Last updated:
April 1, 2026
Cerebral palsy is a disorder of movement and posture due to a non-progressive brain injury or malformation, which results in permanent neurological damage. The most common cause is anoxic brain injury during the perinatal period or before 2 years of age.
It affects 2 in 1000 live births and is the most common cause of major motor impairment.
Causes of cerebral palsy
| Cause | Examples |
|---|---|
| Antenatal | Maternal infection, trauma during pregnancy |
| Perinatal | Birth asphyxia, pre-term birth |
| Post-natal | Meningitis, intraventricular hemorrhage, severe neonatal jaundice, and head injury |
Classification of cerebral palsy
| Classification | Description |
|---|---|
| Spastic CP (Pyramidal, 75%) | Increased muscle tone with increased muscle velocity (hypertonia) and hyperreflexia. Most common subtype. Due to damage to the upper motor neurons. |
| Athetoid (Dyskinetic/Extrapyramidal) | Problems controlling muscle tone with hypertonia and hypotonia, which cause involuntary writhing movements and oro-motor problems. Results from damage to the basal ganglia. |
| Ataxic | Issues with coordination and balance. Results from damage to the cerebellum |
| Hypotonic | Loss of muscle tone and strength, resulting in weakness and floppiness |
| Mixed | A mix of spastic, dyskinetic, and ataxic features due to damage to different portions of the brain |
Classification according to limbs affected
| Classification | Description |
|---|---|
| Quadriplegic | All 4 extremities are affected severely. Also often involves muscles of facial expression, seizures, speech disturbances, and other impairments. |
| Diplegic | Two contralateral extremities (typically both lower extremities) are affected |
| Hemiplegic | Two ipsilateral extremities are affected |
| Monoplegic | One limb is affected |
- POSTER criteria for diagnosis
- Posturing
- Oropharyngeal problems: tongue thrusts, grimacing, and swallowing difficulties
- Strabismus
- Tone – increased or decreased
- Evolutionary responses: persistent primitive reflexes or failure to develop equilibrium and protective responses
- Reflexes: deep tendon reflexes are increased, and plantar reflexes are upgoing
- Signs and symptoms
- Failure to meet milestones
- Increased or decreased tone (generally or in affected limbs)
- Hand preference before 18 months
- Problems with coordination, speech, or walking
- Feeding or swallowing problems
- Learning difficulties
- Physical examination
- Hemiplegic/diplegic gait (UMN lesion): legs extended with plantarflexion of the feet and toes. The leg is swung around in a large semicircle when it is moved from behind to the front.
- Good muscle bulk
- Hypertonia
- Spasticity (muscle stiffness or tightness that increases with muscle contraction velocity)
- Brisk reflexes
- Slightly reduced power
- Athetoid movements
- Test for coordination
- Investigations
- Supportive treatment
- Physiotherapy: to stretch and strengthen muscles, maximize function, and prevent contractures
- Occupational therapy: to help the patients manage everyday activities
- Speech and language therapy: to help with speech and swallowing
- Dieticians: to ensure they meet nutritional requirements. Some children can be fed using a PEG or NG tube
- Mobility assistance, e.g., walkers
- Bracing
- Social worker: to help with benefits and support
- Charities and support groups provide opportunities
- Pharmacological treatment
- Muscle relaxants, e.g., baclofen, dantrolene, or botulinum, for spasticity and contractures
- Baclofen is preferred intrathecal
- Anti-epileptic drugs for seizures
- Anticholinergic, e.g., glycopyrrolate or benzhexol, for excessive drooling
- Proton pump inhibitors for acid reflux
- Laxatives and suppositories for constipation
- Muscle relaxants, e.g., baclofen, dantrolene, or botulinum, for spasticity and contractures
- Indications and options for operative treatment
- Hip subluxation or dislocation: tendon release and osteotomies
- Knee contractures: hamstring lengthening procedures
- Foot and ankle deformities: tendon transfers or osteotomies
- Selective dorsal rhizotomy to relax spastic muscles
- Complications and associated conditions
- Learning disability
- Epilepsy
- Kyphoscoliosis
- Muscle contractures
- Hearing and visual impairment
- Gastro-esophageal reflux
Examining for Spasticity