Cerebral Palsy
Overview
Cerebral Palsy (CP) is a general term that refers to a group of non-progressive disorders of movement and posture resulting from injury or malformation of the developing central nervous system. Resulting disabilities may range from mild (apparent only as a stiff gait) to severe (no independent mobility) and may be associated with a variety of co-morbidities including intellectual disability, seizures, poor growth, scoliosis, and visual and hearing deficits.Most CP is congenital, although it may not be detected for months or years. [Marcì: 2009] CP also may result from an insult to the developing brain that occurred before, during, or after birth. In the US and Europe, most cases of CP (approximately 80%) are due to prenatal factors. Maternal risk factors for having a child with CP include:
- Multiple fetuses
- Malnutrition
- Placental problems
- Infection (e.g., bacterial kidney infection, chorioamnionitis) [Bax: 2006])
- Toxin ingestion (e.g., methamphetamine)
- Complicated labor
- Hypothyroidism
- Maternal seizures
The diagnosis of CP may be straightforward and the etiology clear; however, in approximately 19% of children with CP, the cause may not be identifiable. [Hagberg: 1989] When children have signs of CP, such as developmental delay and spasticity, but no medical history compatible with brain injury, a careful evaluation is necessary to determine the etiology of the abnormalities and to rule out an underlying genetic syndrome or a progressive neurological or metabolic condition. Management of the child with CP requires coordination of multidisciplinary team efforts to address the multiple medical, social, psychological, and educational needs.
Other Names & Coding
G80.X, cerebral palsy
The “X” indicates the need for additional one-digit coding that indicates further details of diagnosis. ICD-10 Cerebral Palsy Coding Reference provides more information.
Prevalence
According to the Center for Disease Control and Prevention (CDC), every year approximately 10,000 babies born in the United States are identified as having CP. The prevalence is 2-3 children per 1,000 over the age of three. [Ashwal: 2004] Males are slightly more likely to have CP than females, and CP is more common in families with lower socioeconomic status. [van: 2007] In a recent meta-analysis, the prevalence of CP was found to be 2.11 per 1000, similar to the prevalence given by the CDC. There is no evidence that the incidence of CP is changing, despite the increased survival of infants at risk for having CP. [Oskoui: 2013]Genetics
Though rare, sometimes children with CP have an underlying genetic disorder (e.g., in Miller-Dieker syndrome, severe lissencephaly due to a deletion in chromosome 17p13.3, [Kato: 2003] or dopa-responsive dystonia, which can present as a delay in walking and/or stiff gait [Cheyette: 2008]). Congenital neurologic disorders (e.g., schizencephaly, hydranencephaly) may be initially misdiagnosed as CP. A large controlled study is currently being conducted. [Gibson: 2008]Prognosis
The manifestations, severity, and course of CP vary dramatically across individuals. Accurate predictions of outcomes are difficult in infants. Brain MRI is often helpful, but may be misleading. [Distelmaier: 2007] In general, the more delayed the achievement of milestones, the more affected the child will be. Children who are not sitting by age 3-4 and walking by age 7-8 are not likely to learn to walk. However, motor milestones do not predict IQ, which is more predictive of the ability of the child to function independently as an adult. IQ testing may be difficult to do because most tests require motor coordination. Children with CP, e.g., those with restrictions of movement due to spasticity, may need special IQ testing by psychologists familiar with this population.Published predictions of life expectancy for children with motor limitations and/or intellectual disability are generally based on abilities such as mobility, feeding, and toileting. However, these are difficult to apply to an individual child. Children with severe motor problems are at high risk for death due to pneumonia, urinary tract infections, and sepsis. Comprehensive, coordinated care may optimize the life span for individuals with CP. (For a discussion, see Life Expectancy of Cerebral Palsy (cerebralpalsy.org).)
Practice Guidelines
Ashwal S, Russman BS, Blasco PA, Miller G, Sandler A, Shevell M, Stevenson R.
Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of
the American Academy of Neurology and the Practice Committee of the Child Neurology Society.
Neurology.
2004;62(6):851-63.
PubMed abstract / Full Text
Delgado MR, Hirtz D, Aisen M, Ashwal S, Fehlings DL, McLaughlin J, Morrison LA, Shrader MW, Tilton A, Vargus-Adams J.
Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based
review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the
Child Neurology Society.
Neurology.
2010;74(4):336-43.
PubMed abstract / Full Text
Roles of the Medical Home
A child with CP needs a medical home for well-child and chronic-care visits where progress and problems can be reviewed and proactively managed. In addition, a child with CP often needs access to a large number of subspecialists and the medical home should be the initiator and coordinator of these visits with input from the family, who will sometimes be more familiar with treatment and therapy options than the medical home provider. The goal is to have the child see the subspecialists needed, but to avoid duplication of services or unnecessary appointments.Resources that can help with primary care include:
- Tracking Form for Children With Cerebral Palsy (AAP) may be helpful with care coordination.
- Recommended Components of Medical Homes for Children With Cerebral Palsy (AAP) lists applications of the medical home model as related to caring for children with CP.
Clinical Assessment
Overview
The initial assessment of a child for possible CP should focus on determining the cause of the abnormal signs (e.g., spasticity or delay in achievement of milestones). In some cases, the diagnosis of CP may be straightforward, as in the child who was born prematurely and is known to have had a high-grade intraventricular hemorrhage, or the child who had significant hypoxic-ischemic encephalopathy in the newborn period. In other cases, the diagnosis may require prolonged observation and become a diagnosis of exclusion. For roughly 20% of children with developmental delay and non-progressive motor involvement, a clear diagnosis cannot be determined. It is important to rule out an underlying genetic syndrome or a progressive neurological or metabolic condition that might occur in subsequent pregnancies.For guidelines regarding the diagnostic evaluation of children with CP of unknown etiology, and an evaluation algorithm, see Practice Parameter: Diagnostic Assessment of the Child with Cerebral Palsy (

Pearls & Alerts for Assessment
Regression in developmental abilities may signal a new problem and unknown etiologyNew problems could include frequent seizures interfering with concentration or other abilities. (About 40% of children with CP have seizures; clinicians should ask about seizure activity.)
Consider (or re-consider) the diagnosisBecause new causes for CP are being recognized, the clinician should consider (or re-consider) the diagnosis of CP at each visit in any child with CP without an obvious historical cause, even in older children. [Hoon: 1997] If there is any question about the diagnosis, refer the child to neurology or genetics.
Determining if delayed development indicates CPSome children with CP will present initially with delayed development and no other signs. The developmental quotient (DQ) helps determine if the child's skill development is out of the broad range of normal. To calculate the DQ, divide the "motor age" (the average age of the child's current developmental milestones by a standardized test such as the Denver II) by the chronological age (corrected for prematurity). For example, the DQ of a 1 year old born at term who just started crawling (average age of attainment is 9 months) would be 9/12=75%. In general, a DQ above 70% with a normal neurologic exam and normal quality of movements suggests that development is in the broad range of normal. Also, see Developmental Screening Tools (AAP).
