cp describes a group of permanent disorders of the development of movement and posture , causing activity limitation , that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain .
the motor disorders of cp are often accompanied by disturbances of sensation , perception , cognition , communication , and behavior , by epilepsy and secondary musculoskeletal problems .
various studies had been carried out from all over the world for prevalence , reporting estimates of cp ranging from 1.5 to > 4 per 1000 live births or children of a defined age range .
a number of factors contribute to the development of cp including antenatal , natal , and postnatal factors .
intrapartum factors such as perinatal asphyxia also play role for the development of cp which have more contribution in developing countries .
prematurity also became an important factor as survival of preterm babies is increasing owing to better health facilities .
the physiological classification classifies cp children into spastic , dyskinetic , hypotonic , and mixed types on the basis of major motor abnormality while topographical classification divides them into monoplegia , diplegia , triplegia , quadriplegia , paraplegia , and hemiplegia , indicating involved extremities . besides movement and motor dysfunction , common
associated comorbidities are epilepsy , speech , hearing and vision impairment , oromotor dysfunction , and intellectual disability .
this study aimed to describe clinical spectrum , associated comorbidities , and risk factors associated with cp children presented to our hospital that will help in better understanding of etiology and presentation of cp children .
this hospital - based observational study was conducted from march 2012 to march 2013 in tertiary level hospital in jaipur .
one - hundred and eighty cp children aged 112 years were enrolled from paediatric neurology outdoor and child development centre .
detailed birth history including antenatal , natal , postnatal , socioeconomic status , and maternal nutritional status was taken .
detailed examination performed to classify cp children according to topography and physiological classification and also for associated comorbidities .
in this study , most of children ( 35.56% ) were in 34 years age group followed by 56 years age group ( 22.78% ) .
of the 180 children , males were 56.11% while females were 43.33% of total children [ table 1 ] .
in other prenatal risk factors , antepartum hemorrhage , pregnancy - induced hypertension ( pih ) and infections contributed to 5.5% , 4.4% , and 3.3% , cases respectively [ table 2 ] . among natal factors ,
small for gestational age ( sga ) ( 25.5% ) and prematurity ( 17.7% ) were also common risk factors for cp [ table 3 ] .
seizure in postnatal life was the second most common risk factor for cp after asphyxia .
pathological jaundice and infections are responsible for 15.5% and 25% cases , respectively [ table 4 ] .
distribution of patients according to age and sex antenatal risk factors , n ( % ) natal risk factors , n ( % ) postnatal risk factors , n ( % ) spastic cp ( 84.4% ) was the most common physiological type and quadriplegia ( 56.6% ) was the most common topographical type observed in this study .
hypotonic and dyskinetic types contributed for equal cases ( 5.5% each case ) [ table 5 ] .
distribution of cerebral palsy children according to physiological and topographical classification , n ( % ) one or more comorbidities were present in cp children in this study .
intellectual disability ( 47.7% ) followed by epilepsy ( 41.6% ) was the most common comorbidity .
speech delay , hearing defects , and visual impairment were present in 27.7% , 10% , and 10% cases , respectively [ table 6 ] .
in the present study , we described the clinical spectrum , risk factor profile , and comorbidities associated with cp children .
as cp is the most common and costly form of chronic motor disability in children , understanding of probable risk factors that can cause cp is utmost important .
a european study by johnson also showed similar result with male : female ratio of 1.33:1 .
maternal anemia contributed for 17.7% cases followed by antepartum hemorrhage ( 5.5% ) , hypertension ( 4.4% ) , and infections ( 3.3% ) .
described probable etiological factors of cp children in central india and found that antepartum hemorrhage and hypertension contributed 10% and 6% , respectively .
pattar and yelamali described similar results with equal frequency of maternal anemia , pih / toxemia , and aph ( in 6% cases each ) as risk factors of cp .
consistent with literature , our study also showed asphyxia ( 45.5% ) as the most common risk factor of cp .
anwar et al . observed that majority ( 53.6% ) of the cp cases were reported to had perinatal asphyxia .
they also observed that mothers of 43.6% cp children had history of prolonged labor while in our study only 1.6% cp chil - dren 's mothers had prolonged labor history .
our study result was supported by similar finding in study performed by gedam et al .
they found 2% mothers of cp children had history of prolonged labor . in this study ,
o'callaghan et al . estimated epidemiological risk factors of cp children and found that 43.9% and 29.3% cp children were sga and preterm at birth , respectively .
seizure ( 35.5% ) was the most common risk factor in postnatal life for the development of cp , and majority of these cases were consequences of hypoxic ischemic encephalopathy .
pathological jaundice and infection contributed for 15.5% and 25% cases , respectively . in developed countries , children of spastic diplegia cp
are increasing as survival of preterm babies is improved , but in this study , spastic quadriplegia was the most common topographical type and contributed for 56.6% cases .
these results were consistent with results of study by singhi et al . who reviewed clinical profile of 1000 cp children .
intellectual disability and epilepsy were the most common comorbidities associated with cp children while 27.7% cp children had speech delay .
other associated comorbidities are visual impairment , hearing defect , malnutrition , and oromotor dysfunction .
even with advancement of health - care system , asphyxia is the most common risk factor , and spastic quadriplegia is the most common type of cp .
there is still a need for improving the health facilities to overcome this costly and common neuromotor disability .
widespread knowledge of common risk factors that can predispose to cp can prevent the cp development to some extent and knowledge of clinical spectrum , and comorbidities can improve their targeted treatment which can improve their growth and social participation .
 aim and objective : cerebral palsy ( cp ) is the most common motor disability in childhood . 
 this study aimed to describe clinical spectrum , comorbidities , and risk factors associated with cp children.materials and methods : this hospital - based observational study was conducted in tertiary level hospital in jaipur including 180 cp children aged 112 years , attending the paediatric neurology outdoor and child development centre . 
 a detailed history of antenatal , natal , and postnatal events taken and thorough examination was performed to stratify children in proper topographical and physiological classification.results:mothers of 47.7% cp children were primigravida and 17.7% mothers had anemia during pregnancy . among natal factors , 
 asphyxia contributed to maximum cases ( 52.2% ) . 
 seizure in postnatal life was the second most common risk factor for cp after asphyxia . 
 spastic cp ( 84.4% ) was the most common physiological type , and quadriplegia ( 56.6% ) was the most common topographical type observed in this study . 
 intellectual disability ( 47.7% ) followed by epilepsy ( 41.6% ) was the most common comorbidity.conclusion:even with the advancement of health - care system , asphyxia is the most common risk factor , and spastic quadriplegia is the most common type of cp . 
 there is still a need of improving the health facilities to overcome this costly and common neuromotor disability . 
 widespread knowledge of common risk factors that can predispose to cp can prevent the cp development to some extent and knowledge of clinical spectrum , and comorbidities can improve their targeted treatment which can improve their growth and social participation . 
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