Cerebral palsy

===Classification===
CP is classified by the types of motor impairment of the limbs or organs, and by restrictions to the activities an affected person may perform.<ref name="rethlefsen_2010" /> The [[Gross Motor Function Classification System]]-Expanded and Revised and the [[Manual Ability Classification System]] are used to describe mobility and manual dexterity in people with cerebral palsy, and recently the [[Communication Function Classification System]], and the Eating and Drinking Ability Classification System have been proposed to describe those functions.<ref name="multidisciplinary455" /> There are three main CP classifications by motor impairment: spastic, ataxic, and dyskinetic. Additionally, there is a mixed type that shows a combination of features of the other types. These classifications reflect the areas of the brain that are damaged.<ref>{{cite book | vauthors = Ogoke C |title=Clinical Classification of Cerebral Palsy |date=2018 |url=https://www.researchgate.net/publication/329785522 |access-date=21 March 2021}}</ref>

Cerebral palsy is also classified according to the topographic distribution of muscle spasticity.<ref name="Becher" /> This method classifies children as [[spastic diplegia|diplegic]], (bilateral involvement with leg involvement greater than arm involvement), [[spastic hemiplegia|hemiplegic]] (unilateral involvement), or [[spastic quadriplegia|quadriplegic]] (bilateral involvement with arm involvement equal to or greater than leg involvement).<ref name="O'Shea" /><ref name="Becher" />

====Spastic====
{{main|Spastic cerebral palsy}}
Spastic cerebral palsy is the type of cerebral palsy characterized by [[spasticity]] or high muscle tone often resulting in stiff, jerky movements.<ref name=":0:" /> Itself an [[umbrella term]] encompassing [[spastic hemiplegia]], [[spastic diplegia]], [[spastic quadriplegia]] and – where solely one limb or one specific area of the body is affected – spastic monoplegia. Spastic cerebral palsy affects the [[motor cortex]]<ref name=":0:" /> of the brain, a specific portion of the [[cerebral cortex]] responsible for the planning and completion of voluntary movement.<ref>{{Cite web|url=https://nba.uth.tmc.edu/neuroscience/m/s3/chapter03.html|title=Chapter 3: The motor cortex| vauthors = Knierim J |date=2020|website=Neuroscience online: An electronic textbook of the neurosciences from the University of Texas at Houston|url-status=dead|archive-url=https://web.archive.org/web/20191217070517/https://nba.uth.tmc.edu/neuroscience/m/s3/chapter03.html|archive-date=17 December 2019|access-date=4 March 2020}}</ref>  Spastic CP is the most common type of overall cerebral palsy, representing about 80% of cases.<ref>{{Cite web|url=https://www.cdc.gov/ncbddd/cp/facts.html|title=What is Cerebral Palsy? {{!}} CDC|last=CDC|date=2018-04-18|website=Centers for Disease Control and Prevention|language=en-us|access-date=2020-03-05}}</ref> [[Botulinum toxin]] is effective in decreasing [[spasticity]].<ref name=Farag2020/> It can help increase range of motion which could help mitigate CPs effects on the growing bones of children.<ref name=Farag2020/> There may be an improvement in motor functions in the children and ability to walk. however, the main benefit derived from botulinum toxin A comes from its ability to reduce muscle tone and spasticity and thus prevent or delay the development of fixed muscle contractures.<ref name=Farag2020/><ref>{{cite journal | vauthors = Nolan KW, Cole LL, Liptak GS | title = Use of botulinum toxin type A in children with cerebral palsy | journal = Physical Therapy | volume = 86 | issue = 4 | pages = 573–584 | date = April 2006 | pmid = 16579673 | doi = 10.1093/ptj/86.4.573 | doi-access = free }}</ref>

====Ataxic====
{{main|Ataxic cerebral palsy}}
Ataxic cerebral palsy is observed in approximately 5–10% of all cases of cerebral palsy, making it the least frequent form of cerebral palsy.<ref>{{cite journal | vauthors = McHale DP, Jackson AP, Levene MI, Corry P, Woods CG, Lench NJ, Mueller RF, Markham AF | title = A gene for ataxic cerebral palsy maps to chromosome 9p12-q12 | journal = European Journal of Human Genetics | volume = 8 | issue = 4 | pages = 267–272 | date = April 2000 | pmid = 10854109 | doi = 10.1038/sj.ejhg.5200445 | doi-access = free }}</ref> Ataxic cerebral palsy is caused by damage to cerebellar structures.<ref>{{cite journal | vauthors = Cheney PD |title=Pathophysiology of the corticospinal system and basal ganglia in cerebral palsy |journal= Mental Retardation and Developmental Disabilities Research Reviews |volume=3 |pages=153–167 |year=1997 |doi=10.1002/(SICI)1098-2779(1997)3:2<153::AID-MRDD7>3.0.CO;2-S |issue=2}}</ref> Because of the damage to the [[cerebellum]], which is essential for coordinating muscle movements and balance, patients with ataxic cerebral palsy experience problems in coordination, specifically in their arms, legs, and trunk. Ataxic cerebral palsy is known to decrease muscle tone.<ref>{{cite journal | vauthors = Straub K, Obrzut JE |title=Effects of cerebral palsy on neurophsyological function |journal=Journal of Developmental and Physical Disabilities |volume=21 |pages=153–167 |year=2009 |doi=10.1007/s10882-009-9130-3 |issue=2|s2cid=144152618 }}</ref> The most common manifestation of ataxic cerebral palsy is intention (action) [[tremor]], which is especially apparent when carrying out precise movements, such as tying shoe laces or writing with a pencil. This symptom gets progressively worse as the movement persists, making the hand shake. As the hand gets closer to accomplishing the intended task, the trembling intensifies, which makes it even more difficult to complete.<ref name="O'Shea" />

====Dyskinetic====
{{main|Dyskinetic cerebral palsy}}
Dyskinetic cerebral palsy (sometimes abbreviated DCP) is primarily associated with damage to the [[basal ganglia]] and the [[substantia nigra]] in the form of [[lesions]] that occur during brain development due to [[bilirubin]] [[encephalopathy]] and hypoxic-ischemic [[brain]] injury.<ref name="Hou et al" /> DCP is characterized by both [[hypertonia]] and [[hypotonia]], due to the affected individual's inability to control muscle tone.<ref name="O'Shea" /> Clinical diagnosis of DCP typically occurs within 18 months of birth and is primarily based upon motor function and [[neuroimaging]] techniques.<ref name="ADCP" /><ref name="Mann" />
Dyskinetic cerebral palsy is an [[extrapyramidal system|extrapyramidal]] form of cerebral palsy.<ref name="Jones" /> Dyskinetic cerebral palsy can be divided into two different groups; [[choreoathetosis]] and [[dystonia]].<ref name="O'Shea" /> Choreo-athetotic CP is characterized by involuntary movements, whereas dystonic CP is characterized by slow, strong contractions, which may occur locally or encompass the whole body.<ref name="Becher" />

====Mixed====
Mixed cerebral palsy has symptoms of dyskinetic, ataxic and spastic CP appearing simultaneously, each to varying degrees, and both with and without symptoms of each. Mixed CP is the most difficult to treat as it is extremely heterogeneous and sometimes unpredictable in its symptoms and development over the lifespan.<ref>{{Cite news |date=2023-10-05 |title=World Cerebral Palsy Day 2023: What is it and how does it affect a person? |url=https://www.bbc.com/newsround/67018528 |access-date=2024-03-16 |work=BBC Newsround |language=en-GB}}</ref><ref>{{Cite journal |title=Multi-Organ Dysfunction in Cerebral Palsy |journal=NLM|date=2021 |pmc=8382237 |volume=9 |doi=10.3389/fped.2021.668544 |doi-access=free |pmid=34434904 | vauthors = Allen J, Zareen Z, Doyle S, Whitla L, Afzal Z, Stack M, Franklin O, Green A, James A, Leahy TR, Quinn S, Elnazir B, Russell J, Paran S, Kiely P, Roche EF, McDonnell C, Baker L, Hensey O, Gibson L, Kelly S, McDonald D, Molloy EJ }}</ref><ref>{{Cite web |last=Visco |first=Rory |date=2023-11-09 |title=Early detection, societal support needed to combat cerebral palsy in the PHL {{!}} Rory Visco |url=https://businessmirror.com.ph/2023/11/09/early-detection-societal-support-needed-to-combat-cerebral-palsy-in-the-phl/ |access-date=2024-03-16 |website=BusinessMirror |language=en-US}}</ref><ref>{{Cite web |title=Cerebral Palsy {{!}} National Institute of Neurological Disorders and Stroke |url=https://www.ninds.nih.gov/health-information/disorders/cerebral-palsy |access-date=2024-03-16 |website=www.ninds.nih.gov |language=en}}</ref>