Mixed Cerebral Palsy

Mixed cerebral palsy occurs when a child is exhibiting traits of several types of CP. Children diagnosed with mixed cerebral palsy may have brain damage in more than one area of the brain. Mixed cerebral palsy can cause a variety of physical and neurological symptoms. Learn more about mixed cerebral palsy causes, symptoms, and treatment.

What Is Mixed Cerebral Palsy?

Children who exhibit movement problems that fall into more than one type of cerebral palsy are classified as having mixed cerebral palsy.

Those diagnosed with mixed cerebral palsy have damage to the motor control centers in several parts of their brain. The main symptoms of this cerebral palsy type are issues with movement, imbalance, and lack of coordination. Mixed cerebral palsy can also cause abrupt and convulsive movements (spasticity).

Mixed cerebral palsy varies based on the location of movement impairments. These movement problems can occur in the legs (diplegia), one-half of the body (hemiplegia), or all four limbs (quadriplegia).

Most cases of mixed cerebral palsy are often preventable and are caused by medical negligence. Your family may be eligible to pursue legal action if you believe your child's injuries could have been prevented.

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Mixed Cerebral Palsy Causes and Risk Factors

All cases of cerebral palsy are the result of damage to areas of the brain. Injuries to the various motor control centers lead to different types of cerebral palsy.

In mixed cerebral palsy, multiple parts of the motor control centers may be damaged, causing movement problems and abnormalities in brain development seen across various types of the condition.

Brain damage can be caused by:

  • 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 cause cerebral palsy. Risk factors include severe jaundice, placental failure, and bleeding in the brain.

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 that are sent 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 causes the motor cortex to unsuccessfully transmit signals to the pyramidal tracts.

This type of brain injury also causes movement problems seen with spastic cerebral palsy.

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. This part of the brain controls voluntary movements and cognition. Children with athetoid cerebral palsy have issues with high and low muscle tone. These variations in muscle tone cause involuntary movement and a 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 cerebral palsy also have damage to the cerebellum.

Symptoms of Mixed Cerebral Palsy

Each case of cerebral palsy varies in severity and locations of movement problems. Children with mixed cerebral palsy tend to have an even wider variety of symptoms since each child may experience several different types of brain damage.

Some of the most common signs of mixed CP are:

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

The symptoms of any of the several types of cerebral palsy may apply to a child with mixed cerebral palsy. The most common type of mixed CP is a combination of spastic and athetoid symptoms.

The symptoms of the different forms of cerebral palsy can be found in mixed CP cases.

  • Spastic cerebral palsy – High muscle tone, causing stiffness and jerky movement
  • Athetoid cerebral palsy – Variations in high and low tone, causing rigidity and floppiness
  • Ataxic cerebral palsy – Issues with balance and coordination affect normal movement
  • Hypotonic/dyskinetic cerebral palsy – Floppy muscles resulting in issues with voluntary movement

Mixed Cerebral Palsy Diagnosis

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 cerebral palsy diagnosis until a full evaluation has been performed.

The developmental signs of mixed cerebral palsy in a child include:

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

Treatment for Mixed Cerebral Palsy

The type of treatment required for cerebral palsy is different for every child. Some children may only need 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. Doctors will create a care plan with treatment options such as therapy, medications, and more.

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Physical Therapy

Physical therapy is generally the first step for treating mixed cerebral palsy. Therapists use strength training, flexibility exercises, massage therapy, and assistive devices to improve mobility.

Occupational Therapy

For a child with mixed cerebral palsy, occupational therapy can help with an array of symptoms. 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.

Occupational therapists 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.

Speech Therapy

Limited communication and swallowing disorders are common among children with cerebral palsy. Speech therapy uses several exercises to refine communication skills. These exercises include jaw exercises, breathing exercises, language skills, word association, and articulation therapy.


There are many kinds of medications prescribed to children with mixed cerebral palsy. Some medications help to control motor function. Medication can also treat co-occurring conditions such as seizures and behavioral disorders.


Surgery can relieve painful contractures and make movement more manageable. Children with spasticity are more likely to be recommended surgery. Surgery may be helpful in some cases of mixed cerebral palsy that show signs of athetoid cerebral palsy.

Get Help for Mixed Cerebral Palsy

If you believe your child may have developed mixed type cerebral palsy, contact a cerebral palsy specialist to get medical advice to determine your child's diagnosis.

Download our free Cerebral Palsy Guide to learn more about mixed cerebral palsy. Our guide includes over 60 pages of in-depth information for children and parents of a child with this condition.

Birth Injury Support Team
kristin proctor registered nurseReviewed by:Kristin Proctor, RN

Registered Nurse (RN)

  • Fact-Checked
  • Editor

Kristin Proctor began her nursing career as a U.S. Army Nurse and has been a Registered Nurse (RN) more than 20 years. She has specialized experience in labor and delivery, as well as prenatal, antepartum, and postpartum care. Kristin uses this experience to educate and support families affected by birth injuries.

Cerebral Palsy Guide was founded upon the goal of educating families about cerebral palsy, raising awareness, and providing support for children, parents, and caregivers affected by the condition. Our easy-to-use website offers simple, straightforward information that provides families with medical and legal solutions. We are devoted to helping parents and children access the tools they need to live a life full of happiness

View Sources
  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. What is cerebral palsy? (2020, December 31). Retrieved April 26, 2021, from http://www.cdc.gov/ncbddd/cp/facts.html
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