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Classification of Cerebral Palsy

- Spastic Syndrome:
    - are the most common (70% of cases) and most ammenable to surgery;
    - due to upper motor neuron involvment
    - mild to severe motor impairment
    - characterized by increased muscle tone and hyperreflexia, with slow, restricted movements (because of co contraction of agonist and antagonists);
          - spacsticity is characterized by increased muscle activity with increasingly rapid stretch;
    - hemiplegia
          - both limbs on one side: arm usually worse than leg
          - all hemiplegics will walk, regardless of treatment;
          - present with toe walking only;
    - diplegia:
          - pts have more extensive involvement of the lower extremity than the upper extremity;
          - most diplegics will eventually walk;
          - IQ may be normal, strabismus is common;
          - gait is typically characterized by a crouched gait, toe walking, and flexed knees;
                - heel cord lengthening alone may exacerbate crouched gait;
          - ref: Single-Event Multilevel Surgery in Children with Spastic Diplegia. A Pilot Randomized Controlled Trial 
    - paraplegia (both legs): sparing of arms;
    - quadriplegia: look for oral, lingual, dys f(x); dysarthria;

- Athetoid or Dyskinetic syndromes:
    - 20% of cases
    - result from basal ganglia involvement
    - present w/ slow, writhing, involuntary movements;
    - may affect the extremities (athetoid), or the proximal parts of limbs and the trunk (dystonic);
    - Aburt, jerky distal movements (Choreiform) also may occur;
    - Movements incr during w/ emotional tension and disappear during sleep.
    - Dysarthia is present and is often severe.
    - most difficult to correct with surgery;

- Ataxic syndrome:
    - 10% of cases;
    - involvement of the cerebellum or its pathways;
    - weakness, incoordination, and intention tremor produce unsteadiness,
         wide based gait, and difficulty with rapid or fine movements.
    - poorly ammenable to surgical correction