Index

Significant historical advances, theories, and practices surrounding cerebral palsy from ancient times through the mid-20th century.

Historical Timeline

  • 1196–1190 BCE: Pharaoh Siptah exhibits earliest recorded CP-like symptoms.

  • 1580–1350 BCE: Stele of servant Roma suggests early recognition of motor disability.

  • 460–390 BCE: Hippocrates associates prenatal complications with motor impairments.

  • 10 BCE–54 CE: Emperor Claudius presents features consistent with athetoid CP.

  • 1861: William Little introduces "Little's Disease."

  • 1889: William Osler publishes foundational monograph on CP.

  • 1897: Sigmund Freud emphasizes prenatal origins.

  • 1940s–1950s: Bobath therapy and conductive education introduced.

  • 1953: Virginia Apgar creates Apgar scoring system.

  • 1959: Mac Keith & Polani define modern cerebral palsy.

  • 1980s: GMFM scoring system developed.

  • 1990s: Botulinum toxin therapy and selective dorsal rhizotomy (SDR) popularized.

  • 2001: WHO adopts ICF model, reshaping CP management.

  • 21st Century: Genetic research, stem-cell therapies, advanced neuroimaging, and robotics significantly advance CP care.

Cerebral Palsy (CP) Before the Common Era

  • Pharaoh Siptah (19th dynasty, Egypt, 1196–1190 B.C.)

    • Ruled for 6 years; died at age 20 (typical lifespan for CP at the time).

    • Exhibited marked foot deformity (equinus/equinovarus).

    • Deformity details:

      • Inverted right foot, dislocated bones, shortened Achilles tendon.

      • Compensatory positioning for shortened left leg with drop foot.

    • Egyptologists suggest congenital CP due to arm positioning and clenched hands.

    • Alternative diagnoses considered: congenital clubfoot, poliomyelitis, or neuromuscular diseases; possible post-mortem modifications due to tomb disturbances.

  • Roma (Servant depicted on 18th dynasty stele, Egypt, 1580–1350 B.C.)

    • Depicted with severely atrophied leg, using stick as crutch.

    • Differential diagnoses: poliomyelitis, cerebral palsy, or clubfoot.

    • No chance of post-mortem artifact; cause remains uncertain.

  • Ancient Greece and Terminology

    • Greek origins for terms "palsy," "paralysis," and "paresis."

    • Soranos of Ephesus (2nd century AD) detailed neurological terms: apoplexia, paralysis, paresis, paraplegia, paralipsis.

    • Developed early infant assessment methods, similar to modern Apgar score.

  • Hippocrates (460–390 B.C.)

    • Linked CP-like conditions to prematurity, congenital infections, prenatal stress, and fetal distress.

    • Mentioned specific signs of intrauterine brain damage (distorted mouth, eye, hand, or neck positions).

  • Hellenistic Art

    • Temple Fay identified potential hemiplegia in sculpture (possibly Menander).

    • Other Greek historical examples cited but remain speculative.

The Common Era Prior to the 19th Century

  • Roman Emperor Claudius (10 B.C.–54 A.D.)

    • Exhibited signs suggestive of CP (athetoid variant): abnormal gait, involuntary movements, dysarthria, dysphonia, tremors, salivation, emotional instability.

    • Modern reconsideration also suggests possible Tourette’s syndrome.

  • Artistic Depictions (1500s–1600s)

    • Matthias Grünewald’s "Heller Altarpiece" (1510) depicted physical disability.

    • Raphael’s "Healing of the Lame" tapestry (1516) portrayed disability vividly (see cover image).

    • Ribera’s "The Clubfoot" (1642) notably represents physical deformity.1 Pv0JT P0RmLz5GoVZ8L52ARibera’s "The Clubfoot" (1642)

The 19th Century (1800s)

  • Early Pathological Studies

    • Brain lesions and atrophy related to paralysis described (Reil, Lallemand, Pinel, Cazauvieilh, Cruveilhier, Rokitansky, Henoch).

  • William John Little (1810–1894)

    • Defined link between CP, prematurity, difficult births, and neonatal asphyxia.

    • Coined "Little's Disease" for spastic diplegia; associated CP with birth trauma.

    • Advocated surgical methods (tenotomy) but later recommended cautious use.

  • Other Key Contributors

  • William Osler (1849–1919)

    • Monograph (1889) systematically classified CP and emphasized birth-related intracranial hemorrhage.

    • Mentioned jaundice as possible cause of CP.

  • Sigmund Freud (1856–1939)

    • Proposed influential CP classification: congenital, intrapartum, postpartum.

    • Documented poor correlation between neuropathology and clinical manifestations.

    • Disputed birth trauma as primary CP cause, arguing prenatal origins.

Early 20th Century (1900–1950)

  • Neurological Advances

  • Winthrop Phelps (1894–1971)

    • Introduced orthopedic treatment approach; classified CP into spasticity, athetosis, rigidity, tremor, ataxia.

    • Advocated multidisciplinary approach.

  • Developmental and Behavioral Research

    • Schaltenbrand, Georg(es) described normal motor development stages.

    • Walshe and Magnus identified abnormal tonic reflexes in CP.

    • Alfred A Strauss & Laura E Lehtinen linked emotional/behavioral disorders with CP.

  • Virginia Apgar (1953)

    • Created Apgar scoring system to identify newborns at risk for brain injury.

    • Promoted early recognition and intervention.

Mid-20th Century (1950s)

  • Neuroscience and Therapy Advances

    • Temple Fay developed hierarchical neurological development theory.

    • Andreas Pető established conductive education (Hungary), integrating education with CP management.

    • Margaret Rood and Herman Kabat proposed neuromuscular re-education techniques.

  • Modern Concepts and Definitions

    • Mac Keith & Polani (1959): Established widely accepted CP definition emphasizing early-onset, non-progressive brain disorders affecting movement/posture.

    • Crothers and Paine (1959): Emphasized multidisciplinary evaluation based on neurological signs; linked kernicterus to distinctive CP features.

  • Influential Figures

    • Delacato, Doman, Vojta expanded early motor rehabilitation theories emphasizing early developmental reflex correction.

    • Prechtl and Beintema (1964): Developed assessment methods to predict CP through primitive reflexes and spontaneous infant movements.

    • Christensen and Melchior (1967): Authored comprehensive neuropathological analysis on CP cases.

  • Emerging Therapies

    • Physiotherapy methods, neurodevelopmental approaches, botulinum toxin, intrathecal baclofen, selective dorsal rhizotomy, and assistive technologies were increasingly applied to improve mobility and quality of life.

    • Advances in neonatal care, neuroimaging, and early intervention improved CP prognosis significantly.