![]() ![]() Infants whose prenatal, perinatal, or postnatal histories containcertain risk factors merit close developmental follow-up and especiallythorough developmental and neurologic examination at regular intervals.The premature infant-prematurity is still the number one riskfactor for cerebral palsy-and the full-term infant who has sustainedperinatal asphyxia both should raise red warning flags in yourmind. A more rational approach is to confront the child'sdevelopmental problems as they arise, even though they may notbe completely expressed. Moreover, delaying physical therapy until thechild's spasticity is well established can both reduce the eventualphysiologic benefit of treatment and impair the child's emotionalresponses to it. Unless we acknowledge that one ofour primary roles as physicians is to manage, even if not usuallycure, children with complex disabilities and to provide supportto their families, our patients will not receive the comprehensivecare they require.īefore discussing the diagnostic process, a caveat about treatmentis in order: Don't succumb to the misconception that therapeuticefforts cannot begin until you have made a conclusive diagnosis.Too-strict adherence to the medical disease model may preventyou from recommending functional interventions that are possibleduring infancy. Consequently, some physicians still think that littlecan be done for a child who has cerebral palsy and that earlydiagnosis is of little value. Unfortunately, medical training programs and critical reviewsof the effectiveness of early intervention often have underemphasizedthe benefits. Early interventionthus benefits both the child and the family. Their distress and concern deserve prompt attention.A diagnosis of cerebral palsy, however dismaying, at least shedslight on the reasons their infant has been so "difficult"and lets them plan for long-term treatment. Professionalswho work closely with children who have cerebral palsy generallyagree that the largest gains are obtained if intervention startsduring infancy, even though many questions about the long-termresults of physical therapy remain unanswered.įurthermore, the parents of an infant who is developing signsof cerebral palsy often encounter difficulties and frustrationsrelated to the feeding, handling, sleeping, and temperament ofthe infant. Why stress the earliest possible identification of cerebralpalsy? The primary reason is so that treatment-which means primarilyphysical therapy-can begin as soon as possible. The average ageat diagnosis of spastic diplegia-one of the most common typesof cerebral palsy-is around 18 months, and many mildly affectedchildren remain undiagnosed until their preschool years. This goal often goesunrealized throughout the United States today. In recent years, physicians, therapists, and others who workwith children who have cerebral palsy have made ever-strongerpleas for early diagnosis of the disorder. To that end, it presents some useful assessmentstrategies and clues to assist in making the diagnosis and differentiatingthe two major types of cerebral palsy-spastic (pyramidal) andextrapyramidal. The main purpose of this article is to persuade the primarycare physician of the importance of diagnosing cerebral palsyearly-during the first year of life or, in severe cases, duringthe first six months. 1,2 Because signs and symptomsof the original brain injury change as the brain grows and develops,we also define cerebral palsy as a static encephalopathy witha developmental presentation. Cerebral palsy is thus a clinical syndrome with numerousspecific etiologies. Such injurymay result from an extrinsic brain insult (hypoxic-ischemic, traumatic,infectious, toxic) or an intrinsic developmental defect that occursduring the period of brain growth and maturation extending fromthe prenatal period through approximately three to five yearsafter birth. ![]() ![]() Cerebral palsy is a nonprogressive disorder of movement andposture that is caused by brain damage or defect.
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