Classification and Types
While many advocates are pushing for a move to a universal classification system for cerebral palsy, we could still be years from seeing the creation and institution of such a system. Currently, there are three primary systems used to classify cerebral palsy, each focusing on different aspects of the condition. Each system offers its own unique advantages and disadvantages, and preferences vary depending on the intended use. For example, neurologists typically prefer using a system that focuses on the cause and effect of cerebral palsy within a patient’s brain, whereas parents usually prefer a system that focuses on severity level to better understand their childrens’ impairments and abilities.
The Gross Motor Function Classification System (GMFCS) is based on simple tests that can easily be administered at home for repeatable and reproducible results. It places emphasis on sitting, transfers and mobility. Currently, it’s one of the preferred systems for classifying cerebral palsy as it is seen as being one of the most accurate. The GMFCS recognizes five different levels based on the amount of mobility and the abilities of those with the condition. It specifically focuses on whether or not a person with cerebral palsy can walk sit or stand with no assistance, or if he relies on the use of physical assistance, a walker, a wheelchair, a power chair or any other form of support for mobility. Different classifications exist within the GMFCS for each age group to ensure accurate classification based on a person’s abilities at each age. For example, the diagnostic criteria for children under the age of two is very different than the criteria for children aged 12 to 18.
The Topographical Distribution Method (TDM) focuses on the body parts affected by the condition. The TDM is useful for identifying how and where a person is affected by cerebral palsy. The terms “paresis,” meaning weakened, and “plegia/plegic,” meaning paralyzed, are used as prefixes to describe how each limb or body part is affected. For example, “Monoparesis” means that only one limb is weakened, while “Quadriplegia” means all four limbs are paralyzed. This system is only useful for describing the physical aspects of cerebral palsy, and does not take a person’s independence, intelligence or other capabilities into consideration.
Cerebral palsy can also be classified by severity level. While parents often prefer this system at first, in reality it offers only a general classification and it isn’t based on any specific criteria. Classification within this system may also vary from one doctor to another. For example, one doctor may determine that a patient’s symptoms are only mild, while another may rule that the symptoms are moderate. This system is further complicated by the fact that no two people are affected in exactly the same way by cerebral palsy, so two people who are classified as “moderate” may differ drastically in their abilities, intelligence and independence. The severity level classification system recognizes four broad levels of cerebral palsy; mild, moderate, severe and no cerebral palsy.