Cerebral palsy can affect any of a person’s motor skills — skills related to movement — including fine, gross, and oral motor skills.
Fine motor skills refer to tasks that use small muscles from one area of the body, usually the hands, fingers, and toes. These skills include writing, eating with silverware, curling your toes, turning a doorknob, or buttoning a shirt, for example.
Gross motor skills use many muscles throughout the body for large movements such as jumping, running, swimming, bending, reaching, and carrying items.
Oral motor skills are related to anything you do with your mouth, such as eating, drinking, or chewing gum.
Early Signs of Cerebral Palsy
For babies, missing one or more developmental milestones could be early signs of cerebral palsy. Milestones are the approximate ages when most children can do a certain skill, such as rolling over, sitting independently, picking things up, talking, or crawling. The CDC has a comprehensive list of what skills your child should have by certain ages, from 2 months to 5 years old.
However, delayed milestones could be related to many other types of conditions, or a child with some delays may not have any condition at all.
Parents may also notice the following signs in their children, though babies without cerebral palsy may show some of these also. Babies showing these signs should be evaluated by a pediatrician or family physician. (1)
Babies younger than 6 months
- Body stiffness
- Body floppiness
- Arching or seeming to push away while being held
- Lagging head when they are picked up
- Stiff legs that cross or look like scissors
Babies older than 6 months
- Not rolling over
- Unable to bring hands together or to their mouth
- One hand is in a fist when the other reaches out
Babies older than 10 months
- Dragging their limbs while crawling, seeming to use only half their body
- Scooting on their bottom instead of crawling on legs and hands
General Symptoms of Cerebral Palsy
As a child grows, more specific symptoms of cerebral palsy become clear. These include a variety of movement problems, such as the following:
- Stiffness or floppiness in muscle tone
- Exaggerated or abnormal reflexes (involuntary responses to stimuli)
- Little or no muscle coordination
- Involuntary/uncontrolled movements
- Poor motor skills in general
- Inability to control bowels
- Tremors or shaking
- Slow, writhing movements
- Mostly using only one side of the body
- Problems with walking, such as walking only on toes, leaning over while walking, knees crossing like scissors, or a wide or mismatched stride
- Excessive drooling or difficulty swallowing, sucking, or eating
- Poor or delayed speech development
- Problems with fine motor skills, such as difficulty grasping objects
Common Cerebral Palsy Terms
Certain terms are frequently used in describing symptoms of cerebral palsy.
- Ataxia refers to not having muscle coordination.
- Athetosis refers to slow, writhing, or squirming involuntary movements.
- Choreoathetosis refers to a combination of chorea (sudden, uncoordinated movements) and athetosis.
- Dystonia refers to involuntary muscle contractions with twisting, repetitive movements.
- Hypotonia refers to decreased muscle tone, which makes muscles look too loose or “floppy.”
- Hypertonia refers to increased muscle tone, which causes stiffness.
- Spasticity refers to stiff, tight muscles and exaggerated reflexes.
- Tremor is small, rhythmic shaking of the hands or another body part.
- Plegia is a suffix that means “paralysis of.” Types of paralysis include monoplegia (one limb), diplegia or paraplegia (two limbs), hemiplegia (one side of the body), quadriplegia (the whole body).
Diagnosis of Cerebral Palsy
There is no single test for cerebral palsy. Doctors collect information on symptoms, make clinical observations, and conduct tests to look for brain damage before making a diagnosis.
A person with suspected cerebral palsy will probably undergo at least one brain imaging test. Doctors use these images to look for brain damage or abnormalities.
Several types of brain imaging exist:
- Magnetic resonance imaging (MRI) uses a large magnet to create an image of the brain, revealing where and how the brain is damaged.
- A cranial ultrasound bounces sound waves off an infant’s brain to create an image.
- Computed tomography (CT) scans use X-rays to show cross-section images of the brain. Because of the radiation doses from a CT scan, many times an MRI or CUS may be preferred.
In addition, a child may undergo an electroencephalogram (EEG), which involves attaching electrodes to a child’s scalp to record electrical activity in the brain. An EEG also lets doctors tell if brain seizures are occurring. (2)
Types of Cerebral Palsy
No two cases of cerebral palsy are exactly the same. Cases can be mild, moderate, or severe, and the disorder may affect only certain parts of the body or the entire body. However, the way muscles are affected can be used to classify cerebral palsy into three types: spastic, dyskinetic, and ataxic. People can also have a mixed type, which includes characteristics from two or more types.
Spastic cerebral palsy is the most common type, found in 70 to 80 percent of people with cerebral palsy. People with spastic cerebral palsy have increased muscle tone, which causes stiffened muscles. This stiffness makes their movements look awkward or forced. (1)
Spastic cerebral palsy includes three subtypes based on which muscles are involved.
- Spastic diplegia or diparesis refers to muscle problems in the legs.
- Spastic hemiplegia or hemiparesis means only one side of a person’s body has muscle stiffness.
- Spastic quadriplegia or quadriparesis means a person’s entire body is affected — their face, trunk, and both arms and legs. These individuals are more likely to have other problems, such as seizures or intellectual, vision, hearing, or speech disabilities.
Dyskinetic, or athetoid, cerebral palsy occurs in about 10 percent of cerebral palsy cases. With this type, a person’s muscle tone can be too tight or too loose, and it may frequently change between those extremes in a single day. People with dyskinetic cerebral palsy do not have complete control over their hands, arms, feet, and legs. They may have rapid, jerky movements or slow, writhing movements. If their face is affected, swallowing, sucking, and talking may be difficult.
Ataxic cerebral palsy also makes up 10 percent of cases. It primarily affects a person’s balance and coordination. It is difficult for people with ataxic cerebral palsy to walk steadily or to do tasks requiring strong muscle control, such as sewing, writing, or washing dishes.