Abnormal muscle tone - Muscle tone is the amount of activity in muscle when you are not trying to move, or how much the muscle is “on”. Normal movement occurs when the brain sends signals through the spinal cord to the muscles to move. The spinal cord sends and received many more signals than are needed to move. In the unaffected person, the unwanted signals are quieted, or inhibited by the brain. In cerebral palsy, the damaged part of the brain cannot inhibit these signals. The result is unwanted muscle activity, or spasticity.

Hypotonia – is lower than normal tone, creating muscles that are “floppy”. Hypotonia may be seen in young infants with some forms of cerebral palsy.
Spasticity –is defined as “velocity-dependent resistance to passive movement”, which means the faster a joint, such as an elbow, is straightened, the tighter, or more spastic, the muscle feels. It results from an injury to the motor, or pyramidal tracts (pyramid shaped structure) of the brain. Spasticity may be mild and only appear during strenuous activity or it may be present all the time. Moderate or severe spasticity may hinder movement, making muscles and joints tight and cause contractures.
Rigidity –is resistance to movement regardless of the speed of the passive movement. Muscles that have rigidity feel heavy and like “a lead pipe” when they are passively moved.

Involuntary movement – may take many forms. Dyskinesia, a general term for abnormal movement, usually results from injury to the extra-pyramidal system, which is defined as those parts of the brain outside of the pyramidal tracts. The extrapyramidal system controls the quality of movement and includes structures such as the basal ganglia. Examples of dyskinesia are dystonia, athetosis and chorea.

Dystonia - is sustained muscle contraction causing twisting and repetitive movements or abnormal postures. It can be seen in involuntary movements of the eyes, mouth neck, trunk arms or legs.
Athetosis - is slow, writhing movement of face and extremities.
Chorea – is brief, irregular movements.

Weakness – is common in cerebral palsy but is not always easily detected. Spasticity may mask weakness, making it difficult to fully assess. Treatments that take away spasticity, such as an intrathecal baclofen pump or a selective posterior rhizotomy, often reveal underlying weakness. Weakness may be present in conjunction with spasticity, and may manifest itself in gait deviations or difficulty performing activities of daily living. A physical or occupational therapist may identify muscle weakness and develop an individualized program to increase muscle strength.

Impaired motor control – is the inability to recruit muscles with normal speed or timing. Normally, muscle movement can occur in any direction, in any joint, without unwanted movement in adjacent joints. This is called selective movement. In cerebral palsy, the injury to the brain interferes with selective control and instead movement is in synergy. Synergistic motor control is when movement at one joint, such as the ankle, cannot occur unless movement also occurs at another joint, such as the knee. Impaired motor control may interfere with functions such as walking or holding a pencil.

Poor balance – may be caused by many factors. Balance is a complex response to gravity and movement involving many different parts of the brain. Balance is the coordination of sensory information received and motor activity. Falling may be the result of poor balance due to an injury to the brain that controls posture, or it may be caused by tripping over a foot that gets in the way. A thorough evaluation by an experienced practitioner is necessary to determine the source of poor balance and if any intervention can improve balance and function.

Contracture - is when a joint, such as an elbow or knee, cannot move through its normal range of motion. Spasticity can cause muscles to be tight and for contractures to develop. Contractures may limit a person’s ability to sit in chair, stand up straight or open a hand. Conventional treatments are available to treat contractures

Perceptual motor dysfunction – is a problem interpreting what is seen. Visual acuity, or the clarity of vision, may be unaffected. Visual skills that may be affected include discriminating contrast or color, depth perception, object discrimination or identifying shapes, visual memory or the ability to locate or focus on one object.

Primitive reflexes – are present in all newborn babies. These are stereotypical movements that occur when the infant is held upright or the head is moved. Primitive reflexes are normally integrated, or disappear, at various stages during the first year of development. In cerebral palsy there may be a delay this integration, and the child may have difficulty moving out of primitive reflex patterns. In some cases, the reflexes persist into adolescence and adulthood. These reflexes may be helpful, such as a primitive flexion or extensor pattern that stabilizes a joint in a purposeful manner. Some reflexes, however, interfere with positioning and function, such as rolling standing or walking.

Oral-motor dysfunction – includes problems with eating and talking. During early development, parents may notice that their baby may not be able to suck on a pacifier or take a bottle due to muscle weakness in and around the mouth. The ability to suck, swallow, and breathe during breast/or bottle-feeding may be influenced by weakness or tightness of the supporting muscles. As an older child, eating solid foods may be challenging if the mouth is influenced by abnormal tone and safety with swallowing can be compromised. Oral-motor dysfunction may lead to problems managing secretions, which results in drooling.

Nutritional Concerns – Optimal nutrition is important for everyone to maintain good health and well being. For children, good nutrition is essential to help them achieve their full potential for growth and development. Some people with cerebral palsy may face special nutrition-related challenges. The most common include:

• Difficulty chewing or swallowing foods, which may result in inadequate nutritional intake

• Poor weight gain and poor growth (in children) or difficulty managing weight

• Excessive weight gain

• Constipation

• Increases risk for osteoporosis because if low calcium and vitamin D intake or medications which interfere with their absorption

Osteoporosis – is when bones are less dense, or weaker compared to age-matched normative data. It is diagnosed using a DEXA scan, which measures bone mineral density. Osteoporosis can increase the risk of developing a fracture, and has been detected in both children and adults with cerebral palsy. Researchers are still investigating the causes of osteoporosis, as well as the risk any individual may have for developing a fracture. Causes include a diet lacking in calcium and vitamin D, immobility, lack of weight bearing, medications such as anticonvulsants and an impairment of the endocrine system.