There are 6 types according to clinical manifestations.
(1) spastic type ;
(2) Irregular movement type;
(3) Tonic type;
(4) Ataxic type;
(5) Hypotonia type;
(6) mixed type.
There are 5 types of paralysis according to the site of paralysis.
(1) monoplegia;
(2) Diplegia;
(3) triple paresis;
(4) hemiplegia;
(5) Quadriplegia.
Because cerebral palsy is a syndrome caused by brain injury, with complex causes, complex injuries, and complex clinical manifestations, there are certain difficulties in classification, and it is difficult to classify from a single perspective or to strictly identify a certain type.
Clinical manifestations of cerebral palsy.
Regardless of the type of cerebral palsy, it is characterized by non-progressive brain injury or developmental disorders. The clinical phenotype is characterized by delayed motor development, abnormal posture and movement patterns, delayed disappearance of primitive reflexes, delayed appearance of upright reflexes (corrective reflexes) and balance reflexes, and abnormal muscle tone.
1. Spastic type The main site of injury in spastic cerebral palsy is the conus system, but the clinical manifestations vary with different lesion sites, and the main manifestations are as follows.
(1) Increased muscle tone, with a “folding knife”-like increase in muscle tone when the limb is passively flexed and extended. The range of motion of the joint becomes smaller, the movement is impaired, and the posture is abnormal.
(2) Due to the increased tone of flexor muscles, most of the major joints exhibit flexion and internal rotation and retraction patterns.
(3) The upper extremities exhibit finger joint flexion, hand clenching, thumb inversion, wrist flexion forearm rotation forward, elbow flexion, and shoulder joint inversion. Excessive use of the upper extremity is prone to joint reaction, so that the development of the upper extremity is affected.
(4) The lower extremities are characterized by pointed feet, inward and outward turning of the feet, knee flexion or hyperextension, hip flexion, inward and internal rotation, thigh inversion, toe landing when walking, and scissor gait. The lower limbs are restricted to separate movement, and it is difficult to support the weight of the lower limbs when the soles of the feet touch the ground.
(5) Mostly seen in trunk and upper limb extensors, some flexors of lower limbs and some extensors with reduced muscle strength.
(6) Small movement amplitude, fixed direction, and slow movement rate.
(7) Spastic diplegia is the most common in children with cerebral palsy. It is mainly characterized by generalized involvement, with the lower extremities being heavier than the upper extremities, and mostly manifests as upper extremity flexion pattern and lower extremity extension pattern.
(8) Spastic quadriplegia generally has heavier clinical manifestations than spastic diplegia, which may manifest as generalized hypertonia, similar degree of damage in the upper and lower extremities, or heavier upper extremity than lower extremity. Since most of them focus on the other side, they have obvious postural-motor asymmetry.
(9) Children with spastic hemiplegia have milder clinical symptoms, with obvious asymmetric postural movements, and generally show symptoms after 6 months of age, with significant differences around 1 year of age. While normal children rarely develop sharpshooting before 12 months of age, children with spastic hemiplegia may develop sharpshooting before 12 months of age. Clear imaging changes are seen in this type.
(10) Slow visual development, insufficient visual experience effect, and underdeveloped visual function affect the speed and quality of gross and fine motor development.
(11) There may be varying degrees of intellectual backwardness, timidity, shyness, and introverted personality.
(12) Clinical examination reveals cone bundle signs, hyperactive tendon reflexes, enhanced periosteal reflexes, positive ankle clonus, and still positive pathological reflexes after 2 years of age.
(13) Low birth weight and asphyxiated children are prone to this disease, and this type accounts for about 60%-70% of children with cerebral palsy.
2. Irregular movement type The injury site is mainly in the extrapyramidal system, and the main manifestations are as follows.
(1) Involuntary movements of the whole body that are difficult to control by will, involvement of facial muscles, articulatory and phonatory organs, often accompanied by salivation, chewing and swallowing difficulties, and language impairment.
