Are you worried that your child might have Cerebral Palsy?
Cerebral Palsy is caused by injury to the developing brain either prior to birth (whilst in the womb) or soon after delivery. The injury caused to the brain will often affect the way your baby or child moves and communicates as well as can have impacts on their overall health. There is strong evidence, showing how important early diagnosis is to support Early Intervention (starting early Physiotherapy, Occupational Therapy and Speech-Language Therapy to help support their development) [1]. In addition earlier diagnosis allows greater accessibility to additional funding (such as grants and group funding) to support additional therapy, equipment, and play support as well as accessing social support from other families and organisations.
Is your baby at risk?
Risk factors can increase your baby’s chance of having Cerebral Palsy. Risk factors that increase their likelihood are;
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Being born prematurely (less 30 weeks gestation)
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Low birth weight (less than 1000g)
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Intrauterine growth restriction (birth weight less < 3rd percentile)
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Hypoxic ischaemic encephalopathy (Grade 2 or 3).
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Neonatal encephalopathy
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Neonatal encephalitis or meningitis
However, there are a number of babies who are born at term and have not experienced high-risk factors that are also diagnosed with Cerebral Palsy [1, 2]. Most babies with Cerebral Palsy will present with one or more of the following movement patterns.
Should my child be assessed for Cerebral Palsy?
If your child is showing us one or more of the following;
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Hand preference development before 12 months of age.
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Stiffness or tightness in the legs between 6-12 months of age (not able to bring hold their feet or challenges bringing their feet to their mouths).
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Their hands remain tightly closed (fisted) and feel stiff to open after the age of 4 months.
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They have difficulty holding their head up (older than 4 months of age).
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Sitting without support is challenging after the age of 9 months.
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One side of their body moves very differently than the other at greater than 4 months of age.
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Consistent toe-walking or asymmetric walking after one year of age.
How can we help?
Cerebral Palsy is able to be diagnosed early than the typical ‘wait and watch’ approach that was traditionally used [1]. We can now diagnose infants as young as 3 months of age with a high accuracy rate of > 95% [3] by using specialised testing. These assessments include observing how your baby moves, and completing neurological assessments and brain scans.
Our Cerebral Palsy early diagnosis clinic (Bright Start Cerebral Palsy Assessment Clinic) is a comprehensive joint appointment with Dr Rebecca Griffith from Genesis Paediatrics and Louise Pearce from Auckland Children’s Physiotherapy. Dr Griffith is an experienced developmental paediatrician who is trained in the Prechtl’s Quality General Movement Assessment and works both as a paediatrician both publicly and privately. She is also involved in paediatric research.
Louise Pearce who is a highly skilled paediatric physiotherapist who is advanced trained in the Prechtl’s Quality General Movements Assessment and uses this assessment and the Hammersmith Infant Neurological Examination in her day-to-day clinical work but also as part of research with infants who were born preterm and those with Cerebral Palsy.
Formalised assessments will be completed during your child’s visit following Cerebral Palsy Diagnosis recommendations. These assessments will be chosen dependent on their age.
The diagnosis clinic is a collaboration with Genesis Paediatrics & Auckland Children’s Physiotherapy. The assessments will take place in the beautiful treating rooms at Milk & Honey Paediatrics based in Auckland Central.
- Cerebral Palsy Assessments Used:
- Hammersmith Infant Neurological Examination (HINE)
- Physical examination
- Developmental Assessment of Young Children (DAYC-2)
- Prechtl’s Quality Assessment of General Movements (GMA)
The Hammersmith Infant Neurological Examination (HINE) is a baby (neonatal) examination that assesses your child’s overall neurological function. From this test, we get information about their muscle activity, movements, protective reactions and their behavior that help us understand their motor (movement) development. The assessment is a combination of observation and hands-on assessment.
A comprehensive physical examination will be completed looking at all aspects of your child’s development. We will specifically look at their muscles, joints and reflexes.
The DAYC-2 assesses your child’s development across many areas such as how they are communicating, relating to others, how they manage their feelings. We will assess the different areas through observation them in our clinic, asking you questions and completing special tasks (how they complete a set activity). This test is recommended to be used on children older than 5 months of age for diagnosis of Cerebral Palsy.
Prechtl’s Quality Assessment of General Movements (GMA) is a video observational assessment from birth to 20 weeks of age. The best time to use this video assessment is between 12 to 15 weeks of age.
For more information, please see Starship guidelines. https://starship.org.nz/guidelines/early-diagnosis-of-cerebral-palsy-cp-intervention-and-surveillance/
References
- Novak, I., et al., Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA Pediatr, 2017. 171(9): p. 897-907.
- Boychuck, Z., et al., International expert recommendations of clinical features to prompt referral for diagnostic assessment of cerebral palsy. Dev Med Child Neurol, 2020. 62(1): p. 89-96.
- Williams, S.A., et al., “It Should Have Been Given Sooner, and We Should Not Have to Fight for It”: A Mixed-Methods Study of the Experience of Diagnosis and Early Management of Cerebral Palsy. Journal of Clinical Medicine, 2021. 10(7): p. 1398.
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