Approach to Congenital Hemiparesis

Introduction to Management

The American Academy of Pediatrics recommends immediate comprehensive neurological evaluation with MRI brain, followed by early intensive task-specific motor interventions and orthotic management for foot drop, as early intervention before age 2 optimizes neuroplasticity and functional outcomes 1

The Hammersmith Infant Neurological Examination (HINE) should be used to assess severity in children under 2 years 3
Hand asymmetry is an early observable sign of unilateral cerebral palsy, with reduced or neurologically abnormal voluntary movements and functional abilities such as sitting, grasping, and reaching for toys 4

Constraint-Induced Movement Therapy (CIMT) or Bimanual Training should be started immediately, with the goal of improving hand function and mobility 1
The American Academy of Pediatrics suggests that children learn best in natural settings with personalized, enjoyable training, and that task-specific motor training at home (GAME) can produce better motor and cognitive skills at 1 year compared to usual care 1

Ankle-foot orthosis (AFO) should be prescribed immediately for foot drop, with the goal of improving gait mechanics, preventing contractures, and enhancing mobility 5

Hip surveillance with anteroposterior pelvic radiographs every 6-12 months should be performed to prevent hip displacement, which occurs in 1 in 3 children with cerebral palsy 1
Regular PT/OT for range of motion exercises and contracture prevention, as well as scoliosis monitoring, should be performed to prevent secondary complications 1
The American Academy of Pediatrics recommends that chronic pain, present in 75% of children with CP, should be addressed proactively, and that pharmacological options such as acetaminophen or ibuprofen can be used for musculoskeletal pain 1, 8

Immediate counseling and goal-setting with parents should be performed to reduce depression and anger, and to involve parents in setting functional goals at intervention start 1, 2
The American Academy of Pediatrics suggests that parental mental health should be screened, as prolonged diagnostic uncertainty increases depression risk, and that attachment support and parent-infant interactions can help build parent-infant attachment 1, 2