Fine motor skills refer to tasks that use small muscles from one area of the body, usually the hands, fingers, and toes. These skills include writing, eating with silverware, curling your toes, turning a doorknob, or buttoning a shirt, for example. Gross motor skills use many muscles throughout the body for large movements such as jumping, running, swimming, bending, reaching, and carrying items. Oral motor skills are related to anything you do with your mouth, such as eating, drinking, or chewing gum. However, delayed milestones could be related to many other types of conditions, or a child with some delays may not have any condition at all. Parents may also notice the following signs in their children, though babies without cerebral palsy may show some of these also. Babies showing these signs should be evaluated by a pediatrician or family physician. (1) Babies younger than 6 months
Body stiffnessBody floppinessArching or seeming to push away while being heldLagging head when they are picked upStiff legs that cross or look like scissors
Babies older than 6 months
Not rolling overUnable to bring hands together or to their mouthOne hand is in a fist when the other reaches out
Babies older than 10 months
Dragging their limbs while crawling, seeming to use only half their bodyScooting on their bottom instead of crawling on legs and hands
Stiffness or floppiness in muscle toneExaggerated or abnormal reflexes (involuntary responses to stimuli)SeizuresLittle or no muscle coordinationInvoluntary/uncontrolled movementsPoor motor skills in generalInability to control bowelsTremors or shakingSlow, writhing movementsMostly using only one side of the bodyProblems with walking, such as walking only on toes, leaning over while walking, knees crossing like scissors, or a wide or mismatched strideExcessive drooling or difficulty swallowing, sucking, or eatingPoor or delayed speech developmentProblems with fine motor skills, such as difficulty grasping objects
Common Cerebral Palsy Terms
Certain terms are frequently used in describing symptoms of cerebral palsy.
Ataxia refers to not having muscle coordination.Athetosis refers to slow, writhing, or squirming involuntary movements.Choreoathetosis refers to a combination of chorea (sudden, uncoordinated movements) and athetosis.Dystonia refers to involuntary muscle contractions with twisting, repetitive movements.Hypotonia refers to decreased muscle tone, which makes muscles look too loose or “floppy.”Hypertonia refers to increased muscle tone, which causes stiffness.Spasticity refers to stiff, tight muscles and exaggerated reflexes.Tremor is small, rhythmic shaking of the hands or another body part.Plegia is a suffix that means “paralysis of.” Types of paralysis include monoplegia (one limb), diplegia or paraplegia (two limbs), hemiplegia (one side of the body), quadriplegia (the whole body).
A person with suspected cerebral palsy will probably undergo at least one brain imaging test. Doctors use these images to look for brain damage or abnormalities. Several types of brain imaging exist:
Magnetic resonance imaging (MRI) uses a large magnet to create an image of the brain, revealing where and how the brain is damaged.A cranial ultrasound bounces sound waves off an infant’s brain to create an image.Computed tomography (CT) scans use X-rays to show cross-section images of the brain. Because of the radiation doses from a CT scan, many times an MRI or CUS may be preferred.
In addition, a child may undergo an electroencephalogram (EEG), which involves attaching electrodes to a child’s scalp to record electrical activity in the brain. An EEG also lets doctors tell if brain seizures are occurring. (2) Spastic cerebral palsy is the most common type, found in 70 to 80 percent of people with cerebral palsy. People with spastic cerebral palsy have increased muscle tone, which causes stiffened muscles. This stiffness makes their movements look awkward or forced. (1) Spastic cerebral palsy includes three subtypes based on which muscles are involved.
Spastic diplegia or diparesis refers to muscle problems in the legs.Spastic hemiplegia or hemiparesis means only one side of a person’s body has muscle stiffness.Spastic quadriplegia or quadriparesis means a person’s entire body is affected — their face, trunk, and both arms and legs. These individuals are more likely to have other problems, such as seizures or intellectual, vision, hearing, or speech disabilities.
Dyskinetic, or athetoid, cerebral palsy occurs in about 10 percent of cerebral palsy cases. With this type, a person’s muscle tone can be too tight or too loose, and it may frequently change between those extremes in a single day. People with dyskinetic cerebral palsy do not have complete control over their hands, arms, feet, and legs. They may have rapid, jerky movements or slow, writhing movements. If their face is affected, swallowing, sucking, and talking may be difficult. Ataxic cerebral palsy also makes up 10 percent of cases. It primarily affects a person’s balance and coordination. It is difficult for people with ataxic cerebral palsy to walk steadily or to do tasks requiring strong muscle control, such as sewing, writing, or washing dishes.
