Types and Classifications of Cerebral Palsy
Cerebral palsy can be notoriously difficult to categorize due to the condition’s wide range of physical impairments, but it is generally classified using up to four determining factors:
Using these determinations, you can more accurately specify the child’s diagnosis to provide a concise “classification” of cerebral palsy (e.g., mild spastic cerebral palsy, severe athetoid hemiplegia, etc.). Additionally, the following two classifications are also used to determine levels of disability regarding cerebral palsy.
By Motor Function
While there are many ways to classify cerebral palsy, in the broadest sense, there are four major types: spastic, athetoid, ataxic, and mixed.
Spastic Cerebral Palsy
Almost 80% of cerebral palsy cases are spastic. The muscles of a person with spastic cerebral palsy have increased muscle tone, meaning their muscles are stiff and can become permanently contracted. Trying to move with continually contracted muscles makes motion short and jerky.
The brain of a person with spastic cerebral palsy can’t appropriately tell the muscle how much flexibility to have. Hence, the muscle dominates the signals sent to the spinal cord, and the muscles remain tense (or spastic).
Athetoid or Dyskinetic Cerebral Palsy
Athetoid or Dyskinetic (also referred to as dystonic) cerebral palsy is characterized by unintentional or uncontrolled movements due to continually changing muscle tone. This kind of cerebral palsy affects 10 to 20% of sufferers.
People with Athetoid cerebral palsy usually exhibit movements that look slow and are sometimes circular.
These movements usually affect all four limbs and sometimes the face or tongue. Interestingly, people with athetoid or dyskinetic cerebral palsy often have above-average intelligence.
Ataxic Cerebral Palsy
Ataxic cerebral palsy is a relatively rare disorder that stems from cerebellum damage. Only 5 to 10 percent of people with CP are classified as ataxic.
A lack of coordination, balance, and depth perception characterizes ataxic CP. Quick movements are difficult to complete, and most children with ataxia have an awkward, widespread gait.
Mixed Cerebral Palsy
Many cerebral palsy sufferers have a combination of different types. The most common is a mix of Spastic and Athetoid. The least common mixture is Athetoid and Ataxic. It’s possible, though rare, to have a combination of three or more types of cerebral palsy.
By Body Distribution
Cerebral palsy often affects certain limbs or areas of the body more than others. Some children may have impairment in only one limb (monoparesis or monoplegia), and some may have impairment in both legs (diparesis or diplegia). In contrast, others may be more impaired on one side of the body than the other (hemiparesis or hemiplegia).
Monoplegia / Monoparesis
Refers to a type of cerebral palsy in which only one limb is paralyzed (monoplegia) or weakened (monoparesis). Monoplegia typically affects an extremity such as the hand and foot, making it difficult to perform tasks requiring both limbs.
Diplegia / Diparesis
Refers to a type of cerebral palsy that affects symmetrically-opposed parts of the body and usually affects the legs more severely than the arms. A lack of oxygen during brain formation typically causes a development failure in the pyramidal tracts. MRIs easily detect these malformed areas, called periventricular leukomalacia.
Hemiplegia / Hemiparesis
Refers to a type of cerebral palsy in which one side of the body is weakened (hemiparesis) or paralyzed (hemiplegia) more so than the other. In children with hemiplegia, paralysis in the body occurs on the side opposite the affected part of the brain. For example, if the left side of the child’s brain is injured, the paralysis will be on the right side of the child’s body.
Paraplegia / Paraparesis
Refers to a type of cerebral palsy in which the lower half of the body is severely weakened (paraparesis) or paralyzed (paraplegia).
Quadriplegia / Quadriparesis
Refers to a type of cerebral palsy in which all four limbs are weakened (quadriparesis) or paralyzed (quadriplegia). It is usually accompanied by more severe symptoms of nerve damage interfering with normal muscle movement than the other types.
