What tests are used to diagnose cerebral palsy?
Children should attend well visits with their pediatrician, where their development will be monitored. This monitoring is important for all children, but especially those who are at risk for developmental issues (i.e. if they were born prematurely or at a low birth weight (1). If the doctor is concerned, developmental screenings should be done.
Developmental screenings are when a doctor administers a short test or survey to measure the child’s development. The American Academy of Pediatrics recommends that children be screened for developmental delays at 9 months, 18 months, and 24-30 months of age (1). Parents can also request developmental screenings if they have concerns.
Pediatricians diagnose cerebral palsy by evaluating a child’s signs and symptoms, looking over their medical history, and administering a developmental evaluation (2). They may also refer the child to a pediatric neurologist or other specialists. Testing is commonly done to rule out other conditions that may cause similar symptoms (1). In severe cases, early signs of brain injury are apparent and a diagnosis can be made in infancy. However, in mild to moderate cases, a diagnosis sometimes cannot be made until the child’s brain is more developed, around 30 months (1). The timeline for when children are diagnosed with cerebral palsy varies significantly depending on the severity of the condition and other factors.
It is imperative that the physician take a detailed history and perform a thorough exam and proper testing to classify which type of cerebral palsy the child has (spastic, ataxic, athetoid/dyskinetic, etc.).
Using neuroimaging to diagnose cerebral palsy
Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of the brain. MRIs can show lesions or abnormalities in the brain (2). In addition, a cerebral palsy MRI may provide information regarding the timing of the brain insult. MRI abnormalities in babies with cerebral palsy include hypoxic-ischemic lesions, such as those associated with hypoxic-ischemic encephalopathy (HIE) and periventricular leukomalacia (PVL). An MRI will be abnormal in 90% of children with cerebral palsy (3). It is usually the preferred method of testing on children because it is painless and reveals the structures of the brain. It is, however, noisy and can take a while to complete, so babies will commonly be given mild sedatives (2). It can also sometimes be combined with magnetic resonance spectroscopy (MRS), which can help observe what is going on not just on the structural level, but also on the metabolic level.
Metal cannot go in the machine. Thus, babies who must stay connected to machines that have metal (such as a ventilator or incubator), may not be able to have an MRI performed. However, there are incubators and ventilators made with no metal that can be used during an MRI. In addition, there are techniques that clinicians can use to help the baby tolerate the test, such as the “feed and bundle” technique (one where they are fed and prepared for sleep right before the scan in the hopes that they will sleep through it). Indeed, MRI gives such important information about the brain that clinicians should make every effort to have this test performed on the baby, in most cases.
A computed tomography (CT) scan uses X-rays to make detailed pictures of structures inside the brain. Typically, exposure to radiation should be avoided or minimized in babies, so CT scans are often viewed as a backup option to an MRI. Additionally, while CT scans can identify brain abnormalities in many babies and children with cerebral palsy, MRI is preferred because it has a better capacity for detecting brain injury (3). Furthermore, research shows that MRI is much better at helping to detect the timing of the insult that caused the cerebral palsy, and it is better at helping to determine the actual cause of the cerebral palsy.
Screening for problems associated with cerebral palsy
Screening for developmental disability, vision and hearing problems, speech and language disorders, and disorders of mouth muscle function must be performed as part of the initial assessment for cerebral palsy because these problems are commonly associated with cerebral palsy.
Using EEG testing to diagnose cerebral palsy
An electroencephalogram (EEG), where electrodes are fixed to the child’s scalp to record the electrical activity of the brain, must be performed when there are features that suggest the child has epilepsy. The reason for this is that epilepsy and seizure disorders occur in about 25-45% of children who have cerebral palsy (4). Epilepsy and seizure disorders must be promptly diagnosed and treated because seizures can worsen brain damage, which can increase the severity of cerebral palsy. Furthermore, seizure activity can cause new brain injuries – injuries that cause problems in addition to the cerebral palsy.
Screening for coagulation problems to diagnose cerebral palsy
Some children with hemiplegic cerebral palsy or MRI findings that show cerebral infarction (brain tissue death caused by oxygen deprivation [HIE]) may have a blood clotting disorder called prothrombotic coagulation disorder. It is standard practice to screen for coagulation abnormalities in such patients so that this disorder can be properly managed (3). Children with hemiparesis, which is less severe than hemiplegia, should be tested for HIE.
