The article explains the early diagnosis and management of cerebral palsy (CP). It emphasises the ability to identify CP as early as 6 months old using specific evaluation tools & outlines the subsequent steps for specialised care and support for affected children & their families.

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Although the diagnosis of cerebral palsy (CP) has historically been established at the age of two years old or above, new research indicates that in certain situations, specialised healthcare professionals can make the diagnosis as early as six months of age.

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Defining cerebral palsy

Children with cerebral palsy may also experience difficulties with nutrition, speech and language, vision, hearing, bladder control, and movement.

They can also have complicating factors such as intellectual disability, hip displacement, epilepsy, sleep and behavioural disorders.

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Recognition

Two main categories of very young individuals are identified by the worldwide criteria as needing a cerebral palsy evaluation.

Those with “newborn detectable risks” have clear risk factors identified before, during or soon after birth – these include children with intrauterine growth restriction (IUGR), neonatal encephalopathy and children born preterm.

The second category includes "infant detectable risks," which usually become apparent after 5 months of corrected age, primarily in children who were not treated in a neonatal intensive care unit.

The American Academy of Pediatrics (AAP) recommends developmental surveillance at all preventive care visits and standardised developmental screening of all children at 9, 18, and 30 months.

Notably, these tools involve asking parents questions to learn key elements of motor history and focusing on six agreed-upon signs that should prompt early referral to specialists for detailed evaluation of CP.

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What providers (and families) can expect after a referral

Following a referral, a timely assessment using tools recommended by the 2017 guidelines, which are backed by strong evidence and outlined in the diagnostic algorithm, is crucial.

These include :

• The Hammersmith Infant Neurological Examination (HINE)
• The Prechtl Qualitative Assessment of General Movements (GMs)
• The Test of Infant Motor Performance (TIMP)
• The Developmental Assessment of Young Children (DAYC)
• The Alberta Infant Motor Scale (AIMS)
• The Neuro-Sensory Motor Development Assessment (NSMDA)
• The Motor Assessment of Infants (MAI)

After those evaluations, the following will often occur in specialised programs:

• Diagnosis, counselling and goal setting with parents
• Specialised surveillance, especially of hip problems
• Connection with the main care physician and coordination of care between therapists and specialist providers
• Distribution of evidence-based parent and provider education resources
• The transition of care from early specialised to later multidisciplinary programs, such as the Comprehensive Cerebral Palsy Center at Nationwide Children’s

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Early intervention in patients of cerebral palsy

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Nikhil Repaka is a Neuro physician at Jagruth Super Specialty Hospital, Khammam.