Screening
For Complications
Screen for intellectual disability, hearing and vision impairment, speech and language delays, oral motor dysfunction, and epilepsy.Presentations
The manifestations of CP in a given patient will depend on the extent, timing, and location(s) of abnormal brain development or injury. The age when a child begins to exhibit signs of CP is determined by the type and amount of brain involvement, and the stage of motor development affected by the altered brain function. Because motor development is easily assessed in early infancy, most children with pre- or perinatal causes of CP can be identified between 4 and 9 months of age.Infant characteristics associated with CP include:
- Prematurity and low birth weight - a recent study demonstrated that magnesium sulfate given to mothers who were at risk for having a pre-term delivery reduced the risk of CP in pre-term babies. [Rouse: 2008])
- Genetic or other disorders of brain development, including hydrocephalus
- Infection (e.g., cytomegalovirus, sepsis, encephalitis)
- Low Apgars at 10-20 minutes after delivery
- Periventricular hemorrhage
- Blood type incompatibility
- Factor V Leiden deficiency or other clotting disorder
- Breech presentation
- Jaundice
- Seizures shortly after birth
- Metabolic disease (e.g., glutaric acidemia I)
Diagnostic Criteria
Basic diagnostic criteria include the presence of a non-progressive neurologic deficit secondary to brain maldevelopment or injury to the developing brain.Clinical Classification
Despite many classification schemes for CP, limited agreement among clinicians can occur about an individual's specific CP classification. However, some classification is important for communication among providers: Percentages described below are from [Himmelmann: 2005]:Spastic CP: Increased velocity-dependent muscle tone causing stiff and awkward movement. Almost 80% of people with CP have spasticity. Children with spastic CP may be further described by the areas of the body affected:
- Spastic diplegia (approximately 35% of children with CP): Motor impairment is most significant in the lower extremities. Arm, trunk, and facial musculature are often affected, but to a lesser extent.
- Spastic hemiplegia (approximately 38%): One side of the body is affected, with the arm usually more involved than the lower extremity.
- Spastic quadriplegia (approximately 6%): Whole body involvement (face, trunk, legs, and arms)
Ataxic CP (approximately 6%): Results in problems with balance and depth perception, and may often overlap with other categories.
Mixed CP: A term used when a child has features of more than one type. Examples include the combination of low truncal tone and poor head control and seating posture but with spasticity in the lower extremities or a mixture of spasticity and dystonia (pure dystonic CP is rare).
Differential Diagnosis
The differential diagnosis for CP is becoming increasingly complex as more metabolic and genetic conditions are recognized as having clinical characteristics similar to those in CP. [Hoon: 1997] In those children with signs/symptoms of CP, such as developmental delay and spasticity, but no medical history compatible with brain injury, a careful evaluation is necessary to determine the etiology of the abnormalities and to rule out an underlying genetic syndrome or a progressive neurological or metabolic condition.In a child with CP of unknown cause, clinicians should consider several general categories of conditions other than CP such as:
- Slowly progressive conditions that may present similarly to CP, including familial paraplegia, which presents as spastic diplegia, and some of the leukodystrophies. Brain MRI and serial observations over time will help differentiate these conditions.
- Genetic syndromes causing developmental delay, which may become more obvious as the child ages (e.g., developmental delay, poor feeding, and hypotonia in an infant with Prader-Willi syndrome).
- Metabolic disease that may present with CP-like symptoms, but also may include developmental regression, periods of emesis and dehydration, and failure to thrive.
- Neuromuscular conditions that may present early in life as CP. The absence of reflexes, bowel and bladder dysfunction, and
muscle weakness (sometimes difficult to differentiate from low tone) should distinguish these.
Comorbid & Secondary Conditions
Associated conditions are common, especially in those children with a more severely affected motor exam, and should be considered during the CP evaluation.Associated Condition | Further Information |
---|---|
Intellectual disability (>40%) - With a higher percentage in those children with quadriparesis [Christensen: 2014] |
Intellectual Disability |
Epilepsy (41%) - Co-occurring epilepsy frequency was highest among children with CP who had limited or no waking ability. [Christensen: 2014] |
Seizures/Epilepsy |
Hydrocephalus - Some children will have hydrocephalus, either as the cause of CP or as an associated condition, e.g., from an intraventricular hemorrhage in a child born prematurely. New or increasing hydrocephalus may cause developmental regression or, if acute, symptoms such as headache and lethargy. |
Hydrocephalus and VP Shunts |
Vision impairment (>15%) - Includes strabismus, myopia, cortical blindness and in children with hemiplegia a homonymous visual field defect [Christensen: 2014] |
Visual Impairment |
Hearing problems | Hearing Loss and Deafness |
Drooling/swallowing problems | Drooling in Children with Special Health Care Needs |
Incontinence, constipation - Approximately 25% of children with CP have primary urinary incontinence [Odding: 2006] and constipation is very common. |
Constipation |
Learning problems - Even in children with normal intelligence, such as in children with hemiplegic CP, subtle learning concerns may become evident during grade school. Attention deficit disorder (with or without hyperactivity) is prevalent and should be specifically inquired about once the child has reached the appropriate age. |
Specific Learning Disability (SLD) and ADHD
Attention Deficit Hyperactivity Disorder (ADHD) |
Speech/language deficit | Normal Pattern of Speech Development |
History & Examination
Current & Past Medical History
Questions regarding associated features will help the primary care physician identify areas of focus and/or concern. In general, look first at the pattern of development and whether it has slowed, regressed, or plateaued.Mobility/ADLs: Does the child have abnormal patterns of motor movements? For example, does the child army crawl (lower extremity spasticity), scissor the lower extremities, appear to have early hand dominance (possible hemiplegia), use a Gower maneuver to stand (proximal weakness), have chorea or ataxia, or persistently walk on his/her toes (habitual pattern vs. spasticity)? Has there been any decrease in their mobility or abilities over time? How is fine motor control compared to other children their age (e.g., self feed, grasp objects, dress self, write efficiently)? Have they made progress in activities of daily living? Any changes in the therapies the child is receiving? Any changes in spasticity treatments, equipment, orthopedic surgeries, contractures, stander? Any change in exercise tolerance?
Growth and nutrition: Are there any episodes of emesis? Has nutritional status, growth, or feeding been a concern? Is the child fed orally or by feeding tube? Is the child receiving any therapy to improve oral feeding skills? What is the child's usual calcium intake? The Medical Home Portal’s Nutrition and Growth in Children with CP discusses evaluation challenges and gives assessment tips. The Feeding Tube Issues (general) page lists indications for use of feeding tube and family support tips.
GI: Does the child have constipation and is he/she toilet trained? Does the child have problems that suggest gastroesophageal reflux disease (GERD)? The Medical Home Portal’s Constipation discusses constipation management, clean out procedures, and maintenance medications. Toilet Training provides information and resources for clinicians and families toilet training children with disabilities.
