Early Diagnosis Of Cerebral Palsy
Dr. J. N. Sharma*
Prof. & Head Deptt. of Pediatrics Guwahati Medical College *
Definition
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.
Cerebral Palsy : Classification
A standardized method of blood pressure measurement is the most essential prerequisite of defining HTP. Auscultatory 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 tone 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.
How to Cite URL :
Sharma N J D.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=44
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