Mixed cerebral palsy refers to when an individual experiences the effects of multiple types of cerebral palsy.
For example, one type of CP may predominantly affect movement patterns while another mostly affects fine-motor coordination. If you have mixed CP, you may experience both of these conditions.
Fortunately, many individuals with mixed cerebral palsy learn how to effectively manage their motor impairments, be functional, and maintain a high quality of life.
To help you better understand what mixed cerebral palsy is, this article will discuss:
- Causes of Mixed Cerebral Palsy
- Understanding the 3 Types of Cerebral Palsy
- How to Manage Mixed CP
- Is It Possible to Treat Mixed CP?
Causes of Mixed Cerebral Palsy
Mixed cerebral palsy is caused by damage to multiple areas of the brain. It can occur due to any combination of damage to the developing motor cortex, basal ganglia, and cerebellum.
Individuals with mixed CP usually experience the effects of two different types of cerebral palsy. However, it’s also possible (although much rarer) to experience the effects of all three.
CP is the result of damage to the brain before, during or shortly after birth. Therefore, common causes of mixed cerebral palsy include:
- Premature birth
- Multiple-birth pregnancy
- Hypoxia (lack of oxygen in the brain)
- Maternal infections
- Infant infections
- Traumatic brain injury
- Genetic factors
Now that you understand why individuals with mixed cerebral palsy experience conditions associated with multiple types of CP, let’s take a close look at the major differences between the 3 types of CP.
Understanding the 3 Types of Cerebral Palsy
There are three primary types of cerebral palsy: spastic, dyskinetic, and ataxic.
Individuals with mixed cerebral palsy demonstrate conditions associated with at least 2 of them. The most prevalent combination is spastic-dyskinetic.
Below, we’ll discuss the defining characteristics of each type of cerebral palsy.
Spastic Cerebral Palsy
Spastic cerebral palsy is the most common type of cerebral palsy, making up about 80% of all cases. It’s caused by damage to the motor cortex, the part of the brain responsible for controlling and planning voluntary movements.
Spastic cerebral palsy is characterized by spasticity, which refers to high muscle tone caused by disrupted signals from the damaged brain. Spasticity typically results in stiff or exaggerated movements. However, if not properly managed, it can lead to many negative consequences including pain, poor posture, and non-ambulation (inability to walk).
Spastic cerebral palsy can be further differentiated by the regions of the body it affects. Below, are the 4 types of spastic cerebral palsy:
- Spastic diplegia describes motor impairments that occur primarily in the legs. Generally, it affects both sides of the body equally.
- Spastic hemiplegia describes motor impairments that affect one side of the body.
- Spastic quadriplegia describes motor impairments that affect the entire body. Because it can also affect the muscles that make up the mouth, functions like chewing, swallowing, and speaking may be challenging.
- Spastic monoplegia describes motor impairments that affect a single limb (usually an arm rather than a leg).
Dyskinetic Cerebral Palsy
It’s caused by damage to the basal ganglia and is primarily characterized by uncontrollable movements.
There are two main types of disordered movement patterns individuals with dyskinetic cerebral palsy may experience: athetosis and dystonia.
Athetosis describes uncontrollable fluctuations in muscle tone. The muscles fluctuate between flaccid and spastic, which gives off the appearance of continuous movement.
In contrast, dystonia describes muscle contractions that cause repetitive, twisting movements.
Ataxic Cerebral Palsy
Ataxic cerebral palsy is the least common type of cerebral palsy.
It’s a result of damage to the cerebellum, which is responsible for regulating balance, coordination, and fine-motor skills.
Individuals with this type of CP may walk with a wide-based stance or struggle with tasks that require precision.
In the following section, we’ll discuss how individuals with mixed CP can manage their motor impairments.
How to Manage Mixed Cerebral Palsy
Because every case of mixed cerebral palsy is unique, ideal management interventions will vary from person to person.
Common management interventions include:
- Physical therapy helps individuals improve their motor functions through target exercises. It can help lengthen tight muscles to increase range of motion and strengthen underused muscles to improve motor control.
- Occupational therapy helps individuals improve their independence by practicing new ways to perform daily activities. It can also involve learning how to use adaptive devices.
- Speech therapy helps individuals with oral motor impairments improve their ability to chew, swallow, and speak. A speech-language pathologist may also teach individuals with more severe forms of oral motor impairments how to utilize augmentative and alternative communication methods.
- Orthotic devices like braces, casts, and splints provide musculoskeletal support. Individuals with mixed cerebral palsy may experience a combination of both high and low muscle tone, which can significantly affect posture and cause distortions during growth.
- Feeding tubes can help ensure that individuals with oral motor impairments meet their nutritional needs.
- Baclofen is a muscle relaxant that can help temporarily relieve spasticity. It can be taken orally in the form of a pill or directly delivered to the central nervous system through an implanted pump.
- Botox is a nerve blocker that blocks signals that stimulate muscle contractions. Its effects typically last 3-6 months. Because it is injected directly into spastic muscles, it’s generally more ideal for localized spasticity than generalized spasticity.
- Orthopedic surgeries typically involve manual lengthening of shortened muscles and tendons.
In the following section, we’ll discuss how to use these management interventions to promote improvements in motor functions.
Is It Possible to Treat Mixed Cerebral Palsy?
As with all types of cerebral palsy, there is currently no cure for mixed cerebral palsy. While damage to the brain is irreversible, the central nervous system is capable of utilizing neuroplasticity to make adaptive changes.
Even though cerebral palsy affects movement, the key to improvement lies within stimulating the brain. The brain is extremely adaptive and one of the most effective ways to promote neuroplasticity is through highly repetitive practice of targeted exercises and activities.
Consistently practicing helps reinforce demand for that function in the brain, which stimulates adaptive changes and strengthening. As a result, functions affected by mixed cerebral palsy may be improved by reorganizing them to undamaged regions of the brain.
Mixed CP: Key Points
Mixed cerebral palsy describes when an individual experiences conditions associated with 2 or more types of CP.
By targetting each motor impairment separately with the appropriate interventions, individuals with mixed CP can effectively manage their complications and improve their quality of life.
We hope this article helped you understand what mixed cerebral palsy is and how to manage it. Good luck!
Photos from top to bottom: iStock/olesiabilkei/trumzz