Cerebral Palsy - Classification & Prognosis

Question 1

Classification of CP:

Answer 1

topography
type of muscle tone
function

Question 2

Topographic Classification =

Answer 2

areas of the body affected by CP

primary categories include:
hemiplegia
diplegia
tetraplegia
quadriplegia

Question 3

hemiplegia =

Answer 3

38% of cases

often small, unilateral hemorrhage or pediatric stroke

affects one side of body; arm, leg, trunk, and head

Question 4

diplegia =

Answer 4

37% of cases

often bilateral hemorrhage

lower limbs affected more often

Question 5

tetraplegia and quadriplegia =

Answer 5

~24% of cases
often large HIE = hypoxic ischemic encephalopathy

tetraplegia = affects 3 limbs, and trunk, and head
*fairly uncommon

quadriplegia = affects all 4 limbs, trunk, and head

Question 6

Type of CP Classified by Muscle Tone:

Answer 6

diskinetic
ataxic
spastic
multiple areas

Question 7

diskinetic =

Answer 7

lesion of basal ganglia

involuntary movement

Includes both athetosis (slow, writhing movements) and dystonia (involuntary muscle contractions)

Question 8

ataxic =

Answer 8

lesion of cerebellum

shaky movement
poor balance

Characterized by poor coordination and balance, with decreased muscle tone (hypotonia)

Question 9

spastic =

Answer 9

lesion of motor cortex or corticospinal tracts

muscles appear stiff

most common type of CP

Characterized by increased muscle tone (spasticity) and exaggerated reflexes

Question 10

multiple areas =

Answer 10

combination of types

Question 11

Spastic 
Cerebral Palsy CHARACTERISTICS =

Answer 11

Most common (~86%)
Increased Muscle Tone/Stiffness

Described by parts of body that are affected:
Spastic Diplegia
Spastic Hemiplegia
Spastic Quadriplegia

Question 12

Spastic Diplegia

Answer 12

spastic cerebral palsy that primarily affects the legs, with less involvement of the arms

increased muscle tone in the legs, which can lead to stiffness and difficulty with walking

“scissoring” gait where the legs cross over each other while walking

arms are generally less affected but may show some mild motor impairment or tone abnormalities

difficulty with balance, coordination, and fine motor skills

leading to gait and balance issues

Question 13

Spastic Hemiplegia

Answer 13

affects one side of the body, including both the arm and the leg on that side

increased muscle tone and stiffness affecting one arm and one leg on the same side of the body

arm might be held in a flexed position, and the leg may have difficulties with movement, leading to walking challenges

difficulties with tasks requiring the use of both hands or legs, such as dressing or running

Motor difficulties are confined to one side of the body, leading to asymmetrical movement and strength

resulting in asymmetric motor impairments

Question 14

Ataxic 
Cerebral Palsy CHARACTERISTICS -

Answer 14

~5%

Balance and coordination impairments

They will appear unsteady

Shaky movements

Movements that require a lot of control are super challenging (e.g., writing, dressing, etc.)

appear to stagger or have difficulty walking straight

Problems with tasks that require precise hand-eye coordination, such as writing, buttoning clothes, or using utensils

Question 15

Spastic Quadriplegia

Answer 15

most severe form of spastic cerebral palsy and involves spasticity affecting all four limbs (both arms and legs)

can also affect the trunk and may involve difficulty with head control, sitting, and maintaining balance

difficulties with speech, swallowing, and other bodily functions due to the widespread involvement of motor control

leading to severe motor and functional impairments

Question 16

Dyskinetic 
Cerebral Palsy CHARACTERISTICS -

Answer 16

~6%

Involuntary, variable movement

Dystonia – Twisting, repetitive
Athetosis - Slow, continuous, writhing movements

Chorea - Quick, dance-like, irregular, unpredictable

Choreoathetosis – combination of chorea and athetosis

Question 17

Movement System Diagnoses

Answer 17

fractionated movement deficit

force production deficit

motor coordination deficit

Most prevalent impairment that impacts function will help determine where treatment may begin

Question 18

Fractionated Movement Deficit

Answer 18

inability to control and execute movements in a discrete, controlled manner

difficulties with isolating and coordinating individual muscle movements, which can lead to stiff or awkward motions

Impaired Dexterity: Difficulty with tasks requiring fine motor control, such as writing or manipulating small objects.

Movement Inaccuracy: Challenges in achieving precise, controlled movements, leading to imprecise or jerky motions.

Question 19

Force Production Deficit

Answer 19

difficulty generating the necessary strength or force to perform movements effectively

can result from weakness or reduced muscle power

Limited Endurance: Difficulty sustaining force production over time, leading to fatigue or incomplete tasks.

Functional Limitations: Challenges with activities that require force, such as lifting objects, climbing stairs, or maintaining posture.

Question 20

Motor Coordination Deficit

Answer 20

difficulties in coordinating and integrating motor skills to perform tasks smoothly and accurately

challenges with the timing, sequencing, and integration of movements

playing sports or performing intricate hand movements = hard

Clumsiness: Increased likelihood of dropping objects or making unintended movements due to poor coordination.

