Cerebral palsy is a group of permanent movement and posture disorders caused by a non-progressive injury or malformation of the developing brain. Prematurity, low birth weight, brain injury around birth and infections are key risk factors, and many children also have epilepsy, learning or feeding problems.
Key symptoms
- Delayed motor milestones such as sitting or walking
- Stiff or floppy muscles
- Early hand preference before 12 months
- Feeding and swallowing problems, drooling
- Seizures, or speech, vision or hearing problems
What you find on exam
- Muscle tone: spasticity, hypotonia or dystonia
- Brisk reflexes, persistent primitive reflexes, upgoing toes
- Gait: toe walking, scissoring
- Hip, spine and joint contractures
- Growth and head circumference
Tests
- Clinical diagnosis supported by standardized motor assessments
- Brain MRI to find the injury or malformation
- EEG if seizures are suspected
- Hearing and vision screening; genetic or metabolic tests if the picture is atypical
Treatment basics
- Early intervention with physical, occupational and speech therapy
- Orthoses, mobility aids and hip surveillance
- Spasticity: oral baclofen, botulinum toxin injections, intrathecal baclofen
- Orthopedic surgery or selective dorsal rhizotomy in selected children
- Care for seizures, nutrition, pain and family support
Red flags
- Loss of skills already gained (suggests a progressive disease, not cerebral palsy)
- Choking or coughing with feeds, or recurrent pneumonia
- Hip pain or new asymmetry of the legs (hip dislocation)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.