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For a variety of reasons, the definition and the clawification of cerebral palsy (CP) need to be reconsidered. Modern brain imaging techniques have shed new light on the nature of the underlying brain injury and studies on the neurobiology of and pathology associated with brain development have further explored etiologic mechanisms. It is now recognized that assessing the extent of activity restriction is part of CP evaluation and that people without activity restriction should not be included in the CP rubric. Also, previous definitions have not given sufficient prominence to the non‐motor neurodevelopmental disabilities of performance and behaviour that commonly accompany CP, nor to the progression of musculoskeletal difficulties that often occurs with advancing age. In order to explore this information, pertinent material was reviewed on July 11–13,2004 at an international workshop in Bethesda, MD (USA) organized by an Executive Committee and participated in by selected leaders in the preclinical and clinical sciences. At the workshop, it was agreed that the concept ‘cerebral palsy’ should be retained. Suggestions were made about the content of a revised definition and classification of CP that would meet the needs of clinicians, investigators, health officials, families and the public and would provide a common language for improved communication. Panels organized by the Executive Committee used this information and additional comments from the international community to generate a report on the Definition and Classification of Cerebral Palsy, April 2006. The Executive Committee presents this report with the intent of providing a common conceptualization of CP for use by a broad international audience.

The International Workshop on the Definition and Classification of Cerebral Palsy have proposed a fresh definition and classification of cerebral palsy (CP; p 571). In their accompanying paper they explain their reasoning behind this. Why is there the need for revision of the widely accepted and comfortably familiar definitions of Bax 1 and Mutch 2 ? These definitions are beautifully succinct and clear but perhaps not inclusive enough, making no mention of pathogenesis or of the functional and 'non-motor' features of CP which are most significant when it comes to everyday life. There has been debate in the past as to whether a more aetiological definition should be adopted but we are not yet ready for this. CP remains unexplained in around 15% of children, even after good neuroimaging and metabolic investigation 3 and we recognize that a wide range of CNS disorders can result in a similar clinical picture. Thus, a predominantly phenotypic definition and classification remains the most appropriate. The workshop clearly deliberated long and hard over every word of the revised definition producing a much more detailed description of CP that now encompasses the effect on function (activity limitation) and the comorbid features. As a result, the definition is longer and it does not 'trip off the tongue' in the way the old ones did. I think a fresh classification of CP is most welcome. With the standard classification there is considerable confusion in describing the neurological abnormalities of tone and the anatomical distribution of the disorder. When does hemiple-gia become an asymmetric diplegia or diplegia become quad-riplegia and when does a spastic disorder become mixed spastic/dystonic? Causation is not always described and functional consequences are not systematically recorded. This makes it difficult to document significant changes for an individual (particularly important when it comes to any therapeutic interventions) and is unsatisfactory for scientific research. The Workshop has set out a useful and detailed template listing the important components of a classification system. There is much greater emphasis on timing and causation of injury and I welcome and fully endorse their advice that, whenever possible, the diagnosis should be confirmed with neuroimaging. It is also entirely appropriate that functional assessments should be routinely employed for which suggestions are given in the accompanying document. For clinicians and therapists the most provocative suggestion is that CP should now be classified as unilateral or bilateral with the old terms of diplegia, quadriplegia, etc being abandoned, and that there should be specific description of all body areas affected (including trunk and oromotor involvement). The predominant abnormalities of tone should also be recorded and the presence of a hyperkinetic movement disorder documented. Commentary Definition and classification of cerebral palsy Certainly the old system was confusing and inaccurate. This new system will undoubtedly be helpful for resear...