Types of Cerebral Palsy Explained: Spastic, Dyskinetic, Ataxic

When your child is diagnosed with cerebral palsy, one of the first questions you will have is: what type? The type of CP tells you which movement patterns are affected, which part of the brain was injured, and which therapies are most likely to help. This guide explains each type clearly so you can understand your child’s diagnosis and advocate effectively for their care.

Overview of CP Types

Cerebral palsy is classified by the primary type of movement disorder and by which parts of the body are affected. The movement disorder type is determined by the brain region that was injured.

The four main types are spastic (stiff muscles), dyskinetic (involuntary movements), ataxic (balance problems), and mixed (combination of types). Within spastic CP, there are further subtypes based on which limbs are affected. Understanding these categories helps your medical team choose the right therapies and set appropriate developmental goals.

Spastic CP: What It Is and Subtypes

Spastic cerebral palsy is by far the most common type, accounting for approximately 80 percent of all CP cases. It is caused by damage to the motor cortex or the white matter pathways that carry signals from the brain to the muscles. The hallmark of spastic CP is hypertonia, meaning increased muscle tone that makes muscles feel stiff, tight, and resistant to stretching.

Children with spastic CP move in ways that look stiff or jerky. Their muscles contract too strongly and have difficulty relaxing, which makes smooth, coordinated movement difficult. Over time, persistently tight muscles can lead to contractures (permanent shortening of muscles and tendons) and joint problems, which is why stretching, positioning, and orthotic management are critical from an early age.

Spastic CP is further classified by which limbs are most affected:

Spastic diplegia. Primarily affects the legs, with the arms less involved or minimally affected. Children with spastic diplegia often walk, though they may walk on their toes, with a scissoring pattern, or with a crouched gait. Many use walkers or crutches for part or all of the day. Cognitive function is often preserved or near-typical. Spastic diplegia is most commonly associated with periventricular leukomalacia (PVL), a white matter injury seen frequently in premature infants.

Spastic hemiplegia. Affects one side of the body, with the arm usually more affected than the leg. Children with spastic hemiplegia typically walk independently, though they may have a noticeable limp or asymmetry. They often develop strong compensatory strategies using their less-affected side. Cognitive function is usually preserved, though some children have learning differences. Hemiplegia results from injury to one hemisphere of the brain, often from a stroke before or during birth.

Spastic quadriplegia. Affects all four limbs, the trunk, and often the muscles of the face and mouth. This is the most severe subtype of spastic CP. Children with spastic quadriplegia often have significant difficulty with mobility, feeding, and communication. Many use wheelchairs and require assistance with daily activities. Spastic quadriplegia is most commonly caused by extensive brain injury, such as severe HIE or widespread white matter damage.

Dyskinetic CP

Dyskinetic cerebral palsy is characterized by involuntary, uncontrolled movements. Unlike the stiffness of spastic CP, dyskinetic CP involves fluctuating muscle tone that can shift unpredictably between too high and too low, making controlled movement extremely difficult.

There are three subtypes within dyskinetic CP. Athetoid movements are slow, writhing, and continuous, most visible in the hands, arms, and face. Choreiform movements are rapid, irregular, and jerky, often affecting the extremities. Dystonia involves sustained, abnormal postures caused by muscle co-contraction, where opposing muscles activate simultaneously.

Children with dyskinetic CP often have difficulty holding a stable posture, controlling their hands for tasks like feeding or writing, and producing clear speech. However, many have preserved cognitive function, which means they may understand and think at a higher level than their bodies can express. This is why augmentative and alternative communication (AAC) tools are so important for children with this type of CP.

Dyskinetic CP is most commonly caused by damage to the basal ganglia, the deep brain structures that coordinate smooth, purposeful movement. This injury pattern is strongly associated with HIE, particularly when oxygen deprivation is acute and severe around the time of birth. The MRI typically shows signal abnormality in the basal ganglia and thalamus.

