Cerebral Palsy Assessment and Management

Essential Components of the Physical Examination

The American Academy of Pediatrics recommends systematically assessing motor function, tone abnormalities, topographical distribution, and associated impairments using standardized neurological and functional assessments to accurately characterize the motor subtype, severity, and comorbidities in patients with cerebral palsy 1
The assessment of topographical distribution is critical to document the anatomical pattern of involvement, with patterns including unilateral/hemiplegia (38%), bilateral diplegia (37%), and quadriplegia (24%) 2, 3, 4
The Gross Motor Function Classification System (GMFCS) should be used to standardize severity, with levels ranging from I (walks without limitations) to V (transported in manual wheelchair) 3, 6

Systematic screening for common comorbidities is recommended, including vision (11% affected), hearing (4% affected), speech and communication, cognitive function (49% have intellectual disability), seizure activity (35% have epilepsy), and feeding and swallowing difficulties 1, 3, 4
The assessment of musculoskeletal complications, including hip displacement (28% develop hip displacement), scoliosis, and limb deformities, is essential 1, 4

Measuring and plotting length/height, weight, and occipitofrontal circumference (head circumference) is crucial, as many children with cerebral palsy have growth impairment requiring nutritional intervention 1, 4
Inspecting for pressure areas or skin breakdown, evidence of injury or bruising, and skin color and perfusion is also important 2, 4

Never assume symptoms are static, as cerebral palsy is defined as non-progressive, and any acute neurological deterioration requires urgent neuroimaging to exclude stroke, hemorrhage, spinal cord compression, or hydrocephalus 5
The absence of spasticity does not exclude cerebral palsy, as motor types can evolve during the first 2 years of life, and some children have dyskinetic or ataxic forms without spasticity 6
Screening for pain is essential, as 75% of individuals with cerebral palsy experience chronic pain, which may manifest as irritability, sleep disturbance, or behavioral changes 1