Types of Cerebral Palsy

The types have different symptoms and causes

Muscle tone and control can be impaired in cerebral palsy

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Cerebral palsy is a condition in which motor control is impaired due to congenital brain malformations. According to the Centers for Disease Control and Prevention (CDC), between one and four in 1,000 babies born worldwide have some form of cerebral palsy.

Cerebral palsy is a lifelong condition that can range in severity and may affect voluntary motor control, muscle tone, coordination, and gait (walking). Sometimes it can have other effects, including impaired cognitive development, communication difficulties, and difficulty chewing and swallowing.

Cerebral palsy is present at birth. It is not a degenerative condition (it doesn't get worse), but some symptoms can become more noticeable at different stages of a person’s life. There are four types of cerebral palsy: spastic cerebral palsy, dyskinetic cerebral palsy, ataxic cerebral palsy, and mixed cerebral palsy.

Cerebral Palsy Symptoms and Causes

The symptoms of cerebral palsy can vary from one person to another. The condition also can affect motor control in one or more parts of the body.

For example, a child with cerebral palsy might have a weak foot that drags when walking but no other motor problems or intellectual disabilities. On the other hand, another person who has cerebral palsy could have normal strength, but impaired coordination on one side of the body, severe cognitive deficits, and a seizure disorder. 

Symptoms can include one or more of the following:

  • Slurred speech 
  • Difficulty chewing and swallowing
  • Muscle spasms affecting one or more limbs 
  • Stiffness or floppiness of one or more limbs 
  • Ataxia (lack of muscle control), especially with voluntary movement
  • Weakness of one arm or one leg, one side of the body, both legs, or all four limbs
  • Weakness and decreased control of one side of the face, drooling 
  • Impaired control of bowel or bladder function 
  • Tremors
  • Seizures 
  • Cognitive deficits 
  • Behavioral problems 

Some effects of cerebral palsy are noticeable at birth or even before a baby is born. As a child grows, cerebral palsy can result in deficits in motor and cognitive milestones. Sometimes babies who have cerebral palsy can have diminished muscle tone, which later changes as the muscles become tight.

Causes 

Cerebral palsy is typically present at birth and is usually caused by a brain malformation or injury that occurs during pregnancy. The damage can affect one or more areas of the brain.

Typically the symptoms correspond to the area of damage in the brain. For example, if the area of the brain that controls the left hand is damaged, motor control of the left hand can be impaired. When there are many areas of brain malformation, the effects of cerebral palsy are usually more extensive.

Causes of cerebral palsy include:

  • Cerebral dysgenesis (abnormal fetal brain development) due to a number of causes, including genetics
  • Periventricular leukomalacia, a condition in which the white matter of the brain is damaged, which is common in cerebral palsy
  • Brain damage that occurs during delivery or immediately after birth, a less common cause 
  • A deficit in oxygen supply or impaired blood flow to the developing baby’s brain
  • Infections acquired during pregnancy
  • Premature birth
  • Idiopathic reasons (without an identifiable cause) 

Types of Cerebral Palsy 

The types of cerebral palsy are distinguished by their symptoms as assessed through a physical examination. Some of the symptoms may appear similar, but the movements and muscle tone of each type have certain distinct characteristics.

Spastic Cerebral Palsy 

The most common type of cerebral palsy, spastic cerebral palsy, is diagnosed in approximately 80% of people living with cerebral palsy. This type is characterized by diminished voluntary muscle control and may involve motor weakness (paresis) or complete paralysis (plegia) of one or more limbs.

Over time, muscles can become very stiff and may intermittently spasm. The spasms and stiffness can be reduced with medication, but no treatment can improve the lack of muscle control. 

Spastic cerebral palsy can cause:

  • Spastic hemiplegia or hemiparesis, with weakness and stiffness on one side of the body
  • Spastic diplegia or diparesis, affecting the legs and often causing scissoring (the knees and thighs tightly turning inward)
  • Spastic quadriplegia or quadriparesis, affecting the arms and legs

Spastic cerebral palsy can also affect motor control of the face, neck, and throat.

