Early Assessments and Screenings for Cerebral Palsy

After receiving the CP diagnosis your physicians and therapy professionals will continue to use developmental milestone timelines and other assessments to understand how your child is developing and where support and intervention may be needed. Evaluations, especially those that compare children to their same-age peers are often upsetting to parents because their children are developmentally behind their peers. But keep in mind that this information is being used to identify and understand how to best support your child’s ongoing development, direct interventions/treatments and, in turn, maximize their participation in daily activities.

The following are a variety of assessments/screenings that may be used to evaluate and better understand different aspects of your child’s development and well-being. What is included here is not necessarily an exhaustive list for your child. If you have concerns about an aspect of your child’s health and development, be sure to bring those concerns to the attention of your pediatrician and professional team.

Children with CP have their own developmental timelines and your child’s present conditions do not dictate their future. As a parent, it is important to focus on the progress your child is making, not the specific measurements of these tests. Celebrate your child’s achievements no matter how big or small. Every milestone is a building block to another.

Early Detection Matters

Early detection matters for three reasons:

Optimal Intervention: The most important reason for early identification is it allows for the initiation of therapeutic interventions when the brain exhibits the most neuroplasticity, which means it’s at its most adaptable phase. This can lead to more effective outcomes.
Family Support: You child and your family can still have exceptional lives with cerebral palsy. But knowing and understanding a child’s condition early on equips families with the necessary tools and knowledge to create a supportive environment tailored to the child’s needs… and the parents’ own needs.
Education Planning: Schools and educators can prepare better to manage the issues that come with CP when they know in advance about a child’s needs, ensuring that educational experiences are as fruitful as possible.

Three Screening Tools for Cerebral Palsy

There are three main screening tools for cerebral palsy:

General Movement Assessment (GMA): One of the most reliable methods for predicting cerebral palsy in early infancy. By observing spontaneous movements, professionals can identify irregular movement patterns indicative of cerebral palsy.
Hammersmith Infant Neurological Examination (HINE): This assessment, which you most see for infants aged 2-24 months, evaluates visual attention, posture, reactions, movements, and muscle tone.
Pediatric Evaluation of Disability Inventory (PEDI): PEDI assesses capabilities in mobility, self-care, and social functions in children, giving a comprehensive view of a child’s functional skills.

Movements Tested

Contractures: a term used to describe when muscles, ligaments, and tendons become fixed in a rigid and shortened position. As motor development is delayed or does not progress in CP, muscle growth fails to keep up with the growth of the bones, so that tight muscles gradually become too short relative to the length of the bones. The increased tension in these tissues limits the individual’s range of motion and may cause deformities in the bones. Contractures are usually screened for on a routine basis (typically at least every 6-12 months) by your physician and/or therapist by observing the child’s movements and measuring the range of motion of their joints.
Fine Motor: refers to the use of small muscle groups within the hand or wrist. Examples: grasping a small tool or writing. The Manual Ability Classification System (MACS) describes how children with cerebral palsy use their hands to handle objects in daily activities. MACS describes five levels of fine motor ability for ages 4-18. In September of 2015 Mini-MACS was developed for children under 4 years of age. The MACS levels are based on the children’s self-initiated ability to handle objects and their need for assistance or adaptation to perform manual activities in everyday life. A child with no fine motor problems would be scored at “level 1” whereas a child unable to use their hands would be scored at “level 5”.
Gross Motor: gross motor evaluations look at the use of large muscle groups. Examples: crawling or reaching for objects. The Gross Motor Function Classification System (GMFCS) is a five level classification system that describes the gross motor function of children and youth with cerebral palsy. It was designed to encourage the use of a more meaningful universal common language when discussing how cerebral palsy affects a person’s mobility in daily life. The intention of the GMFCS is to focus on what people can do and move away from terms such as “mild”, “moderate”, “severe” which are limiting and used without any objective measure. The descriptions used in the GMFCS describe general patterns of movement and the child’s present abilities and typical function, rather than their best performance. The GMFCS levels are not intended to describe all aspects of a child’s functional abilities or potential for improvement, especially at a young age. Using the GMFCS is very helpful for setting individual goals, establishing timelines for hip surveillance, evaluating treatments and understanding research about cerebral palsy. Ask your developmental pediatrician, physiatrist or therapy professional for more information.

Genetics

Many cases of cerebral palsy are related to easily identified risk factors such as prematurity, a lack of blood flow to the developing brain, or infection during development. However, not all children with CP have these risk factors. For these children, the development of their CP may be related to genetics, even if there is no family history of the condition.

The 20,000 genes that make up our human genome contain the instructions that tell our bodies how to develop and function properly. Differences between one person’s genes and another’s help determine the body’s basic characteristics, ranging from simple things like hair and eye color to more complex traits such as temperament. Such differences in the genetic code from one person to another are referred to as “genetic variants.” Sometimes a change arises in the genetic code that causes disease. This type of change is referred to as a “mutation.” Genetic tests evaluate your child’s DNA to look for these mutations.

If the cause of your child’s CP is not clear, genetic testing could offer more information. A simple blood draw is used to collect the DNA needed for this analysis. Several different kinds of genetic mutations may lead to CP, and different methods are required to detect them. Given the complex landscape of genetic testing, it is helpful to have the guidance of a physician knowledgeable about genetic causes of CP, as well as a genetic counselor who is a professional trained to interpret and discuss the implications of genetic findings.

Identifying a potential genetic cause of a child’s cerebral palsy is important for a number of different reasons, including:

Families can get a better sense of what their child’s future prognosis will look like and doctors may be better prepared to prevent issues before they arise.
Understanding the actual cause of a child’s cerebral palsy can give families a sense of closure and prevent parents from blaming themselves.
Ongoing research may identify new treatment options for children with genetic forms of CP.
Although rare, some forms of genetic CP may run in families.

Intrapardum Magnesium for Neuroprotection

There was hope magnesium sulfate, which can often slow contractions, might provide protection against the risk of cerebral palsy. Despite earlier promising research, recent findings suggest that administering magnesium intravenously to pregnant women may not prevent cerebral palsy in their offspring. But a recent study suggests otherwise.