The neurological damage or disordered brain development that causes cerebral palsy does not get worse over time. However, because the damaged / disordered part of the brain constantly has an effect on the muscles and movement, these need to keep being worked on over the years.
Symptoms of cerebral palsy include difficulty with fine motor tasks, difficulty maintaining balance or walking, and involuntary movements. The symptoms can differ from person to person and may change over time. Some people with cerebral palsy also have other disorders including seizures, learning disabilities, speech or sensory difficulties.
There is a spectrum of severity in cerebral palsy: it does not always cause profound disabilities, but can be just mild and slightly awkward.
Early signs of cerebral palsy usually appear before three years of age. Infants with cerebral palsy frequently have developmental delay, in which they are slow to reach developmental milestones such as learning to roll over, sit, crawl, smile or walk. (However, there are other causes of developmental delay so this needs to be analysed by a clinician.)
Some infants with cerebral palsy have abnormal muscle tone as infants. Decreased muscle tone (hypotonia) can make them appear relaxed, even floppy. Increased muscle tone (hypertonia) can make them stiff or rigid. In some cases, an early period of hypotonia will progress to hypertonia after the first 2 to 3 months of life. Children with cerebral palsy may also have unusual posture or favour one side of the body when they move.
Children with cerebral palsy exhibit a wide variety of symptoms, including:
- lack of muscle coordination when performing voluntary movements (ataxia);
- stiff or tight muscles and exaggerated reflexes (spasticity);
- walking with one foot or leg dragging;
- walking on the toes, a crouched gait, or a “scissored” gait;
- variations in muscle tone, either too stiff or too floppy;
- excessive drooling or difficulties swallowing or speaking;
- shaking (tremor) or random involuntary movements; and
- difficulty with precise motions, such as writing or buttoning a shirt.
For practical purposes, cerebral palsy is divided into the following types:
spastic (stiff muscles)
athetoid (involuntary movements). This is sometimes described as a dyskinetic cerebral palsy, subdivided into athetoid, choreoathetoid and dystonic, according to the type of movement – slow and sinuous, aimless and fairly continuous, or with abnormal muscle tone. In the UK it is common to use the term “athetoid” generally for them all. Occasionally it is also called extrapyramidal cerebral palsy, referring to the area of the brain’s motor system that is affected.
ataxic (poor balance, coordination and depth perception)
The term –paresis means “weakened”, and –plegia or –plaegia means “paralysed”. So, for example, a child affected on one side of the body has hemiparesis or hemiplegia. If all four limbs are affected, it is quadriplegia. If only, or mainly the upper or lower part of the body is affected, it is diplegia (usually it is the lower part). Diplegia that is more of a weakness than a paralysis is sometimes called diparesis, though this term is not much used in the UK.
In hemiplegia and hemiparesis, there are quite often learning difficulties and some studies show a tendency to behavioural difficulties as well. In diplegia, usually the ability to learn is normal. Quadriplegia is usually severe and associated with moderate-to-severe learning disability. It is the most likely type to involve seizures. In athetoid or dyskinetic cerebral palsy, the ability to learn is usually normal but speech can be difficult because of difficulty in controlling facial muscles. In ataxic cerebral palsy there is often a tremor that gets in the way of using the hands, called “intention tremor” because it gets worse the nearer the hand gets to the thing that is being reached for.
In some cases there is a mixture of several of these types of cerebral palsy.
Each of these characteristics, taken on their own, can be caused by a variety of conditions other than cerebral palsy. Please note, also, that dystonia and ataxia are separate conditions all together and should not be confused with dystonic and ataxic cerebral palsy.
