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Cerebral Palsy

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Expectations

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Expectations

Many of a child's normal developmental milestones, such as reaching for toys (3 to 4 months), sitting (6 to 7 months), and walking (10 to 14 months), are based on motor function. A physician may suspect cerebral palsy if a child is slow to develop these skills. In making a diagnosis of cerebral palsy, the physician takes into account the delay in developmental milestones as well as physical warning signs such as abnormal muscle tone, abnormal movements, and persistent infantile reflexes.

Making a definite diagnosis of cerebral palsy is not always easy, however, especially before the child's first birthday. In fact, diagnosing cerebral palsy usually involves a period of waiting for the definite and permanent appearance of specific motor problems. Most children with cerebral palsy can be diagnosed by the age of 18 months, but this is a long time for parents to wait for a diagnosis, and it is understandable a difficult and trying period.

Making a diagnosis of cerebral palsy is also difficult when, for example, a 2-year-old has suffered a head injury. The child may immediately appear to be severely injured, and three months after the injury he may have symptoms that are typical of a child with cerebral palsy. But one year after the injury the child may be completely recovered, and it's clear that he doesn't have cerebral palsy. Although he has a scar on his brain, the scar is not permanently impairing his motor activities. During the year between the injury and the diagnosis of no permanent injury, the parents will have a difficult time waiting. No matter how frustrating. Making a diagnosis of cerebral palsy is also difficult when, for example, a 2-year-old has suffered a head injury. The child may immediately appear to be severely injured, and three months after the injury he may have symptoms that are typical of a child with cerebral palsy. But one year after the injury the child may be completely recovered, and it's clear that he doesn't have cerebral palsy. Although he has a scar on his brain, the scar is not permanently impairing his motor activities. During the year between the injury and the diagnosis of no permanent injury, the parents will have a difficult time waiting. No matter how frustrating this period of waiting and observing is, however, it must pass before the diagnosis can be made.

In making a diagnosis of cerebral palsy, the most meaningful aspect of the examination is the physical evidence of abnormal motor function. A diagnosis of cerebral palsy cannot be made solely on the basis of an

x-ray or a blood test, though the physician may order such tests to exclude other neurological diseases.

Magnetic resonance imaging (MRI) and computerized topography (CT) scans are often ordered when the physician suspects that the child has cerebral palsy. These tests may provide evidence of hydrocephalus (an abnormal accumulation of fluid in the cerebral ventricles), and they may be used to exclude other causes of motor problems. These scans do not prove whether a child has cerebral palsy, nor can they predict how a specific child will function as he or she grows. Thus, children with normal scans may have severe cerebral palsy, and children with clearly abnormal scans occasionally appear totally normal or have only mild physical evidence of cerebral palsy. A child with an abnormal scan might appear normal until she begins school, for example, when significant learning problems may surface.

As a group, children with cerebral palsy do have brain scars, cysts, and other changes that show up on scans more frequently than in children without cerebral palsy. Therefore, when a scar is seen on a CT scan of the brain of a child whose physical examination suggests he may have cerebral palsy, the scar is one more indication that the child is likely to have motor problems in the future.

Predicting what a young child with cerebral palsy will be like or what he or she will or will not do (this prediction is called the prognosis) is very difficult. Any predictions for a child under 6 months of age are little better than guesses, and even for children younger than 1 year it is often difficult to predict the severity of CP. By the time the child is 2 years old, however, a qualified physician can determine whether the child has Hemiplegia, diplegia, or quadriplegia. Based on this involvement pattern, some predictions can be made.

For a child to be able to walk, some major events in motor control have to occur. A child must be able to hold up his head before he can sit up on his own, and he must be able to sit independently before he can walk on his own. It is generally assumed that if a child is not sitting by age 4 or walking by age 8, he will never be an independent walker. But a child who starts to walk at age 3 will certainly continue to walk and will be walking for the rest of his life.

It is even more difficult to make predictions of speaking ability or mental ability than it is to predict motor function. Here too, evaluation is much more reliable after age 2, although a motor disability can make the evaluation of intellectual function quite difficult.  Sometimes "motor free" tests, which can assess intellectual ability without the child using his hands, are administered by psychologists who are experts in this type of testing. Overall, a child's intellectual ability, far more than his physical disability, will determine the prognosis. In other words, mental retardation is far more likely to impair a child's ability to function than is cerebral palsy.

Because cerebral palsy is a condition caused by damage to the central nervous system, many of the complications of cerebral palsy are neurological. Children with CP may also have orthopedic problems - problems that effect the spine, bones, joints, muscles, or other parts of the skeletal system. And they may have problems that are considered to be "secondary" to the neurological and orthopedic problems. One example of a secondary effect of CP is poor nutrition caused by the child's difficulty in swallowing.

For some children, one of these other kinds of problems may dominate, and the cerebral palsy will be a relatively minor issue. For example, for a child with CP who is able to walk and who has few physical limitations but is severely retarded mentally, the focus of care will be on the mental disability rather than on the cerebral palsy.

 

 The Cerebral Palsy Networkę1997/2014. All graphics are the exclusive property of CPN, unless otherwise indicated. Contact Cerebral Palsy Network   for further information. Last updated 05/04/14