Kinematic Classification

  • Adriano Ferrari


Cerebral palsy (CP) is considered a “persistent but not unchangeable disorder of movement and posture”; therefore, the definition given 50 years ago by Ingram (1955) and Mac Keith & Polani (1959), and subsequently divulged by Bax (1964), is still accepted as valid. In fact, also ad hoc international commission has recently reaffirmed the concept: CP is a disorder of development of posture and movement (Bax et al. 2005). In order to be consistent with this definition, the only way to classify CP would be through an analysis of posture and movement (intended from the kinesiological point of view as gesture), assessed in terms of quality (type) and of quantity (measure) (Ferrari, 1995). Actually, the most popular criterion to classify CP has always been based on the topographic (geographic) distribution of the motor impairment: tetraplegia (quadriplegia), diplegia, hemiplegia, with minor variations to these macro-categories: paraplegia, double hemiplegia, triplegia, monoplegia, reversed diplegia. Taxonomically, no importance is usually given to the location of the brain lesion (internal capsule, basal nuclei, semi-oval centre, cerebellum, etc.), to the timing of the central nervous system (CNS) damage (pre-, peripost-natal) with the exception of hemiparetic forms (see chapter 16), to the etiology (prematurity, dystocia, neonatal asphyxia, intracranial hemorrhage, meningoencephalitis, etc.), to pathogenesis (traumatic, toxic, infective), to CNS lesion extent, which can today be quantified by neuroimaging (see chapter 3), to neurological deficits associated with palsy and their syndromic combination (epilepsy, mental retardation, sensorial deficiency, perceptive disorders, dysphonia, dysarthria, learning disabilities, behavior disorders, etc.), to both primitive and secondary associated signs and symptoms, and to their origin.


