Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- delay in motor development
- delay in speech development
- delay in cognitive/intellectual development
- retention of primitive reflexes
- lack of age-appropriate reflexes
- spasticity/clonus
- selective voluntary motor control impairment
- toe walking/knee hyperextension
- scissoring
- crouched gait
- contractures
Other diagnostic factors
- muscle weakness
- joint instability/dislocation
- dystonia
- chorea
- athetosis
- ataxia
- neonatal hypotonia
- scoliosis
Risk factors
- prematurity
- fetal birth asphyxia
- multiple births
- maternal illness
- fetal brain malformation
- major birth defects
- familial metabolic/genetic disorder
- neonatal complications
- maternal teratogen exposure
- low socioeconomic status
- non-vertex presentation
- postmaturity
- head injury
Diagnostic investigations
Investigations to consider
- ultrasound/CT brain
- coagulation studies
- genetic testing
- metabolic screen
- x-ray of affected joint
- instrumented gait analysis
Treatment algorithm
Contributors
Authors
Los Angeles
CA
Disclosures
See individual author disclosures.
Margaret Jones Kanaar Professor
Orthopaedic Surgery and Cerebral Palsy
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
WLO declares that he has no competing interests.
Research Physical Therapist
UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
LS is a clinical evaluator for several sponsored clinical trials as part of her salaried employment at UCLA. She has received travel, meals, and accomodation to attend training meetings for some of these trials but does not receive any direct reimbursements or personal benefits from the companies, which include Pfizer, Sarepta, Audentes Therapeutics, Bristol-Meyers Squibb, Biogen, Santhera, Fibrogen, Cytokinetics, Italfarmaco, and AveXis.
Associate Director
UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
RH declares that she has no competing interests.
Clinical Coordinator
UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
MG received a grant to UCLA from USAID for developing material and providing direct training to physical therapists in Ukraine. Dissemination of material developed is only to participants in Ukraine in Ukrainian.
Associate Professor
Department of Orthopaedic Surgery
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
EF is a board member of the American Academy of Cerebral Palsy and Developmental Medicine and a Scientific Advisory Committee member for the Cerebral Palsy Foundation. She has received honorarium for a lecture on cerebral palsy at the Burke Cornell Neurological Institute and payment as a consultant for Shriners Hospital for Children for a grant submission.
Dr William L. Oppenheim, Loretta Staudt, Dr Rachel Thomson, Marcia Greenberg, and Dr Eileen Fowler wish to gratefully acknowledge Dr Albert Stroberg, Dr Erika Hassan, Dr Rebecca Hanson, Dr Joan Earle Hahn, Dr Tien T. Nguyen, and Dr Sarah Copeland, previous contributors to this topic.
Peer reviewers
Clinical Professor
Department of Orthopaedic Surgery
University of California at San Diego
Medical Affairs Officer
Rady Children's Hospital
San Diego
CA
Disclosures
HC is an author of a number of references cited in this topic. He has received research support from the National Institutes of Health greater than 6 figures USD.
Orthopaedic Surgeon
Shriners Hospital for Children
Portland
OR
Disclosures
MS declares that he has no competing interests.
Consultant in Paediatric Neurodisability
Evelina Children's Hospital
Guy's & St Thomas' NHS Foundation Trust
London
UK
Disclosures
CF declares that he has no competing interests.
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