Klumpke’s Palsy/Klumpke’s paralysis
This type of injury affects newborn babies and results because of an injury to the brachial plexus where the first thoracic nerve and the eighth cervical nerve is affected. The symptoms vary from mild to severe, contingent on the type and severity of injury to the brachial plexus.
In addition to the more-common body distribution classifications mentioned above, some children fall into more specific categories, such as:
- Triplegia/ triparesis (three limbs affected)
- Double hemiplegia/ double hemiparesis (all limbs affected, one side more than the other)
- Tetraplegia/ tetraparesis (all limbs involved, three more than the other)
- Pentaplegia/ pentaparesis (all limbs affected, as well as head or neck paralysis).
In broadest terms, cerebral palsy can be classified as either mild, moderate, or severe. This level of classification only deals with the general scope of impairment, and is usually used in combination with other classifications (e.g. severe athetoid quadriparesis).
Mild Cerebral Palsy
A child with mild cerebral palsy can generally move without assistance, and requires little specialized care. Many children with mild cerebral palsy are diagnosed with the disorder late because the symptoms are less apparent in the early years of life.
Moderate Cerebral Palsy
A child with moderate cerebral palsy will likely require braces, medication, and/or adaptive technology in order to accomplish daily activities.
Severe Cerebral Palsy
A child with severe cerebral palsy will usually require a wheelchair, and will have significant challenges in accomplishing daily activities.
By Muscle Tone
Cerebral palsy is most-often categorized by either increased muscle tone (spastic and/or hypertonic) or decreased muscle tone (non-spastic and/or hypotonic). While not always used when classifying cerebral palsy, these two terms can be used to describe how CP affects a child’s muscle tone.
Hypertonia simply refers to a heightened muscle tension, rigidity, and/or stiffness. This type of CP is often classified as spastic cerebral palsy. Children with hypertonic CP may exhibit poor balance, muscle contractures, awkward movements, and stiff limbs.
As opposed to hypertonia, children with hypotonic cerebral palsy fall on the other end of the spectrum. A child with hypotonic CP generally has a low muscle tone, and may exhibit “floppy” limbs, poor neck control, and an abnormal truncal tone.
By Physical Ability
The Gross Motor Function Classification System (GMFCS) looks at movements such as sitting, walking and the use of mobility devices in order to categorize the level of physical disability they may face.
GMFCS Level I
The child learns to sit on the floor and use both hands to play with toys and other objects. The child is capable of crawling and pulling themselves up, and by 18 months, can walk.
GMFCS Level II
The child may begin to sit up on the floor, but only with assistance. They may begin to crawl on their hands and knees or on their stomach.
GMFCS Level III
The child can roll and move in a forward position while on their stomach, but need assistance with sitting up.
GMFCS Level IV
The child can roll from their back to their stomach and vice versa, but can only sit upwards with trunk (lower body) assistance.
GMFCS Level V
The child’s voluntary control of movements are physically impaired, and in turn, the child cannot hold their head up or sit up without trunk support. The child may also need assistance to roll over.
International Statistical Classification
The International Statistical Classification of Diseases and Related Health Problems (ICD) is the international standard for reporting diseases and health conditions, and is the standard diagnostic tool for epidemiology, health management and clinical purposes. In September of 2015, the ICD-9 system was discontinued in favor of the revised ICD-10 system.