Swallowing and drooling: Does the child cough and/or choke during eating and drinking? Does it take a very long time to feed the child? Is swallowing or drooling a problem?
Pulmonary: Is there chronic cough or wheezing? Has the child had pneumonia? Does the child have difficulty sleeping? Does the child snore or have frequent awakenings? Are there respiratory concerns?
Neurology: A history of developmental regression should prompt a referral to neurology as it raises the question of a different diagnosis. Has the child had seizures? (The Seizures/Epilepsy module provides diagnosis and management information.) Does the child have any unusual movements or episodes of unexplained pain or agitation? Does the child have a history of hydrocephalus and/or a VP shunt? Any signs of shunt malfunction (e.g., headache, mood, or activity change, emesis)?
Vision/hearing: Does the child have normal vision and hearing? Do they wear glasses or hearing aids?
Musculoskeletal/Bone: Has the child had fractures? Are there any limitations of joint or muscle movement? Fractures without clinical explanation prompt concerns for osteopenia/osteoporosis, especially in the child on antiepileptic medications, or abuse. Do they have a standing program? The Medical Home Portal’s Musculoskeletal Exam for Common Orthopedic Complications of CP and SCI (MHP) (

Urinary: In the child who has attained continence, are there concerns for frequency, urgency, or dribbling of urine?
Other: Is chronic pain a concern? Does the family use any complementary alternative medicine (CAMS)?
Family History
Ask about familial spastic paraplegia, dopa-responsive dystonia, and any neurologic disease in the extended family. Familial stroke and clotting or bleeding problems may be important. Family history of CP (which may not really be CP), other developmental delay, or miscarriages/infant death may suggest a specific etiology. Ask about family members with intellectual disability. If there are possible connections, the family of the child with CP should be asked to gather more information.Pregnancy/Perinatal History
Pregnancy, labor, delivery, and perinatal course should be detailed, including prematurity, birth trauma, APGAR scores, need for oxygen, feeding ability at and around birth, etc.Developmental & Educational Progress
Review developmental milestones and at what age they were achieved. What are the child's current abilities? Parents' estimate of child's mental age? How does the child communicate (e.g., differential cries, eye gaze, signing, augmentative device, verbal). Describe the child's early intervention or school program. Are there new concerns about school or early intervention?Maturational Progress
Ask about signs of pubertal development (common clinical issues include premature adrenarche, normal pubertal development with associated parental concern about how to handle issues such as menarche or behavioral changes, and delayed puberty).Social & Family Functioning
What concerns does the family have? What kinds or levels of support can the extended family offer? Does the family have experience with chronic conditions or developmental delay? How is the family coping? Are there siblings of the child with CP? Is the child functioning well at school? Does the child have recreational activities and opportunities for friendships? Are there behavioral problems or depression? Is the family accessing available financial resources? Do the family members have access to respite supports? What about the extended family?Physical Exam
General
Assess general appearance and interaction of the child with the environment. General appearance of head, shunt palpable? Nutritional status? Use of assistive devices such as a wheelchair, hearing aids, and glasses?Growth Parameters
Height | weight | head circumference: Growth parameter measurements are critical but may be difficult to obtain accurately. Parameters of children who were born prematurely may need to be plotted on preterm growth charts; if standard growth charts are used, correct for prematurity until 18-24 months of age. Children who have low weight, height and head circumference for age may have an underlying genetic syndrome. HC is particularly important to track; a HC crossing percentile lines in the upward direction may signal hydrocephalus whereas a HC crossing percentile lines in the downward direction may reflect microcephaly. See Nutrition and Growth in Children with CP (Medical Home Portal) for a discussion of evaluation challenges and tips.Skin
Look for pressure sores in children with decreased mobility, including under ankle-foot orthotics.HEENT/Oral
Oral exam: The presence of dental caries may signal reflux and may cause food refusal or discomfort. Look for a high arched palate and drooling and/or pooling of saliva at the back of the throat. Look for visual attentiveness, unequal light reflexes, strabismus, and nystagmus. Middle ear fluid should be treated aggressively as it might contribute to hearing loss.Chest
The lung exam should be followed closely in children at risk for aspiration pneumonia and pulmonary hypertension.Neurologic Exam
Evaluate tone, strength, balance, primitive reflexes, coordination, and reflexes. Classify findings by the type of tonal abnormality and the area(s) affected. Dystonia and spasticity can be difficult to differentiate but it is important to do so. Low tone in infants can be very difficult to differentiate from decreased strength. Check supine posture - infants with low tone will lie in the frog-leg position. Check if the infant will slip through the examiner's hands under the infant's arms and whether there is head lag when pulling the infant up from supine. Infants with these problems have low tone but might still be able to kick with good strength if they are angry. Also, check if the infant will bear weight when held in a standing position and, conversely, if the baby wants to keeps his/her legs extended much of the time.New focal findings might signify a progressive course; evaluate for increasing spasticity or dystonia that might need new therapeutic intervention. The "Medical History/Mobility/ADLs" section, above, lists questions that may be helpful for evaluating changes.
Testing
Sensory Testing
Vision screening should be performed with referral to pediatric ophthalmology if problems are suspected. Strabismus and myopia are common, as is cortical blindness. Children with dyskinetic CP may have eye movement problems, such as nystagmus, that interfere with vision and children with hemiplegia may have a homonymous heminanopia. The Visual Impairment issue page provides further detail about vision impairment and CP.Hearing screening should be performed with referral for audiologic evaluation if problems are suspected. Hearing deficits are common in children with CP. Hearing Loss and Deafness (Medical Home Portal) provides diagnosis and management information.
Laboratory Testing
Routine laboratory testing is not indicated; however, some situations may warrant focused lab evaluation:Metabolic - Testing should be considered in a child with developmental regression, periods of emesis/dehydration, or failure to thrive. In a child with dyskinetic or ataxic CP, consider the possibility of a metabolic disorder.
Hematologic - The role of an evaluation for clotting dysfunction in children whose CP is secondary to an intra-uterine stroke is not clearly defined and likely varies clinician to clinician and will continue to evolve as more is understood from research. The role of such evaluation should be discussed with the child’s pediatric neurologist.
Nutritional - Serum markers for nutritional status are of limited value. However, in the child with malnutrition, assessment of targeted vitamin and mineral stores should be considered. In particular, a significant percentage of children with CP demonstrate a deficiency in vitamin D. (Calcium and Vitamin D provides more information.) Some children with CP will have low serum ferritin, evidence of poor iron stores.
Imaging
Neuro-imaging - Imaging in children with CP is frequently abnormal (62-100%) [Ashwal: 2004], and is usually performed as part of the initial diagnostic evaluation in a child with suspected CP.Although frequently requiring sedation, the brain MRI is often the best choice for imaging when looking for an etiology. Imaging around 18 months of age may provide the best yield. Head CT should be considered for several specific issues: if you are looking for calcifications (e.g., if considering congenital CMV), if the child cannot be sedated, or when evaluating emergently for hydrocephalus or subdurals.
