When the brain cells controlling muscle tone and strength are damaged, changes occur to the muscles. With growth of the child, these changes in the muscles affect skeletal and joint development. But the musculoskeletal system is always affected to some degree. In the first year of life, the infant may present as a floppy baby, but with further growth, the muscles often become spastic. The child usually walks but with a limp.
Spastic diplegia occurs when the lower limbs are mostly affected, and the arms are mostly spared.
These children may have limited walking, but are often wheelchair bound. Total body involvement occurs when all four limbs are affected. These children are very severely involved, and often have cognitive problems as well. Deformities occur with growth, due to muscle imbalance that leads to contractures and joint dislocations. Cerebral palsy is best treated by an interdisciplinary team, consisting of a developmental pediatrician or neurologist, orthopedic surgeon, physical therapist, occupational therapist, speech therapist, and social worker.