When a child is exhibiting traits of spastic, athetoid and ataxic CP, it is considered to be the mixed cerebral palsy type.

What is Mixed Cerebral Palsy?

Mixed cerebral palsy is a developmental disorder caused by brain damage that takes place before, during or shortly after birth. Those diagnosed with mixed CP have damage to the motor control centers in several parts of their brain.

Children who exhibit movement problems that fall into one or more types of cerebral palsy are classified as having mixed CP.

Children with this condition may have issues with movement, including: spasticity (abrupt, convulsive movements), involuntary movements, imbalance and lack of coordination. In order to understand mixed cerebral palsy, a quick overview of the primary issues involved with the other types of cerebral palsy can be helpful. The symptoms of each type can be found in mixed CP cases.

  • Spastic – High muscle tone, causing stiffness and jerky movement
  • Athetoid – Variations in high and low tone, causing rigidity and floppiness
  • Ataxic – Issues with balance and coordination affect normal movement

Mixed CP varies based on the location of movement problems. These movement problems can occur in the legs (diplegia), one half of the body (hemiplegia) or all four limbs (quadriplegia). The most common variation of mixed CP is a combination of spastic and athetoid symptoms.

Causes and Risk Factors

All cases of cerebral palsy are the result of damage to the developing brain. Injuries to the various motor control centers give rise to different types of cerebral palsy. In mixed CP, multiple parts of the motor control centers may be damaged, causing movement problems seen across various types of CP.

Damage to Motor cortex

The motor cortex is one of the most important components of the brain’s motor control centers. Movement starts as signals from the motor cortex relayed to other parts of the brain that regulate motor control. These signals are then passed to the nerves in the muscles. Damage to the motor cortex causes spasticity in the muscles, joints and tendons.

Damage to Pyramidal Tracts

The pyramidal tracts are the pathways whereby signals from the motor cortex travel to nerves in the spine. Damage to the pyramidal tracts has a similar effect to a damaged motor cortex, as signals from the motor cortex can’t get through without the pyramidal tracts. Therefore, this type of brain injury also causes movement problems seen with spastic CP.

Damage to Basal ganglia

The basal ganglia are a group of several types of neurons in the center of the brain. The basal ganglia process signals from the motor cortex before sending them along to the brainstem. Athetoid cerebral palsy is caused by damage to the basal ganglia, which help control voluntary movements and cognition. Children with athetoid CP have issues with high and low muscle tone. These variations in muscle tone cause involuntary movement and lack of muscle control.

Damage to Cerebellum

The cerebellum’s role in motor function is to maintain balance and coordination of movement. Children with damage to the cerebellum have issues with posture, walking and fine motor skills. Some children with athetoid CP also have damage to the cerebellum. Children may develop ataxic CP if the cerebellum is only damaged by part of the brain.

There are a number of ways that brain damage can result, including:

  • Infections before or after birth

  • Lack of oxygen at or during birth

  • Traumatic head injury in first years of life

There are several risk factors that may increase the chances of a child developing cerebral palsy, including: severe untreated jaundice, placental failure and bleeding in the brain.

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Symptoms of Mixed Cerebral Palsy

Every case of cerebral palsy is unique because of the different levels of severity and specific locations of movement problems. Children with mixed cerebral palsy, however, tend to have an even wider variety in symptoms since each child is experiencing a unique type of brain damage. The symptoms of any type of cerebral palsy may apply to a child with mixed cerebral palsy.

Some of the most common signs of mixed CP are:

  • Exaggerated, jerky movements
  • Abnormal reflexes
  • Poor posture
  • Tremors or shakiness
  • Issues with coordination

Diagnosing mixed cerebral palsy can take up to 3 years of age, as all children develop at their own speed. It’s also hard to tell if a child with a brain injury will make a recovery and develop normally. Most doctors and specialists typically prefer to delay a CP diagnosis until a full evaluation has been performed.

The developmental signs of mixed CP in a child include:

  • Inability to hold up their head
  • Abnormally stiff muscles
  • Crossed legs or abnormal gait
  • Inability to roll over
  • Favoring one arm when reaching for objects

Treatment for Mixed Cerebral Palsy

The level of treatment required for cerebral palsy is different with every child. Some children may only require minor physical therapy, while others may need more severe treatment methods. Either way, the goal of treating cerebral palsy should be to provide your child with the highest level of independence possible. This is usually accomplished through combining an array of treatment options, such as therapy, medications and more.

Physical therapy

Physical therapy is generally the first step for treating mixed CP. The type of therapies geared toward a child with mixed cerebral palsy depends on the specific movement problems they are experiencing. Physical therapists use several methods to help improve mobility, including: strength training, flexibility exercises, massage therapy and orthotic devices to help with posture and walking.

Occupational therapy

For a child with mixed CP, occupational therapy can help with an array of symptoms. Occupational therapists will use tools such as games, toys and books to help improve motor control and bilateral coordination. This therapy is helpful in strengthening a child’s ability to utilize both sides of their body at the same time. The overall goal of occupational therapy is to improve the quality of life for a child and provide them with the tools to be self-sufficient.

Speech therapy

Speech therapy is different for every child with mixed CP. Issues such as limited communication and swallowing disorders are common among children with this condition. Speech therapy uses several exercises in treatment, such as jaw exercises, breathing exercises, language and word association and articulation therapy.

Medications

There are many kinds of medications prescribed to children with mixed cerebral palsy. Some medications are designed to help control motor function, while others can be used to manage co-occurring conditions, such as seizures and behavioral disorders.

Surgery

Surgery for children with cerebral palsy is generally geared to relieving painful contractures and making movement more manageable. Children with spasticity are the most likely to be recommended surgical treatment, although surgery may be helpful in some cases of mixed CP (with more characteristics of athetoid).

To find out more information on how to treat mixed cerebral palsy, try downloading our free Cerebral Palsy Guide. This guide includes over 60 pages of in-depth information for children and parents of a child with CP.

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Stephanie Williamson,
LPN

Sources & Author Edited: December 19, 2016
  1. Understanding Cerebral Palsy: A Guide for Parents and Professionals. Marion Stanton. Jessica Kingsley Publishers. London and Philadelphia. 2012.
  2. Cerebral Palsy: A Complete Guide for Caregiving 2nd ed. Freeman Miller, M.D. and Steven J. Bachrach, M.D. The Johns Hopkins University Press. Baltimore, MD. 2006.
  3. Children with Cerebral Palsy: A Parent’s Guide 2nd ed. Edited by Elaine Geralis.
  4. Chapter 1: What Is Cerebral Palsy? by Elliot Gersh, M.D. Chapter 7: Physical Therapy, Occupational Therapy, and Speech & Language Therapy by Lynne C. Foltz, M.A., P.T., Georgia DeGangi, Ph.D., O.T.R., Diane Lewis, M.A., C.C.C. Chapter 3: Medical Concerns and Treatment by Dr. Gersh. Woodbine House, Inc. Bethesda, MD. 1998.
  5. http://www.cdc.gov/ncbddd/cp/facts.html
  6. http://neuroscience.uth.tmc.edu/s3/chapter05.html
  7. http://neuroscience.uth.tmc.edu/s3/chapter04.html
  8. http://neuroscience.uth.tmc.edu/s3/chapter03.html
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