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CONDITION/DISORDER SYNONYM

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  • Cerebral palsy (CP)

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ICD-9-CM CODES

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  • 343 Infantile cerebral palsy

  • 343.0 Congenital diplegia

  • 343.1 Congenital hemiplegia

  • 343.2 Congenital quadriplegia

  • 343.3 Congenital monoplegia

  • 343.4 Infantile hemiplegia

  • 343.8 Other specified cerebral palsy

  • 343.9 Infantile cerebral palsy, unspecified

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ICD-10-CM CODES

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  • G80.0 Spastic quadriplegic cerebral palsy

  • G80.1 Spastic diplegic cerebral palsy

  • G80.2 Spastic hemiplegic cerebral palsy

  • G80.3 Athetoid cerebral palsy

  • G80.4 Ataxic cerebral palsy

  • G80.8 Other cerebral palsy

  • G80.9 Cerebral palsy, unspecified

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PREFERRED PRACTICE PATTERN

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  • 5C: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System-–Congenital Origin in Infancy or Childhood1

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PATIENT PRESENTATION

A 3-month-old infant referred to outpatient physical therapy following discharge from neonatal intensive care unit with diagnosis of CP. Infant was born at 27-week gestational age with Apgars of five at 1 minute and seven at 5 minutes. Past medical history includes respiratory distress syndrome, seizure disorder, and gastroesophageal reflux. Upon examination, infant exhibits poor head control, fisted hands, and inability to achieve prone on elbows.

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KEY FEATURES

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Description
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  • Nonprogressive damage to cerebral cortex (and other parts of the brain, such as cerebellum) that occurs during prenatal, perinatal, or postnatal period2

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Essentials of Diagnosis
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  • Four types of muscle tone (and percentage occurrence in children with CP)3

    • Hypotonia

    • Hypertonia (70%–75%)

    • Ataxia (10%–15%)

    • Athetosis (20%)

  • Distribution of muscle tone

    • Quadriplegia: All four limbs involved, arms more than legs; cervical area, oral area

    • Diplegia: Primarily legs involved4

    • Hemiplegia: Primarily ipsilateral arm and leg involved4

    • Monoplegia: Only one limb involved

    • Triplegia: Only three limbs involved

    • In athetosis and ataxia, most often total body distribution: No hemiplegia, diplegia

  • Gross motor function classification system5

    • Level I (least involved)

    • Level II

    • Level III

    • Level IV (most involved)

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FIGURE 232-1

Schematic representation of surgical options for muscle release or lengthening in cerebral palsy. A: Myotomy; B: tenotomy; C: aponeurotomy. (From Skinner HB. Current Diagnosis & Treatment in Orthopedics. 4th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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General Considerations
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  • Muscle tone often presents as hypotonia but changes before 12 months of age, most often to hypertonia depending on the type of CP

  • Infants (under age 12 months) can also have “transient” muscle tone within first year of life; may initially present as hypertonic but resolves spontaneously without development of CP

  • Associated disorders

    • Seizure disorder (in 50% of CP cases)3

    • Cognitive impairment (in 53% of CP cases)

    • Orthopedic deformities

    • Sensory integration dysfunction

    • Speech and language deficits

    • Difficulty feeding

    • Microcephaly3

    • Respiratory distress

    • Bronchopulmonary dysplasia6

    • Hydrocephalus3

    • Retinopathy of prematurity7

    • Visual impairment

    • Auditory impairment

    • Gastroesophageal reflux8

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