ICD-10 Codes Related to Cerebral Palsy
- ICD-10-CM G80 – Cerebral palsy
- ICD-10-CM G80.0 – Spastic quadriplegic cerebral palsy
- ICD-10-CM G80.1 – Spastic diplegic cerebral palsy
- ICD-10-CM G80.2 – Spastic hemiplegic cerebral palsy
- ICD-10-CM G80.3 – Dyskinetic cerebral palsy (Athetoid/Dystonic)
- ICD-10-CM G80.4 – Ataxic cerebral palsy
- ICD-10-CM G80.8 – Other cerebral palsy
- ICD-10-CM G80.9 – Cerebral palsy (unspecified)
- ICD-10-CM G81 – Hemiplegia
- ICD-10-CM G81.0 – Flaccid hemiplegia
- ICD-10-CM G81.1 – Spastic hemiplegia
- ICD-10-CM G81.9 – Hemiplegia (unspecified)
- ICD-10-CM G82 – Paraplegia and tetraplegia
- ICD-10-CM G82.0 – Flaccid paraplegia
- ICD-10-CM G82.1 – Spastic paraplegia
- ICD-10-CM G82.2 – Paraplegia (unspecified)
- ICD-10-CM G82.3 – Flaccid tetraplegia
- ICD-10-CM G82.4 – Spastic tetraplegia
- ICD-10-CM G82.5 – Tetraplegia (unspecified)
- ICD-10-CM G83 – Other paralytic syndromes
- ICD-10-CM G83.0 – Diplegia of upper limbs
- ICD-10-CM G83.1 – Monoplegia of lower limb
- ICD-10-CM G83.2 – Monoplegia of upper limb
- ICD-10-CM G83.3 – Monoplegia (unspecified)
- ICD-10-CM G83.4 – Cauda equina syndrome
- ICD-10-CM G83.5 – Locked-in syndrome
- ICD-10-CM G83.8 – Other specified paralytic syndromes
- ICD-10-CM G83.9 – Paralytic syndrome (unspecified)
ICD-9 Codes (no longer used)
- ICD-9 343.0 – Congenital Diplegia
Congenital diplegia is a form of cerebral palsy which affects both sides of a person’s body. The term congenital means that the condition is usually present from birth or shortly after childbirth. Also known as congenital diplegia disorder, this condition may manifest itself with the lack of sensation and movement of a child’s arms or legs on either side. This lack of movement may also be due to paralysis and damage to a part of the brain which controls motor function.
- ICD-9 343.1 – Congenital Hemiplegia
Congenital hemiplegia, on the other hand is a cerebral palsy variation which affects only one side of the body. This means that the child may have sustained some form of trauma on one side of the brain. This trauma may have been inflicted due to improper or forceful delivery techniques, leaving the baby in the birth canal for too long, or even a brain infection during the 9 month gestational period.
- ICD-9 343.2 – Congenital Quadriplegia
Congenital quadriplegia manifests itself as total paralysis of the body from the neck downward. A person born with congenital quadriplegia may need active assistance in order to go about their daily duties. This is because they aren’t able to control their body and can only move their head. This condition is usually caused by extensive brain and spinal cord damage. In some cases, quadriplegics may have control of their arms and legs but not their fingers and toes.
- ICD-9 343.3 – Congenial Monoplegia
Congenital monoplegia is a condition which presents itself as paralysis of one extremity. This may include things like one arm or one leg, giving the person some type of control and sensation in his other limbs.
- ICD-9 343.4 – Infantile Hemiplegia
Infantile hemiplegia refers to paralysis of one side of the body due to brain trauma. This condition may be manifested during birth or 6 months later, making it a surprising variation of cerebral palsy due to its sudden onset. More boys than girls are diagnosed with this condition, and it’s said to affect the right side of the body twice as much as the left.
- ICD-9 343.8 – Other Specified Infantile Cerebral Palsy
Other specified infantile cerebral palsy may refer to variations of normal cerebral palsy. Under this umbrella, we may find conditions such as spastic paralysis, ataxic cerebral palsy, hypotonic cerebral palsy and others.
- ICD-9 343.9 – Unspecified Infantile Cerebral Palsy
Unspecified infantile cerebral palsy may refer to other general forms of cerebral palsy which occur before, during or shortly after birth. Variations include infantile brain palsy, atonic cerebral palsy, neuromuscular cerebral palsy, hypotonic cerebral palsy and many more.
As previously mentioned, there is no single agreed-upon classification standard for cerebral palsy. As such, there exist several specific types of cerebral palsy, including: