Cerebral palsy

==History==
Cerebral palsy has affected humans since antiquity.<!-- <ref name="History2013" /> --> A decorated grave marker dating from around the 15th to 14th century BCE shows a figure with one small leg and using a crutch, possibly due to cerebral palsy.<!-- <ref name="History2013" /> --> The oldest likely physical evidence of the condition comes from the mummy of [[Siptah]], an Egyptian [[Pharaoh]] who ruled from about 1196 to 1190&nbsp;BCE and died at about 20 years of age.<!-- <ref name="History2013" /> --> The presence of cerebral palsy has been suspected due to his deformed foot and hands.<ref name="History2013" />

The medical literature of the [[Ancient Greece|ancient Greeks]] discusses paralysis and weakness of the arms and legs; the modern word ''palsy'' comes from the [[Ancient Greek]] words ''παράλυση'' or ''πάρεση'', meaning paralysis or paresis respectively.<!-- <ref name="History2013" /> --> The [[Hippocratic Corpus|works of the school of Hippocrates]] (460{{endash}}c. 370&nbsp;BCE), and the manuscript ''On the Sacred Disease'' in particular, describe a group of problems that matches up very well with the modern understanding of cerebral palsy.<!-- <ref name="History2013" /> --> The Roman Emperor [[Claudius]] (10 BCE{{endash}}54 CE) is suspected of having CP, as historical records describe him as having several physical problems in line with the condition. Medical historians have begun to suspect and find depictions of CP in much later art.<!-- <ref name="History2013" /> --> Several paintings from the 16th century and later show individuals with problems consistent with it, such as [[Jusepe de Ribera]]'s 1642 painting ''[[The Clubfoot]]''.<ref name="History2013" />

The modern understanding of CP as resulting from problems within the brain began in the early decades of the 1800s with a number of publications on brain abnormalities by [[Johann Christian Reil]], [[Claude François Lallemand]] and [[Philippe Pinel]].<!-- <ref name="History2013" /> --> Later physicians used this research to connect problems in the brain with specific symptoms.<!-- <ref name="History2013" /> --> The English surgeon [[William John Little]] (1810{{endash}}1894) was the first person to study CP extensively.<!-- <ref name="History2013" /> --> In his doctoral thesis he stated that CP was a result of a problem around the time of birth.<!-- <ref name="History2013" /> --> He later identified a difficult delivery, a [[preterm birth]] and [[perinatal asphyxia]] in particular as risk factors.<!-- <ref name="History2013" /> --> The [[spastic diplegia]] form of CP came to be known as Little's disease.<ref name="History2013" /> At around this time, a German surgeon was also working on cerebral palsy, and distinguished it from polio.<ref>{{cite journal|title=The Definition and Classification of Cerebral Palsy|journal=[[Developmental Medicine & Child Neurology]]|date=28 June 2008|volume=49|pages=1–44|doi=10.1111/j.1469-8749.2007.00201.x|s2cid=221645066|doi-access=free}}</ref> In the 1880s British neurologist [[William Gowers (neurologist)|William Gowers]] built on Little's work by linking paralysis in newborns to difficult births.<!-- <ref name=History2013/ --> He named the problem "birth palsy" and classified birth palsies into two types: peripheral and cerebral.<ref name="History2013" />

Working in the US in the 1880s, Canadian-born physician [[William Osler]] (1849{{endash}}1919) reviewed dozens of CP cases to further classify the disorders by the site of the problems on the body and by the underlying cause.<!-- <ref name="History2013" /> --> Osler made further observations tying problems around the time of delivery with CP, and concluded that problems causing bleeding inside the brain were likely the root cause.<!-- <ref name="History2013" /> --> Osler also suspected polioencephalitis as an infectious cause.<!-- <ref name="History2013" /> --> Through the 1890s, scientists commonly confused CP with [[Poliomyelitis|polio]].<ref name="History2013" />

Before moving to psychiatry, Austrian neurologist [[Sigmund Freud]] (1856{{endash}}1939) made further refinements to the classification of the disorder. He produced the system still being used today.<!-- <ref name="History2013" /> --> Freud's system divides the causes of the disorder into problems present at birth, problems that develop during birth, and problems after birth.<!-- <ref name="History2013" /> --> Freud also made a rough correlation between the location of the problem inside the brain and the location of the affected limbs on the body and documented the many kinds of movement disorders.<ref name="History2013" />

In the early 20th century, the attention of the medical community generally turned away from CP until orthopedic surgeon Winthrop Phelps became the first physician to treat the disorder.<!-- <ref name="History2013" /> --> He viewed CP from a [[musculoskeletal system|musculoskeletal]] perspective instead of a neurological one.<!-- <ref name="History2013" /> --> Phelps developed surgical techniques for operating on the muscles to address issues such as spasticity and muscle rigidity.<!-- <ref name="History2013" /> --> Hungarian [[physical rehabilitation]] practitioner [[András Pető]] developed a system to teach children with CP how to walk and perform other basic movements.<!-- <ref name="History2013" /> --> Pető's system became the foundation for [[conductive education]], widely used for children with CP today.<!-- <ref name=History2013/ --> Through the remaining decades, physical therapy for CP has evolved, and has become a core component of the CP management program.<ref name="History2013" />

In 1997, Robert Palisano ''et al.'' introduced the [[Gross Motor Function Classification System]] (GMFCS) as an improvement over the previous rough assessment of limitation as either mild, moderate, or severe.<ref name="rethlefsen_2010" /> The GMFCS grades limitation based on observed proficiency in specific basic mobility skills such as sitting, standing, and walking, and takes into account the level of dependency on aids such as wheelchairs or walkers. The GMFCS was further revised and expanded in 2007.<ref name="rethlefsen_2010" />