Evaluation of a child with cerebral palsy

Evaluation of a child with cerebral palsy (CP) requires a multidisciplinary approach with a team of professionals comprising of a pediatrician or pediatric neurologist, occupational therapist, a physiotherapist, child psychologist, and a social worker. The assessment is necessary to confirm the diagnosis, determine the cause, assess the motor function and associated problems.

The diagnosis of CP is clinical but selected investigations may be required for ascertaining the cause. Evaluation includes assessment for common medical problems of childhood particularly nutritional disorders and assessment of family functioning. Additional disabilities are common.

Routine assessment of vision and hearing is required in children with CP. Since CP is a changing disorder, some limitations may not be evident early in life but manifest in the school age or later. The evaluation of a child with CP is an ongoing process and should be a part of continuing care as the child grows from infancy to adolescence.

Cerebral palsy (CP) a heterogenous group of persistent disorder of movement and posture caused by non-progressive defects or lesions of immature brain, is the most common cause of childhood physical disability. The incidence of CP in developed world is 2-2.5/1000 live births.[1] Evaluation of a child with CP requires a multidis­ciplinary approach with a team of professionals comprising of a pediatrician or pediatric neurologist, occupational therapist, a physiotherapist, child psychologist, and a social worker. Evaluation of a child with CP is necessary to confirm the diagnosis, determine the severity of the problem and its cause. The team of professional need to work together in close co-operation of parents and teachers to help the child reach his maximum potential.

Early detection

Accurate and early diagnosis of CP is important for medical and social reasons. Given the availability of limited resources it becomes critical to accurately identify, as early as possible, those most in need of services. The periodic evaluation of “at risk” infants is a an effective strategy for early diagnosis. The probability of CP increases with increasing prematurity, multiple pregnancies, and adverse perinatal events. Abnormal neurological examination in infants helps in identifying children at risk for subsequent motor difficulties. In preterm infants, presence of atypical features e.g. coarse jitters, dominant asymmetric tonic neck reflex (ATNR), paucity of movements, hypotonia/hypertonia predict major motor dysfunction.[2] Ultrasound abnormalities especially grade 2-4 leukomalacia together with early visual and neurocognitive assessment data is a good predictor for later neurodevelopment.[3] All such patients who have risk factors or have abnormal neurological signs should be followed closely for motor development. Ellenberg and Nelson report that a combination of low birth weight and hypertonus at 4 months is highly predictive of CP at 7 years.[4] A cluster of certain behavioral symptoms and deviation from normal motor patterns are suggestive of CP [Table - 2].