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Classic Presentations of Cerebral Palsy

About 1 million people in the United States have cerebral palsy (CP), and CP occurs in 1.5 - 2.5 of every 1000 live births. Cerebral palsy is not one specific disease or disorder. Rather, it refers to a loosely-associated group of disorders that involve motor or postural abnormalities that occur early in the child's development. United Cerebral Palsy (UCP), the national organization devoted to people with cerebral palsy, defines cerebral palsy as a syndrome that includes a number of different types of injury, to a variety of areas within the child's developing brain:

failure of a variety of developing brain cells to migrate from their point of origin to the appropriate functional location in the brain during neurological development
failure of specialized brain cells to deposit myelin on cell fibers, which causes poor transmission of nerve impulses
death of brain cells, including the grey matter within the cerebral cortex
poor function at the synapses, or connections between brain cells, which causes faulty or nonexistent transmission of nerve impulses between the cells

Instant Feedback:

Cerebral palsy arises from a variety of injuries to different parts of the child's brain.

Cerebral palsy is generally considered to be a "static" form of encephalopathy, that does not progress throughout the child's life. However, it is important to note that clinical symptoms and developmental abilities do change significantly as children with CP grow up, and their nervous systems develop.

There are four classic presentations of cerebral palsy, as outlined in Figure 1. While these categories are useful for diagnosing and communicating information about the child's overall condition, it's important to remember that every child is a unique individual with specific strengths, impairments, and medical problems. Without a thorough nursing assessment to explore the unique qualities of each child, the nurse has no grounds for the nursing process.

Figure 1. Classic Presentations of Cerebral Palsy

Type of CP	Deficits
Spastic hemiplegic	unilateral upper motor neuron deficit arm usually affected more than leg oral-motor dysfunction specific learning disabilities may have one-sided sensory deficits visual field deficits and strabismus seizures common
Spastic diplegic	legs more involved than arms scissoring gait pattern toe-walking learning disabilities less common seizures less common
Dyskinetic (extrapyramidal)	hypotonia and movement problems some spasticity oral-motor dysfunction gait disorders unstable trunk possible deafness
Spastic quadriplegic	all extremities involved trunk spasticity OR hypotonicity limb spasticity cognitive impairments common multiple medical problems seizures common

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There are four classic presentations of cerebral palsy, and symptoms vary significantly from one type to another.

Going back to the classroom scenario presented in the Introduction, let's think about what type of cerebral palsy Mary has.

She walked up to the blackboard in an inclusive classroom setting, with a slight limp because of a slight hemiparesis of her right leg. Because her right arm is significantly impaired from the CP, she writes her spelling words with her left hand. The writing is slow and deliberate because Mary does have some underlying learning disabilities. When she reads the words aloud, Mary follows her speech and language pathologist's advice to speak slowly and enunciate carefully, to minimize her oral-motor impairments. She also turns her head slightly to the side to compensate for a visual field defect. Except for a seizure disorder that is well-controlled with anticonvulsant medications, Mary's medical history is unremarkable and she is able to ride the bus and play with her friends. Mary has spastic hemiplegic cerebral palsy.

Juan Carlos, on the other hand, uses a specially-fitted wheelchair and wrist splints to compensate for the low tone in his trunk, as well as his limb spasticity. With his severe cognitive impairments, Juan Carlos requires a highly-modified curriculum and significant accommodations in his special day classroom. Because of his tracheostomy, gastrostomy, and seizure disorder, he requires the services of a one-on-one health aide at school. Juan Carlos displays the classic characteristics of spastic quadriplegic cerebral palsy.

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Children with cerebral palsy are placed in special education classrooms so they can have individually tailored programs and interact with their disabled peers.