Define Cerebral Palsy. Describe its aetiology, classification, clinical features and investigations.

Definition

• Cerebral palsy (CP) is a group of permanent, non-progressive disorders of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances in the developing brain (occurring before, during, or in the first 2–3 years after birth).
• Although the brain lesion is static, the clinical picture may change as the child grows.

Etiology

• Prenatal (commonest overall) — congenital infections (torch), brain malformations, prematurity.
• Perinatal — birth asphyxia (HIE), prematurity/low birth weight, kernicterus.
• Postnatal — meningitis/encephalitis, head trauma, hypoglycaemia, severe hyperbilirubinaemia, intracranial haemorrhage.

Classification (BY Type of Motor Disorder)

Clinical Features

• Delayed motor milestones and abnormal tone (spasticity or, early on, hypotonia).
• Persistence of primitive reflexes beyond the expected age, and delayed postural reflexes.
• Abnormal posture and movement patterns; early hand preference (before 1 year) in hemiplegia.
• Feeding difficulties, drooling and, later, contractures/deformities.

Associated Problems (must Be Actively Sought)

• Intellectual disability and learning difficulties; epilepsy.
• Visual and hearing impairment; speech and language problems.
• Feeding/swallowing difficulties and malnutrition; behavioural problems; constipation.

Diagnosis & Investigations

• Primarily a clinical diagnosis based on the history and neurological examination over time.
• MRI brain — to identify the underlying lesion/aetiology.
• Assess the associated problems — vision, hearing, EEG (if seizures), and developmental/cognitive evaluation.

Management (multidisciplinary)

• Physiotherapy, occupational therapy and speech therapy to maximise function.
• Spasticity management — orthoses, oral baclofen, botulinum toxin, and orthopaedic surgery for contractures.
• Treat associated conditions — epilepsy, feeding (may need gastrostomy), vision/hearing, and nutrition.
• Family support and education, assistive devices, and inclusive schooling; long-term, goal-directed care.

Prevention

• Good antenatal and perinatal care, skilled birth attendance and neonatal resuscitation.
• Prevention/prompt treatment of neonatal jaundice, hypoglycaemia, infections and birth asphyxia.

Early Warning Signs (helping Earlier Diagnosis)

• Delayed motor milestones and abnormal tone (early hypotonia or evolving spasticity).
• Persistent primitive reflexes, fisting beyond 3 months, and early hand preference (< 1 year).
• Feeding difficulties, irritability and abnormal postures.

Functional Classification (GMFCS)

The Gross Motor Function Classification System (GMFCS, levels I–V) grades mobility from independent walking (I) to fully dependent (V), and is used to plan management and predict function.

Differential Diagnosis

• Progressive/degenerative neurological disorders — CP is non-progressive, so a child who is losing skills needs a workup for a metabolic/neurodegenerative disease.
• Spinal cord lesions, muscular dystrophies and hereditary neuropathies.

Orthopaedic & Spasticity Care

• Prevent and treat contractures and hip subluxation (regular monitoring).
• Options — physiotherapy, orthoses, oral baclofen, botulinum toxin, intrathecal baclofen, and orthopaedic/selective dorsal rhizotomy surgery.

Nutrition & General Care

• Feeding/swallowing difficulties are common — assess nutrition; a gastrostomy may be needed for safe feeding.
• Manage drooling, constipation, dental care, and sleep; prevent aspiration.

Role of the Family & Community

• The family is central to therapy — home exercises, positioning, and use of aids.
• Community-based rehabilitation, inclusive education, disability support and realistic goal-setting all improve participation and quality of life.

Multidisciplinary Team

• Paediatrician, physiotherapist, occupational and speech therapists, orthopaedic surgeon.
• Ophthalmologist, audiologist, dietitian, psychologist, special educator and social worker.
• Coordinated, goal-directed care around the child and family.