Most cerebral palsy is present at birth (congenital), and signs of it may be apparent shortly after delivery; however, delayed development when the baby becomes two or three months old is often the first signal that there is a problem. While many children with CP are diagnosed before they are two years old, milder cases of CP may elude diagnosis until the child is four or five years old.
Evaluating for Cerebral Palsy
When a doctor suspects a child may have cerebral palsy, he or she will first evaluate the patient’s motor skills. A through medical history will be taken. Because many other disorders present symptoms similar to cerebral palsy the possibility of these conditions must be ruled out before a diagnosis of cerebral palsy can be confirmed
The first step in ruling out another condition consists of determining whether or not the child’s disability is getting progressively worse. Cerebral palsy is not a progressive disorder, although complications over time can make it worse. If the child’s condition is getting progressively worse, CP is ruled out.
Doctors will test for genetic or muscle diseases, if the disorder proves not to be cerebral palsy. Tumors or a metabolism disorder will also be tested for. A coagulation disorder can mimic the symptoms of CP because it causes strokes in the unborn or newborn baby which block blood flow and deprive the brain of sufficient oxygen. A coagulation disorder may also be the cause of CP. If a coagulation disorder is still present, it must be treated to prevent further brain damage.
If the child’s condition is not getting progressively worse, it is a sign that CP may indeed be the cause of the child’s problems. To confirm a diagnosis of CP, many diagnostic tests can be used.
Tests which can confirm CP.
To confirm a diagnosis of cerebral palsy, doctors will use brain imaging techniques which allow them to see brain abnormalities and brain damage. The particular tests used are chosen in part based on the patient’s overall condition.
A cranial ultrasound is easier on patients than some of the other tests and so it is used on fragile, premature babies. A cranial ultrasound cannot show the detailed brain images that an MRI or a CT scan can, but it does give doctors some idea about what is happening in the baby’s brain.
For patients in less fragile condition a CT (computerized tomography) scan or an MRI (magnetic resonance imaging) scan will be used. The CT scan shows the structure of the brain in detail and allows doctors to more easily pinpoint the location of the damage or abnormalities.
An MRI uses radio waves, magnetic fields, and computer analysis to give an even more detailed picture of the brain. It is considered the gold standard for diagnosing any brain disorder.
An EEG (electroencephalogram) which uses electrodes to monitor the brain’s electrical activity may also be given. An EEG is especially useful if doctors suspect a seizure disorder may be present along with CP.
A team approach
Doctors generally use a team approach to diagnosis a complex disorder such as cerebral palsy. The child’s primary physician may refer him or her to a wide variety of specialists, such as pediatric neurologists and development pediatricians. Ophthalmologists and otologists may be consulted. The opinions of these various specialist give the child’s primary doctor a broader-knowledge base on which to base a diagnosis.
Once the diagnosis is made, work begins on a treatment plan. Working with the specialists, the primary physician will help the child’s family decide on the optimum treatment plan for the patient’s particular set of problems. Treatment may include medicines and orthopedic supports. Physical therapy (PT) is a vital part of treating all forms of cerebral palsy; PT strengthens weak muscles and prevents them from atrophying or going into contracture. Speech therapy and occupational therapy may also be given. Some CP patients may need surgery to correct or prevent problems such as ankle equinus (toe walking) or foot drop (difficulty lifting the front of the foot) or other orthopedic difficulties.