MRI may identify an underlying cause (e.g., in-utero stroke or focal brain malformation such as schizencephaly). In the child with spastic quadriplegia, neuroimaging can rule-out white matter disorders that can be so slowly progressive and that they mimic CP. Imaging does not need to be performed after the initial diagnosis unless a new clinical question arises (e.g., a regression in abilities). Many brain malformations are known to be associated with genetic and or metabolic conditions (e.g., lissencephaly-Miller Dieker syndrome and Zellweger syndrome) and, if found, should trigger a referral to genetics. [Ashwal: 2004] [Lequin: 1999] Several excellent neuroradiology texts offer more information regarding neuroimaging abnormalities in CP: [Ball: 1997], [Barkovich: 2005], and [Osborn: 1994].
Skeletal imaging - May be helpful to evaluate orthopedic concerns, most often scoliosis or hip dislocation.
Upper gastrointestinal study (UGI) - Used for assessment of gastroesophageal reflux (although sensitivity and specificity are moderate), delayed gastric emptying, and to rule out a structural cause of GI symptoms.
Genetic Testing
Genetic testing may be indicated if a syndrome or genetic disease is suspected. Also, consider a referral to genetics for testing if there is no explanation for the child's CP, or if there are other signs such as poor growth of height, weight, and head circumference, dysmorphic features, or otherwise unusual presentations.Other Testing
Modified barium swallow (sometimes called a cookie swallow or video swallow) - Performed in collaboration with a speech therapist to assess swallowing function and whether the child is aspirating.DEXA scan - DEXA allows assessment of bone density. In practice, children with significant motor impairment will invariably be found to have low bone density on DEXA. The degree of low bone density does not predict degree of fracture risk and thus the measure has little impact on clinical management. The clinician should focus on optimizing bone health (adequate calcium intake, optimal vitamin D levels, and weight bearing) in all children with CP. Dexa should be obtained in the rare situation it will impact therapy (e.g., when declining over time on a medication that could be discontinued (e.g., Depo-Provera, Depakote) or when a child is being treated with bisphosphonates after recurrent fractures). DEXA scan can also be used to assess body composition and can be very helpful to sort out the degree of fat storage in children with CP since other nutritional assessment approaches are not valid (e.g., BMI or weight for height) due to low muscle mass.
DEXA scans are of limited value before age three due to lack of normative data. Implanted hardware (e.g., spinal rods and baclofen pumps) interfere with DEXA reliability
Sleep study - A sleep study should be considered if the child has difficulty sleeping, disrupted sleep, or signs of obstructive sleep apnea (e.g., snoring, daytime sleepiness, etc.).
Electroencephalogram (EEG) - An EEG is warranted if clinical evidence of a seizure disorder exists. Seizures are more common in children with hemiplegic and quadriplegic CP. Children with CP may have many types of seizures, including generalized tonic-clonic, partial complex, and atypical absence. It can be difficult to determine if some events in children with CP are seizures or behaviors. If the event occurs frequently, a video EEG may be helpful in sorting this out. See the Seizures/Epilepsy module for more information.
Specialty Collaborations & Other Services
Pediatric Neurology (see Services below for local providers)
Assists with diagnosis of CP and offers expertise in management of a seizure disorder or evaluation of new neurological changes. Neurology should evaluate the child's clinical status yearly, or more often if indicated. A child with ataxia should be followed closely by neurology to watch for progression.
Pediatric Genetics (see Services below for local providers)
Assists if a syndrome or genetic disease is suspected in a child without a clear history of pre-, peri-, or post-natal brain injury. Up to 50% of children with ataxic CP have a genetic cause.
Developmental - Behavioral Pediatrics (see Services below for local providers)
Provides neurodevelopmental consultation for the evaluation and diagnosis of children with developmental disabilities such as CP.
Pediatric Physical Medicine & Rehabilitation (see Services below for local providers)
Improves functional quality of life through assistive devices, medication, and other modalities. Care may involve physical, occupational, and speech therapy as necessary for management and treatment of spasticity, feeding and language problems, problems with activities of daily living, etc.
Pediatric Orthopedics (see Services below for local providers)
Monitors for contractures, scoliosis, and hip subluxation; guides interventions to optimize gait efficiency. Most children with CP and significant tonal abnormalities should be followed by an orthopedic specialist.
Pediatric Gastroenterology (see Services below for local providers)
Assists with treatment of children who have weight gaining and feeding problems, GERD, and severe constipation.
Neuropsychiatry/Neuropsychology (see Services below for local providers)
Tests cognitive skills in children with motor and/or sensory impairments, which requires special expertise since the extent of motor impairment may not correlate with the extent of cognitive impairment. Attention deficit disorder is common in this population and should be specifically looked for as part of psychological testing.
Pediatric Ophthalmology (see Services below for local providers)
Examines for visual deficits and strabismus, which are common in CP. This is particularly important if the child does not have the ability to participate in age appropriate visual screening during well child checks. Children with hemiplegic CP should be examined for a homonymous visual field defect.
Pediatric Otolaryngology (see Services below for local providers)
Evaluates and treats drooling and swallowing difficulties. Evaluates need for PE tubes if there are frequent ear infections, which may be affecting hearing.
Pediatric Pulmonology (see Services below for local providers)
Assesses difficulties the child may be having with cough, breathing during sleep, and frequent respiratory infections.
Pediatric Dentistry (see Services below for local providers)
Performs dental care. Children with CP may be more prone to caries and may need anesthesia for some dental procedures. Caries may lead to food refusal and systemic disease if untreated.
General Pediatric Surgery (see Services below for local providers)
Places feeding tube; alternatively, a percutaneous gastrostomy may be available through gastroenterology.
Pediatric Neurosurgery (see Services below for local providers)
Follows children with ventriculo-peritoneal shunts approximately yearly, with additional visits as needed for shunt problems.
Treatment & Management
Overview
The management of CP focuses on maximizing the child's capabilities at home and in the community, treating associated medical conditions, and preventing/treating orthopedic complications. Treatment should be interdisciplinary and start as early as possible. A diagnosis of CP can be helpful in obtaining services for the child and providers should not be hesitant to use the term once the diagnosis is confirmed. Specific interventions are based on:- Child's age
- Overall health
- Medical history
- Extent and severity of the disease
- Type of CP
- Child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Opinion or preference of the child and the parents
- Funding considerations
Pearls & Alerts for Treatment & Management
Complementary alternative medicineMany therapies are reputed to be treatments for CP: Not all are successful, and some may even be harmful. Ask families about herbal treatments, relaxation techniques, or other therapies. [Samdup: 2006]
Medical home can advocate for additional therapyThe educational system may provide physical and occupational therapy focused upon educational goals. Private therapy may be a necessary addition for some children to allow intensive focus on specific medical goals. The medical home should review therapies and frequency with every visit and advocate for families if more therapy would be helpful. Children's Education Services (801-662-4914) may be helpful for coordinating the return to school after being discharged from the hospital. LINCS (801-281-4425) can assist with during the IEP process.
