the spastic muscles tend to remain fixed in their
positions (contractures) as the contracted MUSCLE
fibers eventually shorten. There are four forms of
spastic cerebral palsy that affect the body in differ-
ent ways:
- Spastic diplegia affects both arms and both legs,
though it affects the legs more severely. The
legs of people who have spastic diplegic cere-
bral palsy often turn in at the knees and cross
with walking, causing a characteristic, awkward
“scissors gait.” Balance and sustained move-
ment may be difficult. Severe leg involvement
may result in the inability to walk. When arm
involvement is moderate to severe, the person
may need assistance to eat, bathe, dress, and
carry out many of the functions of daily living. - Spastic hemiplegia (also called spastic hemi-
paresis) affects the arm, trunk, and leg on one
side of the body. Balance is generally better
than with spastic diplegia because one side of
the body functions normally, though gait is
awkward. Spastic hemiplegia may also affect
one side of the face, sometimes resulting in
speech, eating, and swallowing difficulties.
Some people who have spastic hemiplegic cere-
bral palsy experience tremors (uncontrollable
shaking) on the affected side of the body. - Spastic paraplegia (also called spastic parapare-
sis) affects only the legs. As with spastic diple-
gia, movement when walking may be
awkward. Balance is generally better, though,
because the arms and upper body function nor-
mally and can to some extend offset the dys-
functions of the lower body. - Spastic quadriplegia (also called spastic quadri-
paresis) affects the entire body—face, arms,
trunk, legs—with equal severity. People who
have mild spastic quadriplegic cerebral palsy
may function relatively normally, though peo-
ple who have moderate to severe damage may
be relatively immobilized and dependent on
others for care.
Athetoid cerebral palsy Athetoid, or dyskinetic,
cerebral palsy causes persistent, involuntary
movements that are slow, rhythmic, and writhing.
About 15 percent of people who have cerebral
palsy have this form, which most commonly
affects the arms and legs though also can involve
the face. Facial involvement typically results in
speech, eating, and swallowing difficulties. The
movements generally subside during sleep and
often intensify during emotional experiences.
Ataxic cerebral palsy Ataxic cerebral palsy is
the least common form of cerebral palsy, affecting
only about 5 percent of people who have cerebral
palsy. Ataxic cerebral palsy affects a person’s bal-
ance and coordination, causing the person to
adopt a wide stance and gait. In this form of cere-
bral palsy muscle tone may be normal, increased,
or decreased. Tasks that require rapid or prolonged
movements are often the most difficult. People
who have ataxic cerebral palsy may also have
intention tremors, in which their arms or legs
shake uncontrollably with purposeful movement
such as taking a step or reaching for an object.
Mixed cerebral palsy About 10 percent of peo-
ple who have cerebral palsy have a mix of the
standard forms. The most common mixed form is
spastic and athetoid, in which the person has both
stiff, contracted muscles and involuntary, writhing
movement. Mixed forms of cerebral palsy also
range from mild to severe, though are more likely
to interfere with mobility and independence at
less severe levels because of the multiple effects.Symptoms and Diagnostic Path
The symptoms of cerebral palsy generally do not
become apparent until an infant is 2 months to 2
years old. Neurologists have identified hand pref-
erence before age 12 months as one of the first
indications of spastic hemiplegic cerebral palsy; in
the course of normal development a child does
not acquire hand preference until older than 12
months. Infants who have cerebral palsy may
reach developmental markers, such as sitting
unassisted or rolling over, more slowly than nor-
mal. Some have obvious hypertonicity (tense
muscles) or hypotonicity (flaccid muscles).
The pediatrician closely monitors a child at risk
for cerebral palsy, regularly assessing motor skills,
reflexes, and other dimensions of growth and
development. Common at-risk factors include low
birth weight, preterm (premature) delivery,
seizure disorders, severe neonatal jaundice, Rh
incompatibility, and a history of difficulties duringcerebral palsy 239