**Author details**

Ali A. Al-Mayahi1,2\*


#### **References**

As shown in **Figure 2** [69], the guidelines can be translated into clinical practice by adapting core elements to suit individual clinical settings. As soon as the high-risk infants as a neonate (e.g., neuroimaging findings consistent with neonatal encephalopathy) are referred, they undergo surveillance according to the guidelines at the 3- to 4-month visits. In hospitalized extremely preterm infant with white matter injury, the surveillance occurs at the bedside according to the guidelines with a HINE, a Test of Infant Motor Performance, and a general movement assessment. Referred high-risk infant should start close to the point of the pathway, for example, a high-risk infant referred for the surveillance at 9 months due to inability to sit would start with a HINE and a Bayley Scales of Infant and Toddler Development.

HINE, Hammersmith infant neurological examination; TIMP, test of infant motor performance [69].

**Figure 2.** Translation of international guidelines into a clinical practice algorithm in a neonatal intensive care unit follow-up program. \*Select examinations target developmental progression and represent the best feasible evidence for specific concern. \*\*Neurological examination after a 2-year visit includes Amiel Tisonorother. Bayley-III, Bayley scales of infant and toddler development-third edition; CBCL, child behavior checklist; GMA, general movement assessment;

This systematic review has shown that there is good evidence that GMA can accurately predict the development of CP. There is reasonable evidence to support the use of MRI at term corrected age, neurological examination in the older infant, and, to a lesser extent, ultrasound in infants of preterm age for early assessment. The great advantage of detecting an increased risk of CP at such an early stage consists of the possibility of intervention long before the

**7. Conclusion**

12 Cerebral Palsy - Clinical and Therapeutic Aspects

emergence of obvious pathological features of CP.


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**Section 2**

**Classification of Cerebral Palsy**


**Classification of Cerebral Palsy**

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**Chapter 2**

**Provisional chapter**

**Clinical Classification of Cerebral Palsy**

**Clinical Classification of Cerebral Palsy**

DOI: 10.5772/intechopen.79246

The classification of cerebral palsy (CP) remains a challenge; hence the presence of so many classifications and a lack of consensus. Each classification used alone is incomplete. Therefore, a multiaxial classification gives a more comprehensive description of a child with CP. The recent WHO International Classification of Functioning, Disability and Health (ICF) emphasizes the importance of focusing on the functional consequences of various states of health and has stimulated the development of newer functional scales in CP. It is widely accepted that the functional classification is the best classification for the patient because it guides management. The objectives of this chapter are to review the various classifications of CP, to highlight the clinical features used in the various classifications, to outline the recent functional classifications of CP and to highlight how these recent classifications guide current management. It is expected that at the end of this chapter, the reader should be able to understand the difficulties in classifying CP, enumerate and discuss the various classifications of CP, understand the merits and shortcomings of each classification scheme, clinically evaluate and classify a child with CP multiaxially and understand how functional scales predict current and future needs of

**Keywords:** clinical classification, cerebral palsy, functional scales, management, spastic,

The categorization of children with cerebral palsy (CP) into clinical groups remains a challenge, hence the presence of so many classifications that are not comprehensive and the continued search for a holistic classification [1]. The clinical manifestations of CP are heterogeneous as rightly pointed out in the most current definition of CP [1, 2]. This implies that children with CP differ clinically in many aspects. Therefore, different groupings (classifications) are possible [1].

extrapyramidal, SCPE, GMFCS, MACS, CFCS, EDACS, multiaxial

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

Christian Chukwukere Ogoke

Christian Chukwukere Ogoke

**Abstract**

children with CP.