Children with CP may qualify for Deaf/Blind ServicesChildren with both visual and hearing impairment, including cortical blindness or visual impairment, may qualify for a deaf/blind program, which can usually be accessed through the local school for the deaf and blind. Children with dual sensory impairment have a disability that is different and more complicated than the sum of vision and hearing impairments and may qualify for special services. See Deaf/blind information; dual sensory impairment and Additional info and links - deafblindedness.
Pneumonia or recurrent pneumonias are a frequent, often unrecognized, sign of aspirationChildren with CP and other chronic disorders are at risk for acute and chronic respiratory illness due to neurological and anatomical dysfunction.
Systems
Development (general)
Although the benefit is difficult to prove for all children with CP, children who were born prematurely and are at risk for CP perform better cognitively if they have received early intervention services. Children younger than 3 years with suspected or definite CP should be referred to an early intervention program. Children at particular risk (e.g., those with extreme prematurity or birth asphyxia) should be referred early, perhaps even before any clear signs of delay. For children with obvious signs of CP, the therapy received through early intervention may not be frequent enough and referrals to rehabilitation programs may be necessary. See Early Developmental Intervention Programmes Post-Hospital Discharge to Prevent Motor and Cognitive Impairments in Preterm Infants for further resources and information.
Children over 3 years old should be referred to their local school district to determine benefit from developmental preschool and special education. In addition to individualized educational programming, children may receive speech, occupational, physical, vision, and hearing services and adaptive equipment if relevant to educational goals.
Specialty Collaborations & Other Services
Early Intervention for Children with Disabilities/Delays (see Services below for local providers)
Involves therapists who provide treatment in the home and/or at child playgroups, depending on the child's needs. Early intervention programs are low cost, generally with a sliding fee based on family income.
Pediatric Physical Medicine & Rehabilitation (see Services below for local providers)
Improves functional quality of life through assistive devices, medication, and other modalities. Care may involve physical, occupational, and speech therapy as necessary for management and treatment of spasticity, feeding and language problems, problems with activities of daily living, etc.
Mobility/Function/ADLs/Adaptive
Non-surgical interventions may include:
- Therapies - physical, occupational, and speech
- Positioning aids (used to help the child sit, lie, or stand) - If the child is not sitting by him/herself, a corner chair, tumble form or wheelchair is used to allow the child to be in a seated position for feeding and for optimal hand use during play and activities of daily living.
- Braces and splints - used to prevent deformity and to provide support or protection. May be used during the day or night to provide stretch and optimal positioning across joints.
- Standers/walkers - Use additional equipment to allow standing (weight bearing may help prevent osteoporosis, allow full lung expansion, stretches hamstrings, and allow children to be on-level with peers) and supported walking (for children requiring help with balance and support for walking).
- Medications:
- Oral: Although oral antispasmodic agents may cause excessive sleepiness, they are often tried because they are non-invasive. Examples are diazepam (Valium), baclofen (Lioresal), clorazepate (Tranzene), and clonazepam (Klonopin). Valium given before sleep is helpful in some patients and may not cause daytime drowsiness. [Mathew: 2005] There is not as much experience in pediatrics with modafinil (Provigil) [Murphy: 2008] and tizanidine (Zanaflex), but these medications may improve function of children with spasticity. Doses should be titrated to avoid weakness and extensive hypotonia. [Delgado: 2010]
- Injections: Botulinum toxin A (Botox) and B (Myobloc) and phenol injections are used to treat and prevent contractures that lead to tight ankles (difficulty walking) and hygiene problems (hip adduction contractures). These injections are usually combined with physical therapy, splinting, or casting to optimize impact. [Desloovere: 2007] See [Fehlings: 2010] and [Love: 2010] for international consensus articles regarding the use of botulinum injections in upper and lower extremities, respectively. Despite the frequent use of botulinum toxin in children with CP, more studies are called for by some experts to prove efficacy in walking function. [Ryll: 2011]
- Orthopedic surgery to manage scoliosis, hip dislocations, muscle contractures, and ankle, foot and hand deformities. See [Imrie: 2010] and [Loeters: 2010] for discussions regarding the management of scoliosis in CP.
- Baclofen pump - In some patients with severe spasticity, a small programmable pump is placed in the abdomen with a catheter going to the intrathecal space to deliver baclofen. Complications include infection, catheter breakage, and a possible increase in scoliosis. Many patients and families have been very happy with this therapy. Pumps may be implanted in children as young as three years of age. The role of a baclofen pump in treating dystonia is not well understood, but may be of benefit. In the patient, a trial is performed by intrathecal injection of baclofen. The individual child's response is then assessed over the subsequent 8-hour period. See Baclofen Pump Information (Medtronic) for more information.
- Dorsal rhizotomy - Selective dorsal rhizotomy is a neurosurgical procedure performed to treat diplegia and quadriplegic CP in selected patients. Its popularity has waxed and waned over the years. It can be very helpful in selected patients when combined with post-operative rehabilitation. If the child/family and medical home are interested in dorsal rhizotomy, referral to a rehabilitation specialist and neurosurgeon is recommended to allow evaluation, discussion regarding possible risks and benefits, and consideration of alternate therapies.
Specialty Collaborations & Other Services
Pediatric Physical Medicine & Rehabilitation (see Services below for local providers)
Manages and treats spasticity, evaluates use of oral medications, injections, and baclofen pump. May help with coordinating care, long-range planning, and referral management.
Pediatric Orthopedics (see Services below for local providers)
Evaluates at regular intervals and treats as necessary orthopedic complications of spasticity such as tight heel cords, dislocated hips, and scoliosis. Generally, children with CP should be referred at the time of diagnosis to an orthopedic surgeon familiar with treating children with CP.
Pediatric Neurosurgery (see Services below for local providers)
Places baclofen pumps. In some locations, referral will be via physical medicine and rehabilitation.
Nutrition/Growth/Bone
Decreased linear growth and failure for females to experience menarche are also a concern for this population. See the treatment section on maturation for more information.
Dietary calcium and vitamin D metabolism insufficiency, particularly in children on medications for seizures, with resulting osteoporosis and pathologic fractures is of great concern in non-mobile children. See Fractures in Patients with Cerebral Palsy, Osteoporosis and Pathologic Fractures, and Calcium and Vitamin D for more information.
Evaluation and Treatment/Management
Children with CP should be monitored carefully for low weight or decreasing weight gain and referred preventively to nutrition.Specialty Collaborations & Other Services
Nutrition Assessment Services (see Services below for local providers)
Evaluates growth parameters and suggests dietary changes that might be helpful. Performs a diet history for calories and nutrients. Follows skin-fold measurements, which might be a better measure than weight for height in children with CP.
Pediatric Gastroenterology (see Services below for local providers)
Evaluates and manages nutritional issues, including treating associated GI conditions such as constipation and gastroesophageal reflux, which might be adding to poor weight gain. Evaluates need for, and placement of, gastrostomy tubes.