Cerebral Palsy Clinical Form Spastic Cerebral Palsy Support Reaction Spastic Muscle 
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  1. Bax M (1964) Terminology and classification of cerebral palsy. Dev Med Child Neurol 6:295–7PubMedGoogle Scholar
  2. Bax M, Goldstein M, Rosenbaum P et al (2005) Proposed definition and classification of cerebral palsy. Dev Med Child Neurol 47:571–6CrossRefPubMedGoogle Scholar
  3. Bobath B, Bobath K (1975) Motor development in the different types of cerebral palsy. William Heinemann Medical Books, LondonGoogle Scholar
  4. Booth CM, Cortina-Borja MJ, Theologis TN (2001) Collagen accumulation in muscles of children with cerebral palsy and correlation with severity of spasticity. Dev Med Child Neurol 43:314–20CrossRefPubMedGoogle Scholar
  5. Boyd R, Graham HK (1997) Botulinum toxin A in the management of children with cerebral palsy: indication and outcome. Eur J Neur 4:S15–S22Google Scholar
  6. Carr LJ, Tydeman C, Bax, M (2006) Clinical findings from a multicentre European cerebral palsy study; can we distinguish quadriplegia from diplegia? Dev Med Child Neurol; suppl. 107, vol. 48, 4–5Google Scholar
  7. Castle ME, Ryman TA, Schneider M (1979) Pathology of spastic muscle in cerebral palsy. Clin Orthop Rel Res 142:223–32Google Scholar
  8. Cioni G, Lodesani M, Coluccini M et al (2008) The term diplegia should be enhanced (II): contribution to validation of a new classification system. Eur J Physic Rehab Med 44:203–211Google Scholar
  9. Cioni G, Sales B, Paolicelli PB et al (1999) MRI and clinical characteristics of children with hemiplegic cerebral palsy. Neuropediatrics 30:249–255CrossRefPubMedGoogle Scholar
  10. Clayes V, Deonna T, Chrzanowski R (1983) Congenital hemiparesis: the spectrum of lesions. A clinical and computerized tomographic study of 37 cases. Helv Paedriatic Acta 38:439–455Google Scholar
  11. Colver AF, Sethumadhavan T (2003) The term diplegia should be abandoned. Arch Dis Child 88:286–290CrossRefPubMedGoogle Scholar
  12. Dan B, Cheron G (2004) Reconstructing cerebral palsy. J Ped Neurology 2:57–64Google Scholar
  13. Delp SL (2003) What causes increased muscle stiffness in cerebral palsy? Muscle Nerve 27:131–2. ReviewCrossRefPubMedGoogle Scholar
  14. Eliasson AC, Krumlinde-Sundholm L, Rosblad B et al (2006) The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol 48:549–54CrossRefPubMedGoogle Scholar
  15. Ferrari A (1988) Paralisi cerebrale infantile: problemi manifestie problemi nascosti. Gior Ital Med Riab 2:166–170Google Scholar
  16. Ferrari A (1990) Interpretive dimensions of infantile cerebral paralysis. In: Papini M, Pasquinelli A, Gidoni EA (eds) Development, handicap, rehabilitation: practice and theory. Excepta medica, International Congress Series 902, pp 193–204Google Scholar
  17. Ferrari A (1993) Dal concetto di lesione a quello di paralisi. In: Cristofori Realdon V, Chinosi L (ed) Un bambino ancora da scoprire. Marsilio Editore, Venezia, pp 111–117Google Scholar
  18. Ferrari A (1995) Paralisi cerebrali infantili: appunti di viaggio attorno al problema della classificazione. Giorn Neuropsich Età Evol 15:191–205Google Scholar
  19. Ferrari A (1997) Proposte riabilitative nelle paralisi cerebrali infantili. Del Cerro editore, PisaGoogle Scholar
  20. Ferrari A (2003) In tema di postura e di controllo posturale. Giomale Italiano Medicina Riabilitativa, vol. 17 n 1: 61–74Google Scholar
  21. Freud S (1897) Die infantile Zerebral Laehmung. In: Notnagel ab Specielle Pathologie und Terapie. A Holder Inc, Wien 2 pp 1Google Scholar
  22. Friden J, Lieber RL (2003) Spastic muscle cells are shorter and stiffer than normal cells. Muscle Nerve 27:157–164CrossRefPubMedGoogle Scholar
  23. Hagberg B (1989) Nosology and classification of cerebral palsy. Giorn Neuropsich Età Evol 4:12–17Google Scholar
  24. Hagberg B, Hagberg G, Olow L (1975) The changing panorama of cerebral palsy in Sweden 1954–1970. Acta Paediatrica Scand 64:187–199CrossRefGoogle Scholar
  25. Himmelmann K, Beckung E, Hagberg G, Uvebrant P (2006) Gross and fine motor function and accompanying impairments in cerebral palsy. Dev Med Child Neurol 48:417–23CrossRefPubMedGoogle Scholar
