Cerebral palsy

Last reviewed: 18 Apr 2022
Last updated: 26 Aug 2021

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
More key diagnostic factors

Other diagnostic factors

  • muscle weakness
  • joint instability/dislocation
  • dystonia
  • chorea
  • athetosis
  • ataxia
  • neonatal hypotonia
  • scoliosis
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • MRI brain
More 1st investigations to order

Investigations to consider

  • ultrasound/CT brain
  • coagulation studies
  • genetic testing
  • metabolic screen
  • x-ray of affected joint
  • instrumented gait analysis
More investigations to consider

Treatment algorithm

ONGOING

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
William L. Oppenheim

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
Loretta Staudt

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
Marcia Greenberg

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
Eileen Fowler

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.

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