Cerebral Palsy (CP)

Question on a patient with Cerebral Palsy (CP)

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A 3-month old infant is referred to outpatient physical therapy following discharge
from a neonatal intensive care unit with a diagnosis of cerebral palsy. The infant
was born at 27 weeks gestational age with Apgars of 5 at 1 minute and 7 at 5
minutes. Past medical history includes respiratory distress syndrome, seizure
disorder, and gastroesophageal reflux. Upon examination, the infant exhibits
poor head control, fisted hands, and an inability to achieve prone on elbows.

TABLE 232-3 Gross Motor Function Classification System

Level Description

I Walks without restrictions, limitations in more advanced gross motor skills

II Walks without assistive devices; limitations walking outdoors and in the community

III Walks with assistive mobility devices; limitations walking outdoors and in the community

IV Self-mobility with limitations; are transported or use power motor mobility outdoors and in the community

V Self-mobility is severely limited even with the use of assistive technologyData from

Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39:214–223.

Which of the following signs or symptoms would be characteristic of the most
common type of cerebral palsy?
A. “Floppy” feeling when picked up by adult
B. Legs crossed when held in standing
C. Tremors and falls often
D. Writhing movements
B. When held in standing and the legs cross describes hyerptonia or spasticity
which is the most common type of CP. Option A describes hypotonia, option C
describes ataxia, and option D describes dyskinesia – athetosis
For more information about Cerebral Palsy, see The Color Atlas of Physical Therapy, Chapter 232 Cerebral Palsy.

Eric Shamus, DPT, PhD

Professor, Chair of Department of Rehabilitation Sciences, Florida Gulf Coast University