  26. Ingram TTS (1955) A study of cerebral palsy in the childhood population of Edinburgh. Arc Dis Child 30:85–98CrossRefGoogle Scholar
  27. Ingram TTS (1984) A historical review of the definition and classification of the cerebral palsies. In: Stanley FJ, Alberman ED (eds) Spastics international. Oxford Blackwell Scientific, pp 1–11Google Scholar
  28. Ito J, Araki A, Tanaka H et al (1996) Muscle histophatology in spastic cerebral palsy. Brain Dev 18:299–303CrossRefPubMedGoogle Scholar
  29. Lieber R, Friden J (2002) Spasticity causes a fundamental rearrangement of muscle joint interaction. Muscle Nerve 25:265–270CrossRefPubMedGoogle Scholar
  30. Lieber R, Steinman S, Barash I, Chambers H (2004) Structural and functional changes in spastic skeletal muscle. Muscle Nerve 29:615–627CrossRefPubMedGoogle Scholar
  31. Marbini A, Ferrari A, Cioni G et al (2002) Immunohistochemical study of muscle biopsy in children with cerebral palsy. Brain and Development 24:63–66CrossRefPubMedGoogle Scholar
  32. MacKeith RC, Mackenzie ICK, Polani PE (1959) The little club: memorandum on terminology and classification of cerebral palsy. Cerebral Palsy Bulletin 5:27–35Google Scholar
  33. Mc Intosh N, Helms PJ, Smyth RL (2003) Forfar & Arneil’s textbook of paediatrics, 6th edition. Churchill Livingstone, LondonGoogle Scholar
  34. Milani Comparetti A (1965) La natura del difetto motorio nella paralisi cerebrale infantile. Infanzia Anormale 64:587–628Google Scholar
  35. Milani Comparetti A (1978) Classification des infirmités motrices cérébrales. Médicine et Hygiène 36:2024–2029Google Scholar
  36. Minear WL (1956) A classification of cerebrla palsy. Pediatrics 18:841–845PubMedGoogle Scholar
  37. Morrissey RT, Weinstein SL (2001) Lovell and Winter’s pediatric orthopaedics, 5th ed. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  38. Novacheck TF (2003) Cerebral palsy pathomechanics. Lettura al congresso internazionale: Il cammino del bambino con paralisi cerebrale infantile: architettura della funzione e strategie di recupero. Reggio Emilia, November 12Google Scholar
  39. Palisano RJ, Rosenbaum PL, Walter S et al (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39:214–223PubMedCrossRefGoogle Scholar
  40. Perry J (1992) Gait analysis: normal and pathological functions. Slack Inc Thorofare, New YorkGoogle Scholar
  41. Rang M (1990) Cerebral palsy. In: Morrissy RT (Ed) Lovell and Winter’s paediatric orthopedics, 3rd ed. JB Lippincott, Philadelphia pp 465–506Google Scholar
  42. Rodda J, Graham HK (2001) Classification of gait patterns in spastic hemiplegia and spastic quadriplegia: a basis for management algorithm. Eur J Neurol 8:98–110CrossRefPubMedGoogle Scholar
  43. Romanini L, Villani C, Meloni C, Calvisi V (1989) Histological and morphological aspects of muscle in infantile cerebral palsy. Italian Journal Orthopaedic Traumat 15:87–93Google Scholar
  44. Ross SA, Engsberg JR (2002) Relation between spasticity and strength in individuals with spastic diplegic cerebral palsy. Dev Med Child Neurol 44:148–57CrossRefPubMedGoogle Scholar
  45. Rudolph AM, Hoffman JIE, Rudolph CD (1996) Rudolph’s pediatrics, 20th ed. Appleton & LangeGoogle Scholar
  46. Sachs B, Petersen F (1890) A study of cerebral palsies of early life. J Nerv Ment Dis 17:295–332Google Scholar
  47. Segawa M, Hosaya A, Miyagawa F (1976) Hereditary progressiva dystonia with marked diurnal fluctiations. In: Eldridge R, Fahn S (eds) Advances in neurology. New York, Raven Press 14, pp 215–233Google Scholar
  48. Surveillance Cerebral Palsy in Europe (SCPE): a collaboration of cerebral palsy register. Dev Med Child Neurol 2000; 42:816–24Google Scholar
  49. Winters TF Jr, Gage JR, Hicks R (1987) Gait patterns in spastic hemiplegia in children and young adults. J Bone Joint Surg Am 69:437–41PubMedGoogle Scholar
  50. Wright J, Rang M (1990) The spastic mouse and the search for an animal model of spasticity in human beings. Clin Orthop Relat Res; (253):12–9PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2010

Authors and Affiliations

  • Adriano Ferrari
    • 1
    • 2
  1. 1.Child Rehabilitation UnitS. Maria Nuova HospitalReggio Emilia
  2. 2.Department of NeuroscienceUniversity of Modena and Reggio EmiliaReggio Emilia

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