age, Gross Motor Function Classification System, and sex on health-related quality of life in children with cerebral palsy. Dev Med Child Neurol 2016; 58:292.