Scholars around the world have done a lot of research on cerebral palsy, but because cerebral palsy is a relatively complex disease, there is not yet a very complete, clear and precise definition that can be recognized by scholars in all countries. The International Classification of Functioning, Disability and Health (ICF) was officially released by the World Health Organization (WHO) in 2001, and the research development and application of ICF has had an extremely important impact on disability and rehabilitation work. Under the influence of ICF, there have been new developments in the definition, clinical typing and rehabilitation treatment of cerebral palsy in recent years, and the development trend is more in line with the core contents of ICF.
1. Definition
Before 2004, the definition, diagnostic conditions and typing of pediatric cerebral palsy proposed at the First National Symposium on Cerebral Palsy held in Jiamusi in 1988 had been used in China and expressed as “Cerebral palsy is a syndrome caused by non-progressive brain injury during the developmental period from before birth to 1 month after birth [1].” This definition includes the following aspects: 1) the cause of the disease: non-progressive brain injury; 2) the period of brain injury: conception to neonatal period; 3) clinical symptoms: central motor dysfunction and postural abnormalities; the 2004 National Symposium on Pediatric Cerebral Palsy summarized these problems and made a new revision of the definition, diagnostic conditions and typing of cerebral palsy [2]; in 2006, a monthly conference was held in Changsha. The National Pediatric Cerebral Palsy Rehabilitation Symposium revised the 2004 definition [3] and expressed it as follows: cerebral palsy is a syndrome caused by non-progressive brain injury and developmental defects from conception to infancy, mainly manifested by motor dysfunction and postural abnormalities.” and includes the following diagnostic conditions: 1{the injury causing sexual cerebral palsy is non-progressive; 2{the site of the lesion causing the movement disorder is in the brain; 3{the symptoms appear in infancy; 4{sometimes combined with mental retardation, epilepsy, perceptual impairment and other abnormalities; 5{except for central movement due to progressive disease and temporary motor developmental delay in normal children.
In recent years, the international cerebral palsy rehabilitation community has extensively discussed the definition of cerebral palsy originally published in 2004, and after listening to various opinions, especially with reference to the ICF, a revised definition of cerebral palsy was developed in 2006, stating that cerebral palsy refers to a group of persistent motor and postural developmental disorders leading to limitation of movement, which are caused by non-progressive damage to the developing fetal or infant brain. It is caused by non-progressive damage to the developing fetal or infant brain. The motor deficits of cerebral palsy are often accompanied by sensory, cognitive, communication, or behavioral deficits, and/or epilepsy, and/or secondary musculoskeletal disorders.
Each important evolution in the definition of cerebral palsy has marked a new understanding of the disease, and the 2006 international definition of cerebral palsy is now widely accepted, mainly because it points out that the population with cerebral palsy is characterized by limited mobility, and that improving mobility is the aim of rehabilitation medicine, indirectly indicating that rehabilitation is the theme of cerebral palsy treatment. In addition, the inclusion of musculoskeletal problems in the definition also suggests that orthopedic surgery should have an important role in the treatment of cerebral palsy. Although the 2006 revised definition of cerebral palsy in China changed the time frame of the causative factors of cerebral palsy and its secondary developmental abnormalities or pathological damage process from the explicitly defined time frame (before birth to within one month after birth) in the 2004 definition to the vaguely defined time frame (from conception to infancy), which is consistent with most of the international definitions, there are still some differences with the new international definition in 2006. However, there are some differences with the new international definition in 2006.
2. Clinical typing
American Cerebral Palsy Association’s cerebral palsy typology
Physiological (motor) typing
By site
A.Spastic type
B. Tardive dyskinesia
C. Tonic type
D.Dystonic
E.Tremor type
F.Delayed type
G.Mixed type
H.Unspecified type of limb palsy
A.Monoplegia
B.Paraplegia
C, hemiplegia
D.Triplegia
E.Quadriplegia
F.Diplegia
G.Double hemiplegia
In 1988, at the first National Symposium on Cerebral Palsy, the typology of cerebral palsy in China was formulated, basically referring to the American typology, as follows.
The typology according to clinical characteristics
(1) spastic type (2) tardive type (3) tonic type (4) ataxic type (5) tremor type (6) hypotonic type (7 mixed type) (8) unclassifiable type
Two types of paralysis according to the site
(1) Monoplegia (2) Diplegia (3) Triplegia (4) Quadriplegia
(5) Hemiplegia (6) Paraplegia (7) Dual hemiplegia