Bone Densitometry/DEXA (see Services below for local providers)
DEXA scan may be used to evaluate body composition including fat stores and bone density. DEXA should be obtained primarily when results will impact treatment decisions.
Pediatric Endocrinology (see Services below for local providers)
Provides consultation regarding issues of poor linear growth not related to nutrition or issues of premature or delayed puberty. Evaluates and manages osteoporosis, which can be common in children with CP.
Respiratory
Factors contributing to pulmonary disease in children with chronic illness include recurrent pneumonia, oral motor dysfunction with aspiration, chronic aspiration, gastroesophageal reflux, sleep apnea, aspiration during seizures, atelectasis/bronchiectasis, tracheomalacia, restrictive lung disease, airway hyposensitivity and ineffective cough, and inadequate seating posture and scoliosis.
Optimal management of the child with CP includes:
- Minimizing pulmonary risk
- Optimizing nutrition
- Immunizing appropriately - influenza and pneumococcal vaccines
- Ensuring good posture support in seating
- Monitoring for scoliosis
- Educating the family to avoid active/passive tobacco smoke
- Dysphagia/aspiration
- Gastroesophageal reflux
- Sleep apnea/obstruction
- Comorbid pulmonary conditions (e.g., asthma, allergies, BPD)
Specialty Collaborations & Other Services
Pediatric Pulmonology (see Services below for local providers)
Assists when pulmonary problems are suspected.
Gastro-Intestinal & Bowel Function
Gastroesophageal reflux is common, although it might present as arching, irritability, or food refusal rather than vomiting. Treatment can be started empirically with evaluation and/or a referral to gastroenterology if symptoms continue. Treatment is generally initiated with a proton pump inhibitor. Treatment of reflux can be augmented by the use of a motility agent (metoclopramide or low dose erythromycin), but the clinician must monitor closely for side effects (particularly irritability or dystonia with metoclopramide). It is unclear if H2 blocker add-on therapy for a patient already on a proton pump inhibitor and mobility agent provides additional benefit. A clinical trial of add on therapy may be helpful in some patients. Alternately, consideration of checking gastric pH and optimizing PPI dosing to insure adequate suppression might be considered. Regardless, when a patient's symptoms are not adequately controlled on a PPI and motility agent, Gastrointestinal consultation is likely warranted to aid in these treatment decisions. For full management details, see Gastroesophageal Reflux Disease.
If medical therapy is not successful or, despite optimal treatment of reflux, the child remains underweight, surgical procedures may be necessary. Nissen or other type of fundoplication may be recommended and may be performed laparoscopically, shortening hospital and overall recovery time. Many factors should be considered when deciding on Nissen fundoplication and/or gastrostomy tube placement. Gastrostomy tubes may be indicated for: poor oral intake of calories and/or fluids, swallowing difficulties, and severe reflux. If reflux is severe and aspiration is likely, many providers would recommend Nissen fundoplication with gastrostomy placement. Treat for other GI issues, such as constipation, before making these decisions.
For children who do not feed orally or who are poor surgical candidates, another option is moving the distal end of the feeding tube to the small intestine (i.e., GJ tube or J tube). See Feeding Tubes and Gastrostomies for more details.
Constipation is a problem in many, if not most, children with CP due to diet, lack of mobility, and spasticity. Constipation is easier to treat if caught early, and bowel history should be part of every medical home visit. Dietary management might be all that is necessary, with additions of juices and fiber, but many children will need daily treatment with laxatives (PEG 3350, Miralax, Senokot, and Glycolax). The Portal's Constipation has further details for management of this condition.
Specialty Collaborations & Other Services
Pediatric Gastroenterology (see Services below for local providers)
Evaluates and manages general issues such as constipation, reflux, gastrostomy tube placement, and refers for Nissen fundoplication and gastrostomy tube placement when necessary.
General Pediatric Surgery (see Services below for local providers)
Places gastrostomy tubes and Nissen fundoplications.
Nose/Throat/Mouth/Swallowing
Children with significant swallowing problems may need gastrostomy tube placement to allow efficient and safe liquid and/or food delivery. A gastrostomy tube may also be necessary in those children with CP with severe failure to thrive, even if aspiration is not an obvious problem. In some children, placement of a feeding tube might be thought of as a temporary intervention so that the family may focus on the child and the quality of his/her eating without worrying constantly about the number of calories the child has received. In the child with GERD and limited capacity to protect his/her airway, treatment with a Nissen fundoplication may be important. Also, see Feeding Tubes and Gastrostomies and Aspiration/Chronic Lung Disease (general) for more information.
Drooling. Many parents will choose not to treat drooling due to concerns about the side effects of medication and surgery, but drooling in the socially aware older child with CP can be very embarrassing to the child and create a social barrier. See Missing issue with id: 4dbb1a51.xml and [Potulska: 2005] for resources and information about specific treatments. Also, see [Love: 2010] for international consensus recommendations regarding the use of botulinum toxin for drooling.
Specialty Collaborations & Other Services
Developmental - Behavioral Pediatrics (see Services below for local providers)
Coordinates evaluation and management of feeding concerns.
Pediatric Otolaryngology (see Services below for local providers)
Evaluates and treats problems with swallowing (submucosal cleft, etc.) and drooling.
Pediatric Gastroenterology (see Services below for local providers)
Evaluates nutritional and swallowing issues and the placement of gastrostomy tubes.
General Pediatric Surgery (see Services below for local providers)
Performs gastrostomy (and other) tube placements as well as Nissen fundoplications when necessary.
Neurology
Osteoporosis. Children with CP on seizure medication may be at particular risk of osteoporosis. Optimizing bone health is critical including insuring optimal vitamin D levels, adequate calcium intake, and if possible, a weight bearing program. Osteoporosis and Pathologic Fractures, and Osteoporosis and Antiepileptic Medications (general) provides further management information.
Hydrocephalus. If the head circumference is crossing percentile lines or there is a history of hydrocephalus and/or VP shunts, referral to neurosurgery should be considered. The primary care provider should help the family understand when the child with a shunt should be seen emergently, such as with new headaches and vomiting, or in the event of a persistent behavioral or mood change from baseline in the absence of a febrile illness. See Hydrocephalus and VP Shunts.
Specialty Collaborations & Other Services
Pediatric Neurology (see Services below for local providers)
Confirms diagnosis of CP and manages seizures if present.
Pediatric Neurosurgery (see Services below for local providers)
Evaluates and treats hydrocephalus— usually with concurrent management by a neurosurgeon and the medical home.
Sleep
Specialty Collaborations & Other Services
Sleep Studies/Polysomnography (see Services below for local providers)
Evaluates the many possible causes of sleep disorders in children with CP and recommends appropriate treatments.
Pediatric Otolaryngology (see Services below for local providers)
Performs tonsillectomy and adenoidectomy to help alleviate obstructive sleep apnea issues.
