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Did Your Newborn Suffer Cerebral
Palsy or Another Brain Injury Before
or During Labor and Delivery?

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Our Birth Brain Injury Resource Guide

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Get a FREE guide of resources available throughout Ohio to children and families of children who were born with brain injuries.

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Diagnosis of Cerebral Palsy

There are a variety of clinical signs that represent a group of disorders known as cerebral palsy (CP). Activity limitations, impaired movement, and abnormal posture as a result of a brain injury before birth are the major manifestations of CP. The diagnosis is based on clinical evaluation and not on blood tests or radiographic pictures of the brain. CP is a constellation of signs and symptoms, considered permanent, but not progressive. However, the symptoms may change over time as a result of compensations needed to survive important physical milestones and the possibility of complications.

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The most widely used method to diagnose CP is by the Gross Motor Function Classification System (GMFCS). The international working group's consensus opinion is that 'activity limitation' is the bare minimum for a diagnosis of CP. Neurologic abnormalities in the early months of life that persist and are not due to prematurity are the general conditions to warrant a diagnosis of CP. Attainment and timing of motor milestones are observed by parents or clinicians. Activities such as sitting, crawling, standing, walking, reflexes, muscle tone, and posture are delayed or abnormal in children with CP. The diagnosis of CP depends on which neurologic test is performed, the results of that test, and the interpretation of the examiner. The agreed upon definition is a combination of delayed motor skills observed or reported by the parent, deep tendon reflexes, posture, and muscle tone.

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Classification of the type of movement disorder and the anatomic distribution of the motor disorder is included in the diagnostic criteria. Spasticity is the most prevalent abnormality of premature babies with CP. This is measured by determining the angle of the joint when the muscle resists stretching. In one study of very low birth weight babies with CP, 37.5 % had quadriplegia, 37.5% had diplegia, and 25%had spastic CP with hemiplegia. Many of the latter will develop independent ambulation. The degree of functional impairment appears to be the most agreed upon classification system and diagnostic criteria.

Both parents, physicians, and physical therapists were in close agreement in the diagnostic specifics and severity when the child was evaluated under the GMFCS. There are other assessment tools for motor function which include the Bimanual Fine Motor Function (BFMF), the ABILHANDKids, and the Manual Ability Classification System (MACS).

Neonatal cranial ultrasound is historically the most common diagnostic test done on preterm infants with CP, and those results correlate well with computed tomography (CT) results. Grade 1 refers to a hemorrhage limited to the subependymal germinal matrix. Grade 2 bleeding into the cerebral ventricles, Grade 3 is Grade 2 with ventricular enlargement and Grade 4 affected to the periventricular cerebrum.

Magnetic Resonance Imaging (MRI) is used on children suspected of having CP after birth, but who were born at term. Interestingly, only 5% had images specific for hypoxia or ischemia. The most common finding was focal infarction in 22% of cases, 12% had periventricular leukomalacia from prematurity, 33% had a normal MRI, the remainder had evidence of birth defects from a brain malformation.

The differential diagnosis for Cerebral Palsy includes the following: Arginase Deficiency, Glutaric aciduria type 1, Juvenile neuronal ceroid-lipofuscinosis (i.e., Vogt-Spielmeyer disease), a Juvenile variant of metachromatic leukodystrophy, Lysosomal enzyme arylsulfatase, Lesch-Nyhan Syndrome, Mitochondrial disorders, Niemann-Pick disease type C, Pelizaeus-Merzbacher disease, Leukodystrophy classification, Rett syndrome.