Signs and Symptoms

Generally, cerebral palsy is a condition that affects movement and posture. Symptoms of cerebral palsy vary greatly with some people having effects of the entire body, but others have symptoms that affect one or two limbs or one side of the body.

Here is a list of symptoms, according to the Mayo Clinic, that may occur but only some will be present in an individual. It is important when carrying out an assessment to assess for all these symptoms, and then note the ones that apply to an individual patient.

Movement and coordination

 Signs & Symptoms may include:

• Stiff muscles and exaggerated reflexes, known as spasticity. This is the most common movement condition related to cerebral palsy.
• Variations in muscle tone, such as being either too stiff or too floppy.
• Stiff muscles with regular reflexes, known as rigidity.
• Lack of balance and muscle coordination, known as ataxia.
• Jerky movements that can't be controlled, known as tremors.
• Slow, writhing movements.
• Favoring one side of the body, such as only reaching with one hand or dragging a leg while crawling.
• Trouble walking. People with cerebral palsy may walk on their toes or crouch down when they walk. They also may have a scissors-like walk with their knees crossing. Or they may have a wide gait or a walk that's not steady.
• Trouble with fine motor skills, such as buttoning clothes or picking up utensils.

Speech and eating

These symptoms related to speech and eating may occur:

• Delays in speech development.
• Trouble speaking.
• Trouble with sucking, chewing or eating.
• Drooling or trouble with swallowing.

Development

Some children with cerebral palsy have these symptoms related to development:

• Delays in reaching motor skills milestones, such as sitting up or crawling.
• Learning disabilities.
• Intellectual disabilities.
• Delayed growth, resulting in smaller size than would be expected.

https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/symptoms-causes/syc-20353999

Here are some common neurological conditions associated with cerebral palsy:

• Autism
• Attention deficit hyperactivity disorder (ADHD)
• Behavioral problems
• Epilepsy (seizure disorder)
• Intellectual disabilities
• Learning disabilities
• Speech and language issues (dysarthria)
• Sensory impairments
• Visual/hearing impairment

https://www.cerebralpalsyguide.com/cerebral-palsy/symptoms/

According to the US Department of Health and Human Services at the National Institutes of Health these are the signs of cerebral palsy in the early years of life. While these signs may appear in the first few months of life, many children are not diagnosed until age 2 or later.

Here are some age-specific signs:

• Infants younger than 6 months of age
  • Cannot hold up their head when picked up from lying on their back
  • May feel stiff or floppy
  • When picked up, their legs get stiff or cross
  • When held, they may overextend their back and neck, constantly acting as though they are pushing away from you
• Infants older than 6 months of age
  • Cannot roll over
  • Cannot bring their hands to their mouth
  • Have a hard time bringing their hands together
  • Reach out with only one hand while holding the other in a fist
• Infants older than 10 months of age
  • Crawl in a lopsided way, pushing with one hand and leg while dragging the opposite hand and leg
  • Scoot around on their buttocks or hop on their knees but do not crawl on all fours
  • Cannot stand even when holding onto support

https://www.nichd.nih.gov/health/topics/cerebral-palsy/conditioninfo/signs

Types of Cerebral Palsy

The CDC lists this classification of the types of Cerebral Palsy by the kind of movement disorder involved and the affected areas of the brain. It is possible a person can have one or more of the following motor disorders. (click graphic to exand and minimize)

• Stiff muscles (spasticity)
• Uncontrollable movements (dyskinesia)
• Poor balance and coordination (ataxia)

There are four main types of CP

1. Spastic Cerebral Palsy

Spastic CP affects about 80% of people with CP. People with spastic CP have increased muscle tone. This means their muscles are stiff and, as a result, their movements can be awkward.

• Spastic diplegia/diparesis - In this type of CP, muscle stiffness is mainly in the legs, with the arms less affected or not affected at all. People with spastic diplegia might have difficulty walking because tight hip and leg muscles cause their legs to pull together, turn inward, and cross at the knees (also known as scissoring). (click graphic to exand and minimize)
• Spastic hemiplegia/hemiparesis - This type of CP affects only one side of a person’s body; usually the arm is more affected than the leg.
• Spastic quadriplegia/quadriparesis - Spastic quadriplegia is the most severe form of spastic CP and affects all four limbs, the trunk, and the face. People with spastic quadriparesis usually cannot walk and often have other developmental disabilities such as intellectual disability; seizures; or problems with vision, hearing, or speech.  https://cprn.org/spastic-cerebral-palsy

2. Dyskinetic Cerebral Palsy (also includes athetoid, choreoathetoid, and dystonic cerebral palsies) People with dyskinetic CP have problems controlling the movement of their hands, arms, feet, and legs, making it difficult to sit and walk. The movements are uncontrollable and can be slow and writhing or rapid and jerky. Sometimes the face and tongue are affected, and the child has a hard time sucking, swallowing, and talking.

3. Ataxic Cerebral Palsy
   People with ataxic CP have problems with balance and coordination. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something
4. Mixed Cerebral Palsy
   Some people have symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP. (click graphic to exand and minimize)

Common CP Comorbidities that are not part of the core CP definition may include:

• pain (75%)
• intellectual disability (50%)
• inability to walk (33%)
• hip displacement (33%)
• inability to speak (25%)
• epilepsy (25%)
• incontinence (25%)
• behavioral or sleep disorders (20% to 25%), (Vitrikas & Briesh, (2020)