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Early Diagnosis Of Cerebral Palsy
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ASSAM PEDICON 2007, SILCHAR, 22-23 December 2007
Dr. J. N. Sharma
Prof. & Head Deptt. of Pediatrics
Guwahati Medical College
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| Definition:
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Cerebral palsy is a persistent disorder of posture and/or movement, due to a non-progressive damage to the developing brain.
The upper age limit of brain insult is not strictly defined
Arbitrarily fixed at 5 yrs by AAP.
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| Cerebral Palsy : Classification
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A standardized method of blood pressure measurement is the most essential prerequisite of defining HTP. Auscultator method is the gold standard of all methods with available normative data for sex, age and height. It consists of the following steps in succession:
- Type of motor disorder
Spasticity
Athetosis
Rigidity
Ataxia
Hypotonia
Mixed
- Anatomical distribution
Diplegia
Tetraplegia
Triplegia
Hemiplegia
Monoplegia
- Severity
Mild, Moderate, severe
Major risk factors:
Prematurity (75 fold)/VLBW
Exposure to disrupted brain perfusion/oxygenation in fetal, natal, neonatal period
Birth asphyxia (10%)
Apgar score 3 or less a 20 minutes (250 fold increased risk)
Postnatal causes (18%)
Minor Risk Factors:
Mother 40 years or older
Mother 20 years or younger
Father 20 years or younger
First born or 5th or later born
Twin
Birth weight < 1.5 kg.
Gestation < 37 weeks
Risk factors:
Rh or ABO incompatibility
IU Infection in early pregnancy (German Measles)
CNS infection of the infant
18% of CP is acquired afterbirth (meningitis, head trauma)
Follow up:
High risk newborns
Need regular follow-up and neurodevelopmental examination
From birth onwards
For early detection and intervention
Early diagnosis:
Early neuromotor behavior
Milestones
Neurodevelopmental assessment
Corrected age for preterm for assessment.
Early neuromotor behavior:
Lack of alertness and poverty of movements, poor sleep
Excessive crying
Kicks both legs together
Constant fisting and adduction of thumb
Primitive reflexes beyond 6 months
Obligatory ATN reflex
Delayed milestones
Milestones:
Social smile : 2 months completed
Holds head steady : 4 months completed
Sits alone : 8 months completed
Stands alone : 12 months completed
Delayed milestones
Abnormal neuromotor behavior
Referral for neurodevelopmental assessment
Neurodevelopmental assessment:
Infant motor screen
Amiel Tison method
Trivandrum developmental screening chart (TDSC)
Amiel Tison method:
Steps of examination
Examination of the head : sutures, fontanelle and head circumference.
Sensory development : Visual pursuit and acoustic blink reflex.
Assessment of muscle tone:
Spontaneous posture
Is observed when the baby lies undisturbed. Look for constant closure of hands and asymmetry of face or limbs.
Active tone:
Is studied with the infant moving spontaneously in response to a given stimulus e.g., pull to sit. In addition to tone, reflexes viz., stepping and placing reflexes, parachute reflex, knee jerk and ankle clonus are to be examined.
Passive one is studied by:
Adductor angle
Heal to ear angle
Popliteal angle
Dorsiflexion angle of foot
Scarf sign
Conclusion:
Early diagnosis and early intervention
Is the corner stone for effective rehabilitation of these children
To help them live a quality life.
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Last Updated on 15-02-2008
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| How to cite this url |
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Assam Pedicon 2008 - Conference Abstracts.Pediatric Oncall [serial online] 2008 [cited 15 February 2008(Supplement 2)];5. Available from:
http://www.pediatriconcall.com/fordoctor/Conference_abstracts/
assampedicon2007/diagnosis_cerebralpalsy.asp
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