Using reflex tests to diagnose cerebral palsy
In normally-developing babies, certain developmental reflexes pertaining to posture disappear when the baby is between three and six months of age. These reflexes do not disappear when a child has cerebral palsy. Therefore, delay in the disappearance of a developmental reflex may be an early indication of cerebral palsy (5). Exaggerated developmental reflexes are also an early sign of cerebral palsy.
Testing the tonic labyrinthine reflex (TLR) is very important. The TLR is a primitive reflex found in newborns. With this reflex, tilting the head back while lying on the back (supine position) causes the back to stiffen and arch backwards, the legs to straighten, stiffen and push together, the toes to point, the arms to bend at the elbows and wrists, and the hands to become fisted or the fingers to curl. The presence of the TLR past the first six months of life may indicate that the child has cerebral palsy (5). In children with cerebral palsy, the TLR may also be more pronounced.
Other abnormal signs can be elicited by the physician when the infant is held in vertical suspension. During a baby’s first few months, the appropriate response is for the baby to assume a sitting position that looks as if they are sitting in the air. An abnormal response when the baby is held in a supported upright position involves leg extension followed by or associated with an abnormal positive support reaction (a reaction where an infant supports some of their own weight, extending the legs and trunk for several seconds and stiffening the legs). Another abnormal response is when the baby keeps the legs extended for more than 30 seconds, especially when accompanied by equinus posturing (tip-toe position).
A diagnosis of cerebral palsy involves assessment by medical and therapeutic specialists from a variety of fields. Some of the most commonly consulted specialists include pediatric neurologists, developmental specialists, neuroradiologists, orthopedic surgeons, and ophthalmologists. It is crucial that cerebral palsy is diagnosed as soon as possible so that treatment and therapy can begin. Research shows that aggressive and consistent treatment and therapy are associated with better outcomes for the child.
Hypothermia treatment, hypoxic-ischemic encephalopathy (HIE), and cerebral palsy
Hypothermia (brain cooling) treatment should not be postponed while assessment for brain injury is taking place. Hypothermia treatment should be administered within six hours after birth.h. Time is critical when it comes to hypothermia treatment, so most guidelines state that it should be administered within six or 12 hours after birth. Recent studies show that therapeutic hypothermia may still be beneficial when started up to 24 hours after birth. Brain cooling treatment has been shown to minimize or prevent brain damage that occurs as a result of oxygen deprivation, which can, in turn, minimize or prevent the symptoms of cerebral palsy.
Award-winning cerebral palsy lawyers
If you are seeking the help of a cerebral palsy lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. ABC Law Centers is a national birth injury law firm that has been helping children with birth injuries for over three decades.
Partners Jesse Reiter and Rebecca Walsh are currently recognized as two of the best medical malpractice lawyers in America by U.S. News and World Report, which also recognized ABC Law Centers as one of the best law firms in the country. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder, or hypoxic-ischemic encephalopathy (HIE), the attorneys at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy, and a secure future, and we give personal attention to each child and family we represent. Our birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success, and no fees are ever paid to our firm until we win your case. Reach out today for a free case evaluation.
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- Screening and Diagnosis of Cerebral Palsy | CDC. (n.d.). Retrieved July 19, 2019, from https://www.cdc.gov/ncbddd/cp/diagnosis.html
- Cerebral palsy. (2016, August 25). Retrieved July 19, 2019, from https://www.mayoclinic.org/diseases-conditions/cerebral-palsy/diagnosis-treatment/drc-20354005
- Glader, L., & Barkoudah, E. (2019, June). Cerebral palsy: Evaluation and diagnosis. Retrieved July 19, 2019, from https://www.uptodate.com/contents/cerebral-palsy-evaluation-and-diagnosis?search=diagnose cerebral palsy&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
- Glader, L., & Barkoudah, E. (2019, June 12). Cerebral palsy: Clinical features and classification. Retrieved July 26, 2019, from https://www.uptodate.com/contents/cerebral-palsy-clinical-features-and-classification?search=cerebral
- Gieysztor, E. Z., Choińska, A. M., & Paprocka-Borowicz, M. (2018). Persistence of primitive reflexes and associated motor problems in healthy preschool children. Archives of medical science : AMS, 14(1), 167–173. doi:10.5114/aoms.2016.60503