Fig. 1

Cerebral Palsy is caused by a lesion in the developing brain, which causes downstream neuromuscular effects. Musculoskeletal effects of CP worsen progressively over time, even though the neural lesion is static. The musculoskeletal pathology may progress in a vicious cycle, where e.g. diminished loading promotes muscle weakness, which further promotes diminished loading. Here we represent both loss of inhibition and loss of connection, and propose that debate and discussion is warranted on the influence that each of these has on the clinical manifestation of CP. Figure our own, created using Adobe Illustrator (Adobe, Inc., San Jose, CA, USA) under the University of Auckland site license