When and How to Evaluate the Child with Possible Cerebral Palsy

Abstract

Cerebral palsy is a neurodevelopmental disorder with lifelong consequences. It includes a group of disorders of movement and posture, attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often associated with disturbances of sensation, cognition, communication, perception, behavior, and by a seizure disorder. CP may be caused by several different etiologies causing insults to the developing brain at different stages of development. CP is a clinical diagnosis based on a thorough history (prenatal, perinatal, and postnatal), review of developmental milestones, and neurologic examination. The work-up may include neuroimaging, metabolic or genetic testing, and testing for specific disorders. Also, the work-up may include testing for the associated conditions and complications: intellectual disability (52%), epilepsy (45%), speech and language disorders (38%), vision defects (28%), and hearing impairments (12%). These children often need long-term multidisciplinary care and therapies and supports for educational and social functioning to optimize the outcome. The disorder may exhibit a wide spectrum of functioning. Although the approach to treatment and rehabilitation may be similar for most children with CP, a description of the condition based on neuroimaging, and metabolic or genetic testing, may help individualize treatment and also help better predict the associated morbidity and what to expect for a particular child.