Maturation/Sexual/Reproductive
Disability and chronic health conditions may result in primary and secondary sexual dysfunction. Fears can include concerns about sexual exploitation in this population, and body image concerns on the part of the adolescents. When surveyed, more than 90% of young adults with CP indicated a desire for more information about sexual function. Sexuality needs to be discussed with adolescents and their parents to overcome often-present assumptions such as:
- Teens with disabilities do not need this information.
- Sex education that is specific to people with disabilities does not exist or is limited.
- Motor impairments may make sexual function difficult, e.g., condom use.
- Presence of intellectual impairment might complicate the imparting and understanding of sex education material.

Specialty Collaborations & Other Services
Gynecology (Ped/Adol, Special Needs) (see Services below for local providers)
Provides reproductive health care for girls with disabilities and can assess issues with delayed pubertal development.
Genito-Urinary
Evaluation and Treatment/Management
Routine evaluation of the urinary tract is not indicated in children with CP. However, some children with CP may have a neurogenic bladder resulting in difficulty attaining continence or urinary tract infections. Studies have suggested that these children have excellent responses to treatment with the majority achieving continence. Urology evaluation should be considered in the following situations:- Patients who have had a UTI.
- Persistent daytime incontinence despite a good training approach (Toilet Training) Note: With the appropriate approach, even children with moderately severe cognitive and motor impairments can achieve continence.
- Changes in bladder function, particularly if after intervention for spasticity with a dorsal rhizotomy
- In children with any of the following symptoms:
- Dribbling
- High voiding frequency or urgency
- Difficulty initiating a void
- Stress incontinence
- Persistent nighttime wetting after a period of daytime continence. Note: an empiric trial of ditropan might be considered in those with symptoms of bladder spasticity.
- Urodynamics (cystometrogram/CMG)
- Renal ultrasound
- VCUG (if there has been a UTI)
- Urinalysis
Eyes/Vision
- Strabismus - More than half of children with CP exhibit strabismus, a condition where the muscles that control eye movement are out of balance, causing the eyes to be misaligned. The misalignment of the eyes causes double vision, which the brain stops by turning off vision in one eye. In children, this change can be permanent if the double vision is not corrected in the early years.
- Acuity Loss - Acuity loss may be present by itself or with cortical visual impairment.
- Field Defects - Field defects, especially homonymous hemianopsia and variants, are seen in hemiplegic CP.
- Processing Disorders (e.g., visual perceptual disorders, cortical vision impairment)
Children with CP should have at least one visit with a pediatric ophthalmologist for an evaluation, even if no problems are reported by parents or observed in the medical home visit because visual problems in the first few years of life may lead to permanent, but avoidable, vision loss. At the first referral, follow up should be specified by the consulting pediatric ophthalmologist.
Children with dual sensory impairment have a disability that is different and more complicated than the sum of vision and hearing impairments and may qualify for other special services. In children younger than 3 years with hearing and/or vision deficits, a referral should also be made to the School for the Deaf and Blind, which coordinates home-based parent education and infant stimulation. Deafblindinfo.org provides answers to frequently asked questions and lists resources by locations.
Specialty Collaborations & Other Services
Pediatric Ophthalmology (see Services below for local providers)
Provides early intervention of potentially reversible vision problems.
Vision Screening (see Services below for local providers)
Many states have Schools for the Blind where vision services for that state originate. Services for children under 3 are sometimes offered in home, and services for school-aged children are offered through the school districts.
Public Special Schools (see Services below for local providers)
Provides the necessary learning services when a child has dual sensory impairment.
Ears/Hearing
Specialty Collaborations & Other Services
Pediatric Otolaryngology (see Services below for local providers)
Refer for children with CP and hearing loss, especially if they have frequent ear infections, middle ear fluid, drooling and/or swallowing problems should be referred to otolaryngology.
Audiology (see Services below for local providers)
Hearing evaluations are sometimes available through the school district at no charge or through the state's Department of Health on a sliding fee basis. Private providers are also an option, although the audiologist should be familiar with issues seen in children with disabilities.
Public Special Schools (see Services below for local providers)
Provides the necessary learning services when a child has dual sensory impairment.
Learning/Education/Schools
Specialty Collaborations & Other Services
Head Start/Early Head Start (see Services below for local providers)
Comprehensive child development program designed to meet the educational, emotional, social, and health needs of children with special needs.
Learning Evaluations, Counseling (see Services below for local providers)
Assists with neuropsychological evaluations, consultation, therapy, and school-provider collaboration.
Recreation & Leisure
Many children with disabilities want to participate in leisure and sports activities. The need for adapted physical education and/or supports or social structuring on the playground should be included in the child's IEP. A physical therapy consultation can be helpful either in the school situation or for home adaptations (e.g., the child who wants a bike for a present but the parents don't know what to purchase, or the child is interested in obtaining a sporting wheelchair).
Community-based athletic programs are an option for many children if the family, child, and program are given adequate support. Not only can athletic activities enhance psychological health, but, as the child grows, they can help counter a drop off in gross motor function in part due to de-conditioning. Success depends upon the appropriate choice of activities, adapted equipment, adapted rules for the special needs child when appropriate, and support from peers, other parents, and coaches. Recreational Activities for CSHCN 2008 (

Transitions
If necessary, guardianship needs to be applied for. This can be a lengthy process including psychological and medical evaluations of the child and the involvement of a lawyer with expertise in this area. Guardianship should be applied for before the child reaches 18 years of age. In some states, children become eligible for Medicaid based on their own financial resources and ability to work at age 18 and may qualify for resources with the Division of Services for People with Disabilities (DSPD) they might have been ineligible for (based on family income) before their 18th birthday. Resources that provide helpful information and tools for planning transitions include:
- Guardianship/Estate Planning - The basics of obtaining guardianship and estate planning.
- Special Needs Trusts - Information and resources for planning for the financial security of a child with special needs.
- Navigating Transitions with Your Child - Information about many aspects of transition including guardianship, living arrangements, and more.
-
Age specific activities to support transition to adulthood (
27 KB) - Eleven age-related steps to planning for transition to adulthood.
Complementary & Alternative Medicine
Issues Related to Cerebral Palsy
Constipation
Gastroesophageal Reflux Disease
Osteoporosis and Pathologic Fractures
Formula Funding
Clinical Assessment
Slowly Progressive Disorders Sometimes Misdiagnosed as CPComplementary & Alternative Medicine
Alternative/Complementary Therapies (general information)Development (general)
Augmentative CommunicationEyes/Vision
Visual ImpairmentFunding & Access to Care
Appealing Funding DenialsGenito-Urinary
Neurogenic BladderLearning/Education/Schools
Inclusion ModelsMaturation/Sexual/Reproductive
Puberty in Children with CP and other Chronic ConditionsMobility/Function/ADLs/Adaptive
Adaptive SeatingBasic Augmentative and Alternative Communication (AAC) Device Characteristics
Neurology
Hydrocephalus and VP ShuntsNutrition/Growth/Bone
Feeding Tube IssuesNutrition and Growth in Children with CP
Osteoporosis and Antiepileptic Medications
Power Packing
Thickening Liquids & Pureeing Foods
Recreation & Leisure
Adapted Athletic ProgramsRespiratory
Aspiration/Chronic Lung DiseaseAsk the Specialist
My child has a diagnosis of cerebral palsy, and his legs are continued to get stiffer despite braces. I thought that cerebral palsy wasn't progressive?
