PEDIATRICS Vol. 18 No. 5 November 1956, pp. 841-852
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SPECIAL ARTICLE

A CLASSIFICATION OF CEREBRAL PALSY

W. L. Minear M.D., Ph.D.1

1 Chairman, Nomenclature and Classification Committee, American Academy for Cerebral Palsy.

The majority of the members of the American Academy for Cerebral Palsy voted to exclude progressive neurological diseases and neoplastic diseases of the brain from the classification of cerebral palsy. The lesion left by the removal of a brain tumor, however, is still considered one of the etiological factors of cerebral palsy.

Cerebral palsy comprises the motor and other symptom complexes caused by a non-progressive brain lesion (or lesions).

The nomenclature and classification questionnaires indicate that the members of the American Academy for Cerebral Palsy wish to accept a motor classification, listing each type of cerebral palsy separately: Spastic, Athetoid, Tremor, Rigidity, Ataxic, Atonic, and Mixed.

The following choices as a basis for classification of cerebral palsy were made by the American Academy for Cerebral Palsy:

First choice: Motor Symptoms

Second choice: Topographic Involvement

Third choice: Etiology

Fourth choice: Anatomical Site (of lesion)

Fifth choice: Severity of Involvement

Sixth choice: Degree of Muscle Tone

Seventh choice: Supplemental Data

The first 3 choices above should be used by the medical record librarian and by doctors discharging patients with cerebral palsy from hospitals or institutions so as to establish a common understanding and uniformity to hospital records. It is understood that the neuroanatomical classification (Fourth choice) is to be used when it can be proven, but not by presumption.

The majority of the members approve of tension, non-tension, dystonic, and tremor-like types of athetosis. The other types were rejected for various reasons. Probably, some of the other types would have been accepted if understood by the members. Each type is described and defined herein. There is a general lack of agreement on the various terms used in cerebral palsy. Definitions of these terms are now being made by a committee for a meeting in 1955.

There is a good deal of evidence that neurological signs and symptoms change in the child with cerebral palsy as the nervous system matures and that one must be cautious in making a final descriptive or symptomatic diagnosis in infancy. The pattern of changing neurological symptoms from infancy through childhood should be studied.

The high cervical syndrome described by Fay is being confused with cerebral palsy. This syndrome needs further study. It should be determined whether the term cerebrospinal palsy would not be more appropriate for the entire neurological group.

The American Medical Association's Standard Nomenclature of Diseases and Operations (Fourth Edition), commonly used by medical record librarians, is not suitable for the classification of cerebral palsy. In this edition, all cerebral palsy is coded "Cerebral spastic infantile paralysis" with supplementary terms added to denote various types.

A complete classification for cerebral palsy is presented, using the majority opinion from questionnaires sent to the members of the American Academy for Cerebral Palsy during 1953 as a basis.




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