FAQ: How is Cerebral Palsy Diagnosed?
If you suspect your child has cerebral palsy, your pediatrician can help identify the condition. Early diagnosis is crucial for children with cerebral palsy. Early intervention programs can help your child learn new skills, access assistive technology, and special education. Therapies like physical, occupational, or speech are most effective when started earlier.
Pediatricians diagnose cerebral palsy by evaluating a child’s signs and symptoms, looking over their medical history, and administering a developmental evaluation. 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.
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. Severity of the condition can affect the timeline for a cerebral palsy diagnosis.
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
- 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.
What Tests Are Used to Diagnose Cerebral Palsy?
Physicians should take a detailed history, perform a thorough exam, and do proper testing to classify which type of cerebral palsy the child has. Types of cerebral palsy include spastic, ataxic, and athetoid/dyskinetic. Different types of cerebral palsy require different types of treatment and accommodations.
Doctors can make a cerebral palsy diagnosis using a combination of the following methods:
- Developmental screenings
- MRI scans
- CT Scans
- EEG Testing
- Reflex Tests
- Screening for Coagulation Disorders
- Additional screenings
Developmental Screening
Children should attend well visits so their pediatrician can monitor the child’s development. This monitoring is important for all children, but especially those who are at risk for developmental issues. Pediatricians should especially watch for delays for babies with a low birth weight or babies born prematurely. If the doctor is concerned, developmental screenings should be done.
During a developmental screening, a doctor administers a short test or survey to measure the child’s development. Parents can also request developmental screenings if they have concerns.
The American Academy of Pediatrics recommends that children be screened for developmental delays at:
- 9 months
- 18 months
- 24-30 months of age
MRI Scans 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.
A cerebral palsy MRI may provide information about when a brain injury happened. Babies with cerebral palsy can have MRI abnormalities from injuries due to hypoxic-ischemic encephalopathy (HIE) and periventricular leukomalacia (PVL). An MRI will be abnormal in 90% of children with cerebral palsy.
MRIs are usually the preferred method of testing on children, because they are painless However, MRIs are noisy and can take a while to complete, so babies will commonly be given mild sedatives. Imaging can 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. 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.
Clinicians can help the baby tolerate the test using specific techniques. The “feed and bundle” technique involves making sure the baby is fed and prepared for sleep right before the scan in the hopes that the baby will sleep through it.
In most cases, MRI gives such important information about the brain that clinicians should make every effort to have this test performed on the baby.
CT Scans to Diagnose Cerebral Palsy
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.
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. 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.
EEG Testing to Diagnose Cerebral Palsy
An electroencephalogram (EEG) is a test where electrodes are fixed to the child’s scalp to record the electrical activity of the brain. It must be performed when symptoms suggest the child may have epilepsy.
Epilepsy and seizure disorders occur in about 25-45% of children who have cerebral palsy. Epilepsy and seizure disorders must be promptly diagnosed and treated. Seizures can worsen brain damage, which can increase the severity of cerebral palsy. Seizure activity can cause new brain injuries that cause problems in addition to cerebral palsy.
Reflex Tests to Diagnose Cerebral Palsy
In normally-developing babies, certain reflexes disappear when the baby is between three and six months of age. These reflexes, which involve posture, do not disappear when a child has cerebral palsy. Delay in the disappearance of a developmental reflex may be an early indication of cerebral palsy. 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
- 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. 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
- Then the 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 tip-toe position (equinus posturing).
Screening for Coagulation Problems to Diagnose Cerebral Palsy
Some children with hemiplegic cerebral palsy or 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.
Additional Screenings for Problems Often Associated with Cerebral Palsy
Doctors should perform additional screenings as part of the assessment for cerebral palsy. These screenings can find other problems commonly associated with cerebral palsy.
Additional screenings should test for:
- developmental disability
- vision problems
- hearing problems
- speech and language disorders
- disorders of mouth muscle function, affecting speech or eating
Hypothermia Treatment, Hypoxic-ischemic Encephalopathy (HIE), and Cerebral Palsy
If a baby has HIE, hypothermia (brain cooling) treatment should be administered within six 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 minimize or prevent the symptoms of cerebral palsy.
Legal Help for Children with Cerebral Palsy
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: Birth Injury Lawyers is a national birth injury law firm that has been helping children with birth injuries for over three decades.
ABC Law Centers is dedicated to helping families like yours. Our team brings compassion, knowledge, and empathy to complicated medical malpractice cases. We focus exclusively on birth injury, because we believe families affected by a traumatic birth need a voice. Your child deserves the best future possible.
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: Birth Injury Lawyers 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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Dealing with a birth injury diagnosis can be difficult, but our attorneys can help. The ABC Law Centers: Birth Injury Lawyers team focuses exclusively on birth injury and are dedicated to earning justice for families like yours.