This type of cerebral palsy is caused by developmental defects that affect the motor strip of the cerebral cortex, which controls voluntary movement of the body. Each side of the cerebral cortex controls the movement of the opposite side of the body, which is why the pattern of involvement often affects one side of the body.

The left and right sides of the cerebral cortex nearest each other control the legs, which is why sometimes both legs are affected without substantial arm involvement. 

Dyskinetic Cerebral Palsy 

Dyskinesia is a type of involuntary movement characterized by slow, often fluid motions rather than the abrupt or stiff movements typical in spastic cerebral palsy. Dyskinetic cerebral palsy, comprising approximately 6% of cerebral palsy cases, affects muscle coordination, making it difficult to walk, speak clearly, and control chewing and swallowing movements.

Involuntary face, tongue, and mouth movements can occur at rest or when a person is trying to move. Dyskinetic cerebral palsy can affect one or more limbs on one or both sides of the body, and a person can have variable muscle tone throughout the day.

Dyskinetic cerebral palsy includes:

  • Athetoid cerebral palsy: Slow, writhing movements of the neck, tongue, trunk, or limbs
  • Choreaoathetoid cerebral palsy: Sudden involuntary movements, usually of the limbs (chorea) and sometimes mixed with athetoid movements
  • Dystonic cerebral palsy: Slow, twisting, involuntary movements at rest or when trying to move

Dyskinetic cerebral palsy can be associated with damage to the basal ganglia—a region in the brain stem that mediates motor control at rest and with movements. 

Ataxic Cerebral Palsy 

Ataxic cerebral palsy, affecting approximately 6% of those who have cerebral palsy, can involve one or more limbs and can involve control of complex motor functions, such as walking. This type of cerebral palsy is characterized by impaired coordination.

A lack of spatial awareness distinguishes this type of cerebral palsy, meaning difficulty in being able to assess the body's position and the position of objects, and it can lead to severe problems with movement.

The condition also can result in problems with fine motor skills, such as using utensils or writing, difficulty with large motor coordination, such as driving or using heavy machinery, or trouble with balance while walking.

Ataxia is a lack of coordination, and it can be caused by defective development of the cerebellum, which is the region of the brain that controls coordination.

Mixed Cerebral Palsy 

Sometimes cerebral palsy can include more than one type of impaired movement due to the involvement of several regions of the brain. Spastic dyskinetic cerebral palsy is the most common mix of cerebral palsy symptoms.

The cerebral cortex and the brain stem can be damaged by the same prenatal factors, and also have an overlapping blood supply, which may result in damage to both regions, with combined symptoms.

The combination of symptoms in mixed cerebral palsy might not be apparent early in a child’s life, but as the child gets older and is expected to reach advancing motor milestones, the pattern can become more noticeable.

Associated Complications

Cerebral palsy is often associated with complications such as intellectual disability, seizures, difficulty with vision, impaired hearing, dental issues, and joint problems.

Some of these issues are caused by the same brain damage that leads to cerebral palsy. For example, seizures, cognitive impairment, visual problems, and hearing deficits can result from damage to the cerebral cortex, but they can be present with any of the types of cerebral palsy.

Other complications, such as joint problems and dental problems, can result from the long-term effects of cerebral palsy–associated problems such as muscle spasms, immobility, and grinding teeth.

These complications are more likely with severe cerebral palsy, and you and your medical team will need to monitor your symptoms so that complications can be identified and treated.

A Word From Verywell 

Cerebral palsy is a not uncommon motor disability that can come with complications affecting individuals with the condition as well as their families. Knowing which type of cerebral palsy you have will help you and your medical team know what to expect as you work together to formulate the best treatment plan.

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Article Sources
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