Summary
Definition
History and exam
Key diagnostic factors
- early general movement abnormalities
- abnormal HINE scores
- 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
- low birth weight
- fetal birth asphyxia
- multiple births
- maternal illness
- fetal brain malformation
- major birth defects
- familial metabolic/genetic disorder
- neonatal complications
- meningitis
- maternal teratogen exposure
- low socioeconomic status
- nonvertex presentation
- postmaturity
- head injury
Diagnostic investigations
1st investigations to order
- MRI brain
Investigations to consider
- ultrasound/CT brain
- coagulation studies
- genetic testing
- metabolic screen
- x-ray of affected joint
- instrumented gait analysis
Treatment algorithm
spastic hemiplegia
spastic diplegia
spastic quadriplegia
dyskinetic
ataxic
Contributors
Authors
UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy, null
Los Angeles
CA
Disclosures
See individual author disclosures.
William L. Oppenheim, MD
Distinguished Professor Emeritus Pediatric Orthopedics
Margaret Jones Kanaar Chair, Cerebral Palsy
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
WLO is an author of several references cited in this topic.
Loretta Staudt, MS, PT
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 accommodation 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. As part of her salaried employment at UCLA, LS is working on a project funded by the Cerebral Palsy Foundation. She is an author of several references cited in this topic.
Rachel Thompson, MD
Assistant Professor-in-Residence, Department of Orthopaedic Surgery
Associate Residency Program Director, Department of Orthopaedic Surgery
Director, UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy
William and Patricia Oppenheim Presidential Chair in Pediatric Orthopaedics
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
RT declares that she has no competing interests.
Marcia Greenberg, MS, PT
Physical Therapist
UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
MG is a consultant for the NGO, UCP Wheels for Humanity, teaching physical therapists in developing countries. She is an author of several references cited in this topic.
Eileen Fowler, PhD, PT
Professor
Department of Orthopaedic Surgery
Director of Research and Education
UCLA/Orthopaedic Institute for Children Center for Cerebral Palsy
Peter William Shapiro Chair
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
EF receives grant funding from the Cerebral Palsy Foundation. She is a member of the Scientific Advisory Committee of the Cerebral Palsy Foundation. She is an author of several references cited in this topic.
Acknowledgements
Dr William L. Oppenheim, Loretta Staudt, Dr Rachel Thompson, 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.
Disclosures
AS, EH, RH, JEH, TTN, and SC declare that they have no competing interests.
Peer reviewers
Hank Chambers, MD
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. HC has received research support from the National Institutes of Health greater than 6 figures USD.
Michael Sussman, MD
Orthopaedic Surgeon
Shriners Hospital for Children
Portland
OR
Disclosures
MS declares that he has no competing interests.
Charles Fairhurst, MBBS MSc
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.
Differentials
- Spinal muscular atrophy
- Muscular dystrophy/myopathy
- Familial/primary dystonia
More DifferentialsGuidelines
- Providing a primary care medical home for children and youth with cerebral palsy
- Indications for gastrocsoleus lengthening in ambulatory children with cerebral palsy: a Delphi consensus study
More GuidelinesPatient leaflets
Cerebral palsy: what is it?
Cerebral palsy: what treatments work?
More Patient leaflets
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer