From the Guidelines
Cerebral Palsy (CP) is classified using several different systems, primarily based on motor function, into four main types: spastic, dyskinetic, ataxic, and mixed, with the most common being spastic, affecting about 80% of cases, as noted in 1. The classification of CP is crucial for developing appropriate treatment plans, predicting outcomes, and communicating effectively about a patient's condition. The four main types of CP based on motor function are:
- Spastic: characterized by stiff, tight muscles
- Dyskinetic: marked by involuntary movements that disappear during sleep
- Ataxic: involving problems with balance and coordination
- Mixed: showing symptoms of multiple types Additionally, CP can be classified by which body parts are affected, including:
- Hemiplegia: one side of the body
- Diplegia: primarily legs
- Quadriplegia: all four limbs
- Monoplegia: one limb
- Triplegia: three limbs The Gross Motor Function Classification System (GMFCS) provides a standardized way to describe mobility limitations on a five-level scale, from Level I (walks without limitations) to Level V (transported in a wheelchair), as discussed in 1 and 1. The Manual Ability Classification System (MACS) similarly describes hand function, allowing for a comprehensive understanding of a patient's capabilities and limitations, which is essential for optimizing treatment and improving quality of life, as highlighted in 1 and 1. It's worth noting that the diagnosis and classification of CP can be complex and may evolve over time, especially in infants, where clinical signs and symptoms emerge and change before age 2 years, as mentioned in 1 and 1. Therefore, a combination of standardized tools and clinical history is necessary for accurate diagnosis and classification, with the goal of providing personalized care and support to individuals with CP, ultimately improving their morbidity, mortality, and quality of life.
From the Research
Classification of Cerebral Palsy
Cerebral palsy (CP) can be classified into different types based on the movement disorders associated with the condition. The main types of CP are:
- Spastic CP: characterized by increased muscle tone, which can lead to stiff muscles and awkward movements 2, 3, 4
- Dyskinetic CP: characterized by involuntary movements, which can be unpredictable and uncontrollable 2, 5, 3
- Ataxic CP: characterized by problems with balance and coordination, which can affect walking and movement 2, 5, 3
- Mixed/other CP: a combination of different movement disorders, which can make diagnosis and treatment more challenging 2
Functional Classification Systems
In addition to the traditional classification systems, there are several functional classification systems that can be used to evaluate the severity of CP and treatment response. These systems include:
- Gross Motor Function Classification System (GMFCS): evaluates the ability to perform gross motor tasks, such as walking and sitting 6
- Manual Ability Classification System (MACS): evaluates the ability to perform manual tasks, such as grasping and manipulating objects 6
- Communication Function Classification System (CFCS): evaluates the ability to communicate effectively 6
- Eating and Drinking Ability Classification System (EDACS): evaluates the ability to eat and drink independently 6
Challenges in Classification
Despite the availability of these classification systems, there can be challenges in differentiating between different types of CP. A study found that there was only fair inter-observer agreement and moderate intra-observer agreement among professionals in classifying the phenotype of children with CP based on standardized videos 5. This highlights the need for clear operational definitions of spasticity, dystonia, and ataxia, as well as the importance of functional domains in assessing the true impact of management options in CP.