Cerebral Palsy Diagnosis and Evaluation

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Pediatrics provides specialized medical care for infants, children, and adolescents. Learn about routine screenings, vaccinations, and treatments.

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Clinical Observation and Developmental Screening

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Diagnosing cerebral palsy takes several steps and usually starts with watching how a child grows and develops. There is no blood test to confirm it. Doctors look for patterns of delayed movement and unusual muscle tone. During regular check-ups, they use screening tools to check if children are meeting milestones. If a child is not sitting, rolling, or walking on time, or uses one hand much more than the other before age one, more tests are done. At Liv Hospital, we use specialized screening tests to detect early signs as soon as possible.

Neurological Examination

A full neurological exam is a key part of diagnosing cerebral palsy. The doctor checks the child’s reflexes, muscle tone, and posture.

Testing Reflexes

The doctor will test deep tendon reflexes. In this condition, these reflexes are often hyperactive (hyperreflexia). They also check for the persistence of primitive reflexes. For example, the asymmetric tonic neck reflex (fencing reflex) usually disappears by 6 months; its persistence is a clinical sign of neurological dysfunction.

Evaluating Tone and Strength

During the exam, the doctor checks if the muscles are too stiff or too floppy by moving the child’s arms and legs. They look for signs like the ‘clasp-knife’ response, where a limb is hard to move and then suddenly relaxes. The doctor also tests muscle strength and coordination to see which areas are affected.

Neuroimaging Techniques

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Neuroimaging provides visual confirmation of brain injury and helps determine the timing and cause.

  • Magnetic Resonance Imaging (MRI): This is the preferred diagnostic imaging tool. It uses magnetic fields and radio waves to create detailed images of the brain. An MRI can reveal malformations, white-matter lesions (periventricular leukomalacia), or evidence of strokes. It is safe and does not use radiation.
  • Cranial Ultrasound: This is often used for premature infants while they are still in the neonatal intensive care unit. It uses sound waves to create images and is excellent for detecting bleeding in the brain (intraventricular hemorrhage) or large areas of damage.
  • Computed Tomography (CT) Scan: While less common due to radiation exposure, a CT scan may be used if an MRI is unavailable or to detect specific types of calcification or bone abnormalities.

Metabolic and Genetic Testing

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Some genetic and metabolic disorders can look like cerebral palsy, so doctors need to rule these out as part of the diagnosis.

  • Metabolic Screening: Blood and urine tests check for the absence of specific enzymes or the presence of abnormal metabolites. This ensures the symptoms are not caused by a progressive metabolic disease that requires a different treatment.
  • Genetic Testing: With advancements in genomics, genetic testing is becoming more common. Chromosomal microarray analysis or whole-exome sequencing can identify genetic mutations that result in brain malformations or motor dysfunction, distinguishing them from injury-acquired CP.

Electroencephalogram (EEG)

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For children who have a history of seizure-like activity or staring spells, an EEG is performed. This test records electrical activity in the brain using small scalp sensors. It helps diagnose epilepsy, which is a frequent comorbidity. The EEG can show specific patterns of brain waves that indicate the risk of seizures and guide the selection of anticonvulsant medication. Even in the absence of obvious seizures, an EEG can provide information about the brain’s background function.

Gait Analysis and Motion Labs

For children who can walk, computerized gait analysis is a sophisticated evaluation tool. It takes place in a specialized motion analysis laboratory.

  • Kinematics: Cameras track markers placed on the child’s joints to record the motion of the body segments in 3D space.
  • Kinetics: Force plates in the floor measure the power and forces generated during walking.
  • Dynamic Electromyography: This measures the electrical activity of muscles while walking to see if they are firing at the right time.

This detailed data helps orthopedic surgeons and therapists plan surgeries or brace prescriptions with high precision, targeting the specific biomechanical issues.

Multidisciplinary Assessment

Usually, more than one doctor is involved in the evaluation. A team of specialists works together to look at all aspects of the child’s health.

  • Orthopedic Evaluation: Checking for hip displacement, scoliosis, and contractures via X-rays.
  • Vision and Hearing Assessment: Ophthalmologists and audiologists check for sensory impairments that could affect learning and communication.
  • Cognitive and Psychological Assessment: Psychologists evaluate learning potential, emotional health, and behavioral needs.
  • Feeding and Swallowing Evaluation: Speech therapists or gastroenterologists assess swallowing safety, sometimes using a modified barium swallow study (videofluoroscopy) to visualize the swallowing mechanism.

Differential Diagnosis

A key part of the evaluation is making sure the diagnosis is correct by ruling out other conditions. Some disorders, like muscular dystrophy or spinal muscular atrophy, get worse over time, but cerebral palsy does not. Doctors also check for tumors or spinal cord injuries. Getting the right diagnosis is important because it guides long-term care. This careful process helps families get the right information and support.

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FREQUENTLY ASKED QUESTIONS

Does an MRI always show brain damage in this condition?

In the vast majority of cases, an MRI will show abnormalities. However, a small percentage of individuals may have a normal-appearing MRI despite having clinical symptoms of the disorder.

Genetic testing is becoming more standard, especially if the cause of the brain injury is not apparent from the history (like birth trauma) or MRI, to rule out other genetic mimics.

Gait analysis provides objective data on how a child walks. This helps doctors make precise decisions about surgery or braces to improve walking efficiency and prevent pain.

While signs appear early, a definitive diagnosis is often confirmed between 18 and 24 months when motor delays become distinct and permanent, though severe cases are diagnosed sooner.

No, evaluation is ongoing. As the child grows, regular assessments of hips, spine, vision, and motor function are needed to adjust treatments and catch complications early.

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