Although certain symptoms of cerebral palsy such as contractures and stiffness tend to worsen over time, the brain lesion responsible for these symptoms does not progress. Children with cerebral palsy are able to make developmental improvements over time, although in very involved children these improvements may be very slow. If you think that your child is regressing in his abilities, this is important information for your physician to know as it is possible that the diagnosis of cerebral palsy is not correct.
I have one child who was born with cerebral palsy and now I am thinking of getting pregnant again. What are the chances that my next child will have cerebral palsy?
The answer to this question is complicated and depends entirely on why your first child has cerebral palsy. Genetic conditions that may cause cerebral palsy may be inherited and lead to an increased risk for CP in subsequent children whereas environmental causes for CP are often very unlikely to happen again. Ask your provider who may refer you to a specialist such as a neurologist or geneticist for answers to this question. Also, it might be appropriate to consult with a perinatologist or high risk obstetrician prior to your next pregnancy.
Does my child with CP have a normal life expectancy?
The answer to this question depends on the type of cerebral palsy your child has and any related complications. Generally, children with more involved CP such as spastic quadriparesis may have shortened life expectancies, as children who are nonmobile and have difficulty eating by mouth by themselves are subject to illnesses such as pneumonia, although many live far into mid and late adulthood. Children with mild CP might be expected to have normal life spans. Because the answer to this question is specific to the child, ask your provider. There are many resources for parents of children with serious illness, for instance, see Partnership for Parents.
Will hyperbaric oxygen help my child with CP?
There are many alternative therapies without proven medical benefit by controlled scientific studies that are offered to families of children with disabilities. As these therapies are often quite expensive, families should research potential benefits and discuss these therapies with their medical home before embarking on any unproven and in some cases, potentially harmful, therapies. The US Dept Health & Human Services Report on Efficacy of Hyperbaric Oxygen Therapy contains conclusions for use of hyperbaric oxygen for children with CP.
Resources for Clinicians
On the Web
Information on Spasticity, Choreoathetosis, and Other Movement Disorders
Information about movement disorders including ataxia, bradykinesia, chorea and choreoathetosis, clonus, dystonia, myoclonus,
restless legs syndrome, rigidity, spasticity, tics and tremor; International Parkinson and Movement Disorder Society
Developmental Behavioral Pediatric Update Course (dbpeds.org)
Slides from lectures given at the DBPeds Prep Course, 2008, with various links, including genetic cases, learning disabilities,
sleep disorders, and others.
Cerebral Palsy Information Page (NINDS)
Information about cerebral palsy that includes latest research; National Institute of Neurological Disorders and Stroke.
Helpful Articles
PubMed Search on cerebral palsy: review articles for the last 2 years
Deon LL, Gaebler-Spira D.
Assessment and treatment of movement disorders in children with cerebral palsy.
Orthop Clin North Am.
2010;41(4):507-17.
PubMed abstract
Helpful information on distinguishing spasticity, rigidity, and dystonia in children with cerebral palsy.
Medline Plus.
Cerebral palsy.
National Institutes of Health; (2014)
http://medlineplus.nlm.nih.gov/medlineplus/cerebralpalsy.html. Accessed on June 2014.
Information regarding the care of a child with CP, including links to many other sources of information.
Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, Stumbles E, Wilson SA, Goldsmith S.
A systematic review of interventions for children with cerebral palsy: state of the evidence.
Dev Med Child Neurol.
2013;55(10):885-910.
PubMed abstract
Describes systematically the best available intervention evidence for children with cerebral palsy.
Clinical Tools
Assessment Tools/Scales
Musculoskeletal Exam for Common Orthopedic Complications of CP and SCI (MHP) ( 239 KB)
A concise, easy-to-use tool to document the limitations of a child's musculoskeletal abilities and exam; Medical Home Portal.
Other
Ten Toy Tips ( 6 KB)
Questions to ask when choosing developmentally appropriate toys for differently-abled kids.
National Lekotek Center
An organization promoting play and toys for children with special healthcare needs. These centers offer a toy lending library,
computer play, family play, and other programs.
Toys for Differently Abled Kids (Toys R Us)
A yearly catalog of toys for children with special needs sorted by type (gross motor, fine motor, communication, etc.).
Specialneedstoys.com
A great source for adapted toys, including sensory toys for every occasion, and specials on certain items.
Resources for Patients & Families
Information on the Web
CP Information (MedlinePlus)
Basic information and links to many additional sources of reliable information; sponsored by the National Library of Medicine.
Resource list, Autism Council of Utah
A list of extensive local resources is available on this web site.
The National Lekotek Center
A nonprofit organization dedicated to making play accessible for children with disabilities.
Cerebral Palsy Guidance
A website offering guidance and assistance to parents of a child with cerebral palsy. Topics include Cerebral Palsy, Financial
Assistance, Living with Cerebral Palsy.
National & Local Support
Cerebral Palsy Support Groups (Children's Disability Information)
A list of support groups for different types of CP and other resources
United Cerebral Palsy
National non-profit organization that provides information on a variety of topics including advocacy, conferences, insurance,
sexuality, policy, and other items for the public and providers.
Services for Patients & Families in Idaho
Bone Densitometry/DEXA
We currently have no Bone Densitometry/DEXA service providers listed; search our Services database for related services.
Developmental - Behavioral Pediatrics
See all Developmental - Behavioral Pediatrics services providers (2) in our database.
Developmental Pediatrics
We currently have no Developmental Pediatrics service providers listed; search our Services database for related services.
Early Intervention for Children with Disabilities/Delays
See all Early Intervention for Children with Disabilities/Delays services providers (150) in our database.
Gynecology (Ped/Adol, Special Needs)
See all Gynecology (Ped/Adol, Special Needs) services providers (2) in our database.
Head Start/Early Head Start
See all Head Start/Early Head Start services providers (70) in our database.
Learning Evaluations, Counseling
See all Learning Evaluations, Counseling services providers (114) in our database.
Neuropsychiatry/Neuropsychology
See all Neuropsychiatry/Neuropsychology services providers (3) in our database.
Nutrition Assessment Services
See all Nutrition Assessment Services services providers (104) in our database.
Pediatric Gastroenterology
See all Pediatric Gastroenterology services providers (2) in our database.
Pediatric Physical Medicine & Rehabilitation
We currently have no Pediatric Physical Medicine & Rehabilitation service providers listed; search our Services database for related services.
Public Special Schools
We currently have no Public Special Schools service providers listed; search our Services database for related services.
Sleep Studies/Polysomnography
See all Sleep Studies/Polysomnography services providers (8) in our database.
For other services related to this condition, browse our Services categories or search our database.
Bibliography
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Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of
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Assessment and treatment of movement disorders in children with cerebral palsy.
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