Cerebral palsy

Referrals pathways for Regional Paediatric model

Index:

Diagnosis

Practice points

Management

Referral pathways

Cerebral Palsy (CP) is a non-progressive disorder of posture and movement resulting from a defect or lesion in the developing brain, occurring in the antenatal, perinatal or postnatal period.

Diagnosis

The diagnosis of CP is largely clinical, made from a constellation of upper motor neurone signs. A diagnosis is often not made until the second year of life.

Imaging is not necessary for diagnosis, and is often only undertaken when an aetiology is unknown. Further investigations (bloods and/or imaging) are undertaken mainly to exclude other diagnoses.

Classification

There are multiple methods to classify CP, although the most commonly accepted are a descriptor of movement (e.g. spastic, choreoathetoid, dystonic) with a descriptor of topographical involvement (e.g. diplegia, hemiplegia, quadriplegia). Functional classification is then undertaken using the GMFCS (Gross Motor Functional Classification System):

• I: walks without restriction
• II: walks without devices, although with some restriction
• III: walks with devices
• IV: self mobile with limitations
• V: dependent for mobility

Practice points

• Cerebral palsy (CP) should be suspected in children under the age of two who show evolving upper motor neurone signs (hyper-reflexia, hypertonicity), particularly when there have been known cerebral insults.
• Many children with known brain insults do not manifest signs in the first few months of life, and may have normal development, however this does not preclude the possibility of CP developing prior to two years of age.
• Children with CP have increased incidence of intellectual disability, seizures, vision and hearing deficits, speech and language difficulties, behavioural problems
• Monitoring for complications remains important with a diagnosis of CP: contractures and hip dislocation (see Other Resource below), pressure sores, saliva control and aspiration, nutrition and growth problems, dental abnormalities, osteopenia and scoliosis, thus regular paediatric review is recommended.

Management

The management of CP is based around the screening and management of associations and complications.

• All children with a diagnosis of CP should have regular medical assessment to monitor for associations and complications
  • intellectual difficulties
  • behavioural concerns
  • speech and language difficulties
  • vision and hearing deficits
  • seizures
  • functional assessment: development, mobility, motor coordination
  • orthopaedic complications: hip subuxation, contractures, scoliosis, osteopenia
  • pressure injuries
  • saliva control and aspiration risk
  • nutrition and growth
  • dental

Funding: Children with CP are eligible for funding and services through the NDIS. Some may be eligible for a Carer’s Allowance, as well as funding through the school services. See the Disability funding index for more detail.

Medication is not routine for the management of CP, however is often considered with certain associations and complications (e.g. spasticity management, saliva control, seizures). They are generally commenced in consultation with a paediatrician.

Referral pathways

• Paediatrician
  • Semi-urgent referral for paediatric outpatient evaluation is recommended if a new diagnosis of CP is suspected
  • Information to bring to any appointments:
    • developmental or other assessments completed
    • your baby book (green folder or blue book)
    • growth charts and records
    • antenatal and birth records and history

• Other services to consider
  • audiology & optometry/ophthalmology
  • allied health and possible Early Childhood Intervention Services (if developmental concerns)
  • paediatric neurology (if complex seizure disorder, diagnosis unclear, etc.)
  • VPRS (if considering botox or short term goal directed allied health therapy)
• Other Resources
  • Hip screening: Australian Hip Surveillance for Children with Cerebral Palsy