(2) When conscious, purposeful movements are performed, they are manifested by an increase in involuntary, uncoordinated and ineffective movements, and the involuntary movements contrary to the intention extend to the whole body, and the involuntary movements disappear when quiet. Poor head control, difficulty in separating movements from the trunk, and difficulty in realizing a body axis-centered orthostatic postural movement pattern.
(3) Myotonia changes, active muscle, antagonist muscle, fixed muscle, synergist muscle contraction sequence, direction, force size can not be coordinated, the intensity and nature of muscle tone constantly change, appearing active movement or postural changes when muscle tone suddenly increased, quiet changes are not obvious. Hypotonia is more common in infants and myoclonus and myotonicity in older children. As a result of hyperactivity of multiple joints, it is difficult to maintain posture and thus poor balance.
(4) The primitive reflexes persist and are usually highly reactive, especially characterized by asymmetrical tense neck reflex posture, presenting asymmetrical, head and trunk dorsiflexion posture.
(5) Due to the vacillation of the upper limbs, the trunk and lower limbs may lose balance and fall easily.
(6) Frowning, blinking, open mouth, contraction of neck muscles, crooked face to the side, and unique facial expressions may also be seen.
(7) Early identification of the disease type is difficult because some infants show flaccidity in the early stage of the lesion and most children have no obvious symptoms.
(8) Children with this type generally have higher IQ than those with spasticity and have better comprehension. They are cheerful and enthusiastic, but highly nervous and afraid of stimulation.
(9) This type can also be divided into tense and non-tensive according to the degree of change in muscle tone.
(10) This type can be characterized by tardive movements, dance-like movements, twisting spasms, etc. It can also have several of these manifestations at the same time, accounting for about 20% of cerebral palsy.
3.Ankylosing type is less common and is caused by extrapyramidal injury, with the following main manifestations.
(1) Stiffness of limbs and reduced activity.
(2) There is continuous resistance of both extensor and flexor muscles during passive movement, so the muscle tone shows lead tube or gear-like increase.
(3) There is no tendon reflex hyperactivity, often accompanied by mental retardation, emotional abnormalities, speech disorders, epilepsy, strabismus, and salivation.
(4) This type generally has heavy clinical symptoms and is more difficult to care for.
4, ataxia type The main site of injury is the cerebellum, manifested as balance disorders, hypotonia, no involuntary movements. Loss of proprioception and balance sensation, and inability to maintain a stable posture. The main performance is as follows.
(1) unstable gait, inability to adjust the pace, drunken gait, easy to fall, small stride length, centered on the heel, wide base, stiff body, inaccurate direction, more excessive or redundant movements, dull and mechanical movements.
(2) Mild tremor can be seen in the hands and head, and nystagmus is extremely common.
(3) Finger-nose test, opposable finger test, and heel-knee-shin test are difficult to complete.
(4) Speech lacks intonation and is sluggish.
(5) This type is not common, but is often mixed with other types, accounting for about 5% of cerebral palsy.
5. Hypotonia type The main manifestation is hypotonia and reduced muscle strength.
(1)Hypotonia, limbs are soft and paralyzed, with little voluntary movement, and the limbs are abducted and externally rotated in the supine position, resembling a supine frog, and the head cannot be lifted in the prone position.
(2) This type is easily confused with muscle retardation caused by myopathy, but tendon reflexes can be elicited.
(3) This type is often the early symptom of infants with cerebral palsy, and it may change to other types after early childhood, mostly involuntary movement type.
(4) This type may also be accompanied by early clinical manifestations of severe cerebral palsy with mental retardation, epilepsy and other comorbidities.
6.Mixed cerebral palsy is called mixed type when symptoms of two or more types of cerebral palsy exist in one child at the same time, and it is common to have spasticity and involuntary movement symptoms at the same time. When two or more types of symptoms are present at the same time, the symptoms of one type may predominate, or they may be more or less the same.