ABSTRACT
This is the most severe form of spastic cerebral palsy. All four limbs are affected, with the arms more affected than the legs, as well as the muscles for chewing and speech. The child usually has severe learning difficulty so is unable to communicate, mainly because of the severe learning difficulty but also because of muscle problems in the voice box. These children frequently cannot sit up or walk independently and are not able to achieve independent existence. They require constant care and attention for all their bodily requirements; this need persists throughout their natural life. Perinatal asphyxia is the cause of a few such cases, but the majority are caused by antenatal insults as described above.