Ataxic CP

Ataxic cerebral palsy is the least common type, accounting for approximately 5 to 6 percent of CP cases. It is caused by damage to the cerebellum, the brain region responsible for coordinating movement, balance, and fine motor precision.

Children with ataxic CP have difficulty with balance and coordination rather than stiffness or involuntary movements. They may have a wide-based, unsteady walk that resembles someone walking on a boat. Their movements tend to be imprecise, so tasks that require fine motor control, such as writing, using utensils, buttoning clothes, or reaching accurately for objects, are particularly challenging. Intention tremor, where shaking increases as the hand approaches a target, is a common feature.

Speech may be affected in a pattern called scanning speech, where words sound broken up with irregular emphasis. Overall, ataxic CP is typically less severe than spastic or dyskinetic CP in terms of gross motor function, and many children with ataxic CP walk independently, attend mainstream school, and live with relatively mild functional limitations.

Mixed CP

Some children have features of more than one type of cerebral palsy. This is classified as mixed CP and accounts for roughly 10 to 15 percent of cases. The most common combination is spastic-dyskinetic, where a child has both increased muscle tone and involuntary movements.

Mixed CP occurs when the brain injury affects multiple regions. For example, an HIE event that damages both the white matter and the basal ganglia can produce a combination of spasticity and dystonia. Treatment for mixed CP requires a nuanced approach that addresses each movement pattern separately, and therapy goals must account for the interplay between different types of motor dysfunction.

How Type Is Determined

The type of cerebral palsy is determined through clinical examination and brain imaging. A pediatric neurologist assesses your child’s muscle tone, movement patterns, reflexes, and posture to identify whether the predominant pattern is spastic, dyskinetic, ataxic, or mixed.

The MRI provides structural evidence that supports the clinical classification. White matter injury or cortical damage points toward spastic CP. Basal ganglia and thalamus injury points toward dyskinetic CP. Cerebellar abnormalities suggest ataxic CP. In mixed CP, the MRI typically shows damage to multiple brain regions.

Classification may evolve as your child grows. In infancy, the predominant pattern may not be fully clear because the motor system is still developing. A baby initially described as having abnormal tone may be classified more precisely at 12 to 24 months as the specific movement pattern emerges. The GMFCS level also becomes more stable and predictable over time.

How Type Affects Treatment

The type of CP directly guides treatment choices. Knowing your child’s type helps you ask the right questions and ensures your therapy team is using the most effective approaches.

Spastic CP treatment focuses on reducing muscle stiffness and preventing contractures. This includes regular stretching programs, physical and occupational therapy, Botox injections to temporarily relax specific muscle groups, oral baclofen for more widespread spasticity, ankle-foot orthotics (AFOs) and other bracing, and in appropriate candidates, selective dorsal rhizotomy (SDR) to permanently reduce lower extremity spasticity.

Dyskinetic CP treatment focuses on movement control, positioning, and functional strategies. Therapy emphasizes trunk stability, head and hand control, and consistent positioning to reduce the impact of involuntary movements. Medications such as trihexyphenidyl or gabapentin may be used for dystonia. AAC devices are often essential for communication.

Ataxic CP treatment emphasizes balance training, coordination exercises, weighted utensils and adaptive tools for fine motor tasks, and strategies to improve stability during walking and daily activities.

All types of CP benefit from early intervention started as soon as possible, and from a multidisciplinary team that includes physical therapy, occupational therapy, speech therapy, and developmental monitoring.

GMFCS Levels Explained

In addition to the type of CP, your child’s functional ability is described using the Gross Motor Function Classification System (GMFCS). This is a five-level scale that describes what your child can do in terms of movement and mobility, rather than what is wrong with their muscles.

The GMFCS level is one of the most useful pieces of information you will receive because it helps set realistic expectations, guides therapy goals, informs equipment decisions, and connects you with other families whose children have similar functional abilities. GMFCS level is generally stable by age 4 to 6, though children at every level can and do make functional gains with appropriate support.