Question 21

Types of CP Classified by Function

Answer 21

5 levels

Gross motor function classification system isn’t based on muscle tone or topography, but
it is based on the individual’s motor function

Lower levels associated with 
greater function

NOT associated with their self reported quality of life!!!!

Question 22

level 1

Answer 22

walks without devices

able to perform all basic activities of daily living and participate in most activities

may have difficulties with more advanced motor skills, such as running or jumping, but does not need assistive devices for walking

Question 23

level 2

Answer 23

walks without devices

Requires some assistance or the use of mobility aids for long distances or challenging terrains

Can walk independently in familiar environments but may have difficulty with more complex motor tasks

Question 24

level 3

Answer 24

walks with mobility devices

Requires a mobility aid (walker or wheelchair) for most activities and may be able to walk short distances with assistance

Has significant limitations in independent mobility and daily activities

Question 25

level 4

Answer 25

self mobility with limitations, may use powered mobility

very limited independent mobility and requires significant support for most activities

wheelchair for most mobility and needs assistance with many daily tasks and personal care

Question 26

level 5

Answer 26

self mobility is severely limited even with use of supporting technology

very limited control over voluntary movements and is dependent on others for most aspects of care and mobility

Requires full assistance with daily activities and uses a wheelchair for mobility

Question 27

GMFCS Stability

Answer 27

Classification tool!
*should not be used
as an outcome
measure

GMFCS level of a child with CP is generally stable once the child reaches around 2 to 4 years of age

Gross motor function 
increases in those early years
of life and levels off around 6

GMFCS levels 3 - 5:
there is a dip in function starting in age 7-9 = likely due to secondary impairments (importance of PT for 
prevention strategies)

Question 28

Prognostic Predictor for Ambulation

Answer 28

sitting independently (without arm support) by 24 months

walking with or without assistance

reflects the child’s core strength, postural control, and motor coordination

Children who achieve this milestone are more likely to achieve further motor milestones, including walking

Question 29

GMFCS level 1 - 6-12 yrs

Answer 29

children walk at home, school , outdoors and in the community

they can climb stairs without the use of a railing

perform gross motor skills such as running and jumping

speed, balance, and coordination are limited

Question 30

GMFCS level 2 - 6-12 yrs

Answer 30

children walk in most settings and climb stairs holding onto a railing

may experience difficulty walking long distances and balancing on uneven terrain inclines, in crowded areas, or confined spaces

may walk with physical assistance, a hand-held mobility device or use wheeled mobility over long distances

only minimal ability to perform gross motor skills such as running and jumping

Question 31

GMFCS level 3 - 6-12 yrs

Answer 31

children walk using a hand-held mobility device in most indoor settings

may climb stairs holding onto a railing with supervision or assistance

use wheeled mobility when traveling long distances and may self-propel for shorter distances

Question 32

GMFCS level 4 - 6-12 yrs

Answer 32

children use methods of mobility that require physical assistance or powered mobility in most settings

may walk for short distances at home with physical assistance or use powered mobility or a body support walker when positioned

at school, outdoors and in the community children are transported in a manual wheelchair or use powered mobility

Question 33

GMFCS level 5 - 6-12 yrs

Answer 33

children are transported in a manual wheelchair in all settings

children are limited in their ability to maintain antigravity head and trunk postures and control leg and arm movements

Question 34

GMFCS level 1 - 12- 18yrs

Answer 34

youth walk at home, school , outdoors and in the community

they can climb stairs without the use of a railing

perform gross motor skills such as running and jumping

speed, balance, and coordination are limited

Question 35

GMFCS level 2 - 12- 18yrs

Answer 35

youth walk in most settings but environmental factors and personal choice influence mobility choices

at school or work they may require a hand-held mobility device for safety and climb stairs holding onto a railing

outdoors and in the community youth may use wheeled mobility when traveling long distances

Question 36

GMFCS level 3 - 12- 18yrs

Answer 36

youth are capable of walking using a hand-held mobility device

may climb stairs holding onto a railing with supervision or assistance

at school, they may self-propel a manual wheelchair or use powered mobility

outdoors and in the community they are transported in a wheelchair or use powered mobility

Question 37

GMFCS level 4 - 12- 18yrs

Answer 37

youth use wheeled mobility in most settings

physical assistance of 1-2 people is required for transfers

indoors, youth may walk short distances with physical assistance, use wheeled mobility or a body support walker when positioned

may operate a powered chair, otherwise are transported in a manual wheelchair

Question 38

GMFCS level 5 - 12- 18yrs

Answer 38

youth are transported in a manual wheelchair in all settings

children are limited in their ability to maintain antigravity head and trunk postures and control leg and arm movements

self-mobility is severely limited, even with the use of assistive technology

Question 39

Cerebral palsy can be classified by:

Answer 39

topography, type of muscle tone, and motor function

Question 40

One early gross motor milestone that is most predictive of walking is =

Answer 40

sitting independently by 2 years of age