1.Typing according to the nature of movement disorders
(1) Spastic type: This type is the most common type, accounting for about 2/3 of the children with cerebral palsy, with lesions mainly in the cone bundle system, varying in severity. This type of cerebral palsy is mainly due to various degrees of increased muscle tone, frequent co-contraction of muscles throughout the body, and the persistence of various primitive reflexes, thus preventing the occurrence of effective movement and causing delay, clumsiness, or even loss of casual movement. When doing complex movements or emotional excitement, muscle tone appears to be significantly increased, making fine movements appear awkward, poorly coordinated, or even completely impossible to do. On examination, the passive motor resistance is increased, there are folded knife-like spasms, and the tendon reflexes are active or hyperactive, often combined with pathological reflexes.
(2) Tardive dyskinesia: This type is often seen clinically, with lesions mainly in the basal nucleus of the brain, and is characterized by constant changes in the level and nature of muscle tone, resulting in involuntary movements. It is characterized by a constant change in the level and nature of muscle tone, resulting in involuntary movements. Due to the uncoordinated contraction of the whole body muscles, the child has difficulty in maintaining a stable posture and limb position. Irregular localized contractions of the neck and facial muscles cause bizarre facial expressions. The child’s involuntary head or articulatory organ movements and irregular respiratory movements are not coordinated with the movements required for articulation, and the more nervous the child is, the worse the coordination and the more severe the speech impairment. These children often have hearing impairment, but mental impairment is less common. On examination, the physiological reflexes are sometimes reduced and the pathological reflexes are often negative.
(3) Ataxia: This type is less common, with lesions mainly in the cerebellum or brain, and is often associated with spasticity and tardive dyskinesia. The muscle tone is often not significantly increased and mostly below normal, thus, poor stability and coordination difficulties occur during movement, and the limbs often show distance discrimination impairment, tension tremor and nystagmus during movement, and thus cannot effectively maintain balance.
(4) Mixed type: i.e., those with two or more types of characteristics, often caused by damage to both the pyramidal fasciculus and the extrapyramidal system or the cerebellum, which is also a common clinical type.
(5) Other types: less common, such as hypotonia, tonicity, tremor, and undifferentiable type.
Hypotonia type: It is characterized by hypotonia, floppy limbs and little voluntary movement. The limbs are abducted and externally rotated in the supine position, resembling a supine frog, and the head cannot be raised in the prone position, but the tendon reflexes are hyperactive. This type is often the early symptom of infants with cerebral palsy, and after infancy, it often turns into other types.
Ankylosing type: caused by extrapyramidal injury. The limbs are stiff and movement is reduced. When doing passive movements, there is continuous resistance to both extensor and flexor muscles, so the muscle tone shows a lead pipe or cogwheel increase. The tendon reflexes are not hyperactive and are often accompanied by mental retardation, emotional abnormalities, speech disorders, epilepsy, strabismus, and salivation.
Tremor type: The main manifestation is a part of the body that shakes in an involuntary and rhythmic manner in one plane. The typical tremor symptoms are mostly resting tremor of the limbs.
Unable to classify the type: There are a few children with complex performance, which is difficult to classify with the above-mentioned typology.
2.Typing according to the part of motor disorder involved
(1) Single limb palsy: The movement disorder involves only one limb, either the upper limb or the lower limb.
(2) Hemiplegia: The movement disorder involves only one limb, usually the upper limb is more impaired than the lower limb, and both are spastic.
(3) Triple limb palsy: Movement disorder involving three limbs, which is also rare in clinical practice.
(4) Quadriplegia: The movement disorder basically involves both limbs and trunk symmetrically, and the degree of involvement of the four limbs is similar, almost all of the tardive dyskinesia type are of this type, and some of the spastic type are also of this type.
(5) Paraplegia: The movement disorder only involves both lower limbs, and the trunk and both upper limbs are normal.
(6) Diplegia: The movement disorder involves all four extremities, but the upper extremities and trunk are less involved, while the lower extremities are more involved. This type is the most common.
(7) Dual hemiplegia: The movement disorder involves both limbs asymmetrically, generally the upper limbs are more severe than the lower limbs, and sometimes the severity of the left and right sides is not consistent.
3.Grading according to the degree of disease
(1)Mild No need for any assistance, life is completely self-care.
(2)Moderate Need some assistance, partial self-care.
(3)Severe All need assistance, life is completely unable to take care of themselves.