The Definition and Classification of Cerebral Palsy: Are We Any Further Ahead in 2006?

After completing this article, readers should be able to:

1. Discuss the new proposed definition of cerebral palsy (CP).

2. Delineate the age at which the diagnosis of CP can be made.

3. Address the developmental disability aspects of CP.

4. Discuss the implications of CP being a lifelong condition.

5. Delineate areas of controversy in the new definition of CP.

In the summer of 2004, an international group of clinicians and researchers gathered for a 2-day meeting in Bethesda, Maryland, to consider one of the perennial questions in the field of developmental disability. For the past 40 years, the definition of cerebral palsy (CP) has been the classic 1964 Bax statement: CP is “a disorder of movement and posture due to a defect or lesion of the immature brain.” Despite some modest but useful enhancement of these ideas by Mutch and associates in 1992 (CP is “an umbrella term covering a group of nonprogressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of development”), uncertainty remains about both of these specific definitions, and more generally, whether the term “cerebral palsy” has outlived its usefulness.

The 2004 meeting was cosponsored by the Castang Foundation in the United Kingdom and the United Cerebral Palsy Research and Educational Foundation in the United States. A number of factors in many fields of the clinical and biologic sciences have increased understanding of developmental neurobiology. For this reason, a reassessment of the concepts and definition of this classic “developmental disability,” which remains very prevalent across the developed world (2 to 2.5 per 1,000), was a useful undertaking.

The new annotated definition, submitted to Developmental Medicine and Child Neurology in the spring of 2006 as the final version of the August 2005 published draft, reads as follows:

“Cerebral palsy (CP) …