Mixed Cerebral Palsy

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Sometimes children show signs and symptoms of more than one form of cerebral palsy, known as mixed cerebral palsy. If a child exhibits symptoms from at least two types of CP, they have mixed cerebral palsy. Mixed CP accounts for around 10% of all people diagnosed with the disorder.[1]

What Is Mixed Cerebral Palsy?

Cerebral palsy is the most common childhood disorder that affects muscles and movement. It most often occurs due to brain damage occurring in fetal development or during labor and delivery. Mixed cerebral palsy causes symptoms of two or more types of this condition. 

All types of cerebral palsy affect how a person moves, balances, coordinates movements, and posture. Symptoms vary depending on the type and severity of the condition.

Cerebral Palsy Types and Mixed Cerebral Palsy Symptoms

There are four types of cerebral palsy. The three primary forms of cerebral palsy include ataxic, dyskinetic, and spastic, while mixed is a combination of two or more of these. A child with mixed cerebral palsy could have any of the symptoms:

Spastic

Spastic cerebral palsy is the most common form of the disorder. It accounts for around 75% of all people diagnosed with CP.

Typical symptoms of spastic cerebral palsy include stiff muscles (on either one side or both sides of the body), abnormal reflexes and gait, distorted movements, and contracture. Some children will have crossed knees, while some may walk on their tiptoes.

Spastic cerebral palsy has several subtypes, including spastic hemiplegia, spastic diplegia, and spastic quadriplegia.

Dyskinetic

Dyskinetic CP causes symptoms that fluctuate from stiff, rigid movements to loose, floppy movements. They cannot always control how their muscles move. Fluctuations between the level of control can change from day to day.

Children with dyskinetic CP typically have issues with walking, balance, coordination, tremors, and grasping objects. They have problems controlling their arms, hands, feet, and legs.

Movement is often uncontrollable and can range from slow to rapid and jerky. Young children can have problems with tongue control that can lead to feeding problems.

Dyskinetic CP symptoms are categorized as:

• Athetosis – slow and writing movements
• Chorea – abrupt and irregular movements
• Dystonia – twisting movements that are often painful

Ataxic

Ataxic cerebral palsy causes poor motor skills, issues with walking, shaking, tremors, balance, and depth perception problems.[2] Ataxic CP is a rare form of the disorder and accounts for around 5% to 10% of all diagnosed cases.

What Is the Most Common Type of Cerebral Palsy?

Spastic is the most common type of cerebral palsy, affecting up to three-quarters of people with a diagnosis. Mixed cerebral palsy is the second most common type, while ataxic and dyskinetic types are rare.

What Is the Most Common Form of Mixed Cerebral Palsy?

Among children with mixed cerebral palsy, the most common combination is spastic-dyskinetic.[1]

These children have stiff muscles, which make it difficult to walk. They also struggle to control movements and may have tremors, jerky movements, and difficulty grasping objects and staying balanced.

Medical Conditions Associated with Mixed Cerebral Palsy

Children with any form of cerebral palsy face medical issues specific to each type. A child with mixed cerebral palsy could face specific medical problems of two or three types of cerebral palsy. For this reason, treatment of mixed CP can be more challenging. 

For example, a child with the spastic quadriplegia form of spastic cerebral palsy is at risk of brain malformations. A child with ataxic CP will have issues grabbing objects and buttoning shirts. A child with both spastic and ataxic is at risk of developing brain malformations and grasping issues.

Children with mixed cerebral palsy are also at risk of developing seizures, ranging from mild to severe. They also may have issues with swallowing, which could put them at risk for malnutrition.

Further, children with mixed CP are at risk of developing intellectual disabilities, ranging from mild to severe.

Additional Mixed Cerebral Palsy Symptoms

Because mixed cerebral palsy includes more than one type of brain damage, and because there are so many associated conditions, the number of potential symptoms is extensive.

Additional symptoms of mixed cerebral palsy include:

• Issues with social interaction and emotional health
• Pain, weakness, and fatigue
• Hearing loss and vision problems
• Delayed growth
• Impaired vision
• Drooling
• Incontinence
• Infections
• Learning disabilities
• Dental issues
• Spinal deformities

Keep in mind that each child is different. While one child may have numerous CP symptoms, another child may only develop a few.

What Are the Earliest Signs of Mixed Cerebral Palsy?

Early interventions are essential for the best outcome for a child with any type of cerebral palsy. Yet, it can be difficult for parents and even doctors to detect mild and moderate cases right away.

The sooner you get your child screened for mixed cerebral palsy, the earlier you can begin treatments for the best results. Look for these early signs: 

• Delays in what is considered normal development, like rolling over, sitting, or crawling
• Unusual floppiness or stiffness in arms, legs, or neck
• Inability to hold up the head
• Abnormal posture or favoring one side of the body

Mixed Cerebral Palsy Causes

All forms of cerebral palsy develop due to atypical brain development or brain damage.[3] Mixed cerebral palsy develops the same way but with some variations.

Maternal or fetal infections are one of the causes of infant brain damage. In some instances, a maternal infection can cause brain damage. In other cases, fetal infections can cause brain damage. Infants with low birth weight are at a heightened risk of developing brain deformity or brain damage, leading to cerebral palsy.

Oxygen deprivation before, during, and after birth can happen for many reasons. If a baby is in distress during maternal labor, medical professionals must act fast to ensure the baby is delivered as healthy as possible.

For example, if a baby is in a breech position and the doctor cannot pull them out, a C-section could become necessary. Delays in starting a C-section could lead to oxygen deprivation. Decreased oxygen supply could lead to devastating results for the baby.

Issues with the umbilical cord and the placenta can lead to oxygen loss, which can lead to cerebral palsy.

Is My Baby at Risk for Mixed Cerebral Palsy?

It is often impossible to pinpoint one exact cause of cerebral palsy, but there are several known risk factors:[4] 

• Preterm birth
• Low birth weight
• Multiples (twins or triplets)
• Maternal infection or illness
• Specific maternal medical conditions, including seizure disorder, developmental disability, and thyroid conditions
• Maternal fever
• Mismatched Rh factor between mother and baby
• Fertility treatments
• Toxic chemical exposure
• Infant seizures
• Infant jaundice
• Complicated labor

For acquired mixed cerebral palsy, which occurs after birth, risk factors include injuries and not getting childhood vaccinations.

How Can I Prevent Mixed Cerebral Palsy in My Child?

There is no surefire way to prevent cerebral palsy. Sometimes it occurs with no known risk factors, but there are also risk factors you cannot control.

Control what you can to lower the risk our child will develop mixed cerebral palsy. Keep up with doctor appointments throughout pregnancy. Keep your child safe from accidents and get all their vaccinations.

Medical malpractice sometimes causes cerebral palsy, especially during labor and delivery. Speak up when you feel something is wrong. Don’t be afraid to ask questions or to request a different doctor or nurse.

Mixed Cerebral Palsy Treatments

Treatment for mixed cerebral palsy depends on the types and symptoms of CP the child develops. The most common examples of treatment include:

• Physical therapy
• Occupational therapy
• Medications
• Recreational therapy
• Surgery
• Complementary and alternative treatment
• Speech therapy
• Assistive devices, such as wheelchairs and walkers

For specific details on the types of treatment options available for children with cerebral palsy, visit our page, Cerebral Palsy Treatment.

For more information on cerebral palsy symptoms, refer to our article Cerebral Palsy Symptoms.

If you believe medical malpractice played a role in your child’s mixed cerebral palsy, a birth injury lawyer can help. They will review your case and help you seek justice and recover damages.