Parents may sometimes wonder why they need to attend so many pediatrician visits for their child during the first two years of life. Aside from immunizations, the main reason for frequent and numerous visits is so that the pediatrician can track developmental milestones. Developmental milestones include many and various indicators from things such as height and weight to the child’s ability to walk and talk. The diagnosis of cerebral palsy is not always apparent in very young infants but rather it is detected when an affected child misses key developmental milestones. Indeed, most of the early signs and symptoms of cerebral palsy are missing abilities rather than observed abnormal behaviors.
Developmental Delays Associated With Cerebral Palsy
As you may expect, delays in motor development provide the first clues to a possible diagnosis of cerebral palsy. These delays usually become evident between 6 months and one year of age. Affected infants may not be able to control their head as expected for their age, may not be able to sit without support or grab items. Certain reflexes, like the Moro reflex, diminish soon after birth and arenormally gone by six months of age. In cerebral palsy, these reflexes persist. Children with cerebral palsy are slow to stand and to begin walking. One milestone that develops prematurely in cerebral palsy is hand preference. In children with cerebral palsy, handedness may occur before age 1 where it normally would not happen until 18 months of age or later.
The first sign of cerebral palsy, usually, is abnormal muscle tone. Most commonly children will have hypotonia (poor muscle tone) first and then develop spasticity later. This is the presentation of children that develop spastic cerebral palsy, which accounts for roughly three-quarters of all cases. Most of the remaining children with cerebral palsy will have the dyskinetic type and will display abnormally slow, writhing movements. These movements may be worse when the child experiences stress but may disappear when the child sleeps.
Musculoskeletal Signs and Symptoms
Since cerebral palsy often affects parts of the body over others (e.g. hemiplegia or diplegia) increased or decreased muscle tone can have a negative effect on developing bones and joints. Constantly and rigorously contracting muscles can cause the affected limb to be shorter than the opposite one by comparison. In severe cases, this asymmetry can cause the spine to become abnormally bent (e.g. scoliosis). Likewise, abnormal pressures on the joints can lead developmental problems in these structures.
While muscle and movement disorders are the most commonly observed finding in cerebral palsy, the brain lesions that underlie the condition may affect various other abilities. It is not uncommon for children with cerebral palsy to develop a seizure disorder. When the muscles of the face are involved, patients may have difficulty speaking and swallowing. In fact, people with severe cerebral palsy may not be able to speak at all. Hearing problems are common, which further complicates verbal communication. Children with cerebral palsy may not be able to hear spoken language but may also lack the muscular control to form words orally. Vision is the other sense that is commonly affected in cerebral palsy patients. The muscles that control the eye may be affected and prevent both eyes from focusing on the object of interest.
Assessment Instruments and Motor Development Curves
There are various tools available to physicians that can help them make the diagnosis of cerebral palsy. These tools precisely measure motor and developmental milestones, though they are generally reserved for use in children that are falling off more generally used developmental curves. One of the more useful diagnostic and prognostic tools is called the Gross Motor Function Classification System for Cerebral Palsy. It tracks a child’s progress through their first 12 years of life and, based on their limitations and abilities, places the child in one of five developmental curves or severity levels. The key benefit of this knowledge is to prepare caregivers for the treatment and accommodations likely to be required for a given child with cerebral palsy.
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Krigger KW. Cerebral palsy: an overview. Am Fam Physician. Jan 1 2006;73(1):91-100.
Rosenbaum PL, Walter SD, Hanna SE, et al. Prognosis for gross motor function in cerebral palsy: creation of motor development curves. JAMA. Sep 18 2002;288(11):1357-1363.
Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. Apr 1997;39(4):214-223.
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