**1. Introduction**

http://dx.doi.org/10.5772/intechopen.79246

#### **Clinical Classification of Cerebral Palsy Clinical Classification of Cerebral Palsy**

#### Christian Chukwukere Ogoke Christian Chukwukere Ogoke

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.79246

#### **Abstract**

The classification of cerebral palsy (CP) remains a challenge; hence the presence of so many classifications and a lack of consensus. Each classification used alone is incomplete. Therefore, a multiaxial classification gives a more comprehensive description of a child with CP. The recent WHO International Classification of Functioning, Disability and Health (ICF) emphasizes the importance of focusing on the functional consequences of various states of health and has stimulated the development of newer functional scales in CP. It is widely accepted that the functional classification is the best classification for the patient because it guides management. The objectives of this chapter are to review the various classifications of CP, to highlight the clinical features used in the various classifications, to outline the recent functional classifications of CP and to highlight how these recent classifications guide current management. It is expected that at the end of this chapter, the reader should be able to understand the difficulties in classifying CP, enumerate and discuss the various classifications of CP, understand the merits and shortcomings of each classification scheme, clinically evaluate and classify a child with CP multiaxially and understand how functional scales predict current and future needs of children with CP.

DOI: 10.5772/intechopen.79246

**Keywords:** clinical classification, cerebral palsy, functional scales, management, spastic, extrapyramidal, SCPE, GMFCS, MACS, CFCS, EDACS, multiaxial

#### **1. Introduction**

The categorization of children with cerebral palsy (CP) into clinical groups remains a challenge, hence the presence of so many classifications that are not comprehensive and the continued search for a holistic classification [1]. The clinical manifestations of CP are heterogeneous as rightly pointed out in the most current definition of CP [1, 2]. This implies that children with CP differ clinically in many aspects. Therefore, different groupings (classifications) are possible [1].

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

These classifications (groups) differ in the characteristic(s) used and their individual uses or purposes. A classification may be used for describing the nature of the disability, for predicting current and future management needs, comparing cases in different areas and assessing change following an intervention [1]. Generally, it is desirable that any classification used should be reliable, valid, quantitative, and objective and most importantly assist management [1].

arm function/manual dexterity), Communication Function Classification System (CFCS) [16] (speech/communication function) and Eating and Drinking Ability Classification System (EDAC) [17] (eating and drinking/oropharyngeal function). They are mainly used for predicting current and future management needs of children with CP, and their use agrees with

Clinical Classification of Cerebral Palsy http://dx.doi.org/10.5772/intechopen.79246 23

Advances in management of CP including the biopsychosocial method of service delivery that recommends liberal use of assistive devices require additional characteristics or variables to be added to traditional classifications in order to assist management and satisfy other important purposes like clinical description and research [1, 4, 5]. Such a classification would be called holistic, comprehensive or standardized. A consensus on what characteristics/components such holistic classification should incorporate is yet to be reached by experts in the

The traditional classifications of CP are basically the Minear [7] classifications in seven axes

This is based on the type/nature of motor or movement disorder (quality and changes in tone) and classifies CP into two types: spastic (pyramidal) and non-spastic (extrapyramidal). Generally speaking, neuromotor findings in spastic CP are consistent and persistent while

• Tone is invariably increased (hypertonia), that is, persistently increased with little or no variation in the awake (movement, tension and emotion) or sleep states. This is further confirmed by asking caregivers whether their child feels stiff when touched or held most

**3. Traditional classifications of CP based on single characteristics**

current thinking in management of CP.

field of CP.

namely:

**1.** Physiological **2.** Topographic **3.** Supplemental

**4.** Aetiologic

**6.** Therapeutic **7.** Functional

**5.** Neuroanatomic (radiologic)

**3.1. Physiologic classification**

variability is the rule in extrapyramidal CP [6, 18, 19].

The clinical features of spastic CP are as follows [6, 18, 19]:

times of the day even during sleep. The answer is usually a "yes."

Besides early identification and intervention, the current trend in neurodevelopmental pediatrics is a focus on functional effects of different states of health [3, 4]. This is the outcome of the recent WHO International Classification of Functioning, Disability and Health (ICF) which in the field of CP led to the development of newer measures of functional abilities (functional scales) [3, 4]. There are functional scales for a number of functions impaired in CP. It is widely accepted that the functional classification remains the best classification for a patient with CP because it guides management [1, 5, 6].
