- While asymmetries may be present, there is always total body involvement with the upper extremities more affected than lower extremities.
- Hemiplegia: Unilateral motor impairments with the hand affected more than the leg. Often the result of an in utero middle cerebral artery stroke or a focal brain malformation.
- Diplegia: Bilateral involvement with legs affected more than hands. Hand involvement may be affect gross motor movements or be more subtle affecting fine motor control. (It is the presence of hand involvement which distinguishes diplegia from paraplegia). Asymmetries are common. Diplegia is most commonly the result of prematurity with injury to the periventricular area. The incidence of spastic diplegia has not decreased with the advent of improved survival of premature infants. Some infants with prematurity may have quadriplegic patterns of motor involvement due to brain injury resultant from recurrent low flow or hypoxic states.
- Spastic Quadriplegia: full body involvement with arms more or equally involved as lower extremities. Generally this reflects diffuse brain injury or malformation and extrapyramidal features are also substantial (i.e. Mixed CP). A common etiology for this pattern is birth asphyxia near term or after birth. This pattern is also seen in premature infants with prolonged intensive care stays complicated by repeat hypoxic events. Diplegia may be so severe that it is not distinguishable from quadriplegia, however, in these patients associated extrapyramidal features are less severe.
- Other terms used rarely include:
- Triplegia: One extremity substantially spared, usually an arm; and
- Monoplegia: One extremity involvement.
Why is it helpful for a primary care clinician to understand this classification system?
- The topography may drive the etiologic workup.
- Different patterns have different associated conditions.
- Topography is important in functional prognosis.
- Topography allows for better communication between clinicians:
- Compare: A 7 year old girl with mental retardation and cerebral palsy vs. A 7 year old girl with diplegia and moderate cognitive challenges who utilizes a walker to assist in ambulation.