Cerebral palsy can be divided into following types:
•Spastic cerebral palsy
•Choreoathetoid cerebral palsy
•Hypotonic cerebral palsy
Spastic cerebral palsy
Spastic cerebral palsy refers to a condition in which the muscle tone is increased, causing a rigid posture in one or more extremities [arm(s) or leg(s)]. This rigidity can be overcome with some force, ultimately giving way completely and suddenly the spasticity leads to a limitation of use of the involved extremity, largely due to the inability to coordinate movements. The spasticity occurs on one side of the body (hemiparesis), but it can also affect the four limbs (quadriparesis) or be limited to both legs (spastic diplegia).
Spasticity is the result of damage to the white matter of the brain, but it can also be due to damage of gray matter. The degree of spasticity can vary, ranging from mild to severe. Children who are mildly affected may experience few limitations of their function while severely affected children may have little to no meaningful use of the affected limb(s). Spasticity, if not properly treated, can result in contractures, which are permanent limitations in the ability of joint movement. Contractures can be greatly limiting in the care of children with cerebral palsy. Spasticity can also be quite painful, requiring medication to relax the muscle tone.
Choreoathetoid cerebral palsy: Choreoathetoid cerebral palsy is associated with abnormal, uncontrollable, writhing movements of the arms and/or legs. Different from spastic cerebral palsy, persons with choreoathetoid cerebral palsy have variable muscle tone often with decreased muscle tone (hypotonia).The abnormal movements are activated by stress, as well as by normal emotional reactions such as laughing. There are different types of abnormal movements. Two of the most common are choreoathetotic movement disorder with rapid, irregular, unpredictable contractions of individual or small muscles groups and dystonia with a persistent but not permanent, abnormal posture of some body parts (arms, legs, trunk) due to abnormal muscle contractions. The dystonic disorder also affects the muscle of the facial expression, swallowing, deglutition and speech, resulting in severe functional deficiencies.
Hypotonic cerebral palsy: Hypotonia is diminished muscle tone. The infant or child with hypotonic cerebral palsy appears in early infancy, hypotonia can be easily seen by the inability of the infant to gain any head control when pulled by the arms to a sitting position (this symptom is often referred to as head lag). Children with severe hypotonias have the most difficulty of all children with cerebral palsy in attaining motor skill milestones and normal cognitive development. Hypotonic cerebral palsy is often the result of severe brain damage or malformations.
Mixed cerebral palsy: Many (possibly most) children with cerebral palsy have multiple symptoms with combinations of the various forms of cerebral palsy. For example, children with spastic cerebral palsy often continue to have a head lag, which is representative of hypotonia. Children with choreoathetoid or hypotonic cerebral palsy often have increased deep tendon reflexes, which are suggestive of some spasticity.