Diagnosis of Cerebral Palsy
The first person to notice signs of Cerebral palsy are often the parents. Since Cerebral Palsy is a form of brain damage, most of the symptoms will not occur until the child reaches an age where he or she is beginning to crawl, talk, and play. Of course, those parents who meet the above mentioned risk factors, and have been told their children is at higher risk, are more likely to notice these signs earlier. During the early stages of development, parents may notice a variety of atypical signs that their child is experiencing some developmental challenges. Some very early signs may include:
- Diminished alertness and activity
- Atypical reflexes
- A low level trembling or shaking of the arms and legs
- Abnormal posture
- Excessive irritability
- A strange cry that may take on a high pitch
The above signs may be so slight that a parent or doctor may just think that this is part of the infant’s personality. However, as the child develops, the signs may become more apparent, especially when a parent has the opportunity to compare their child’s behavior to those of other children. Between 4-6 months of age, the parents may notice some of the following behavioral and physical characteristics:
- A drastic and noticeable change in muscle tone from limp to extremely stiff
- A tendency for the child to maintain his or her hands in a rigid fist
- A tendency for the child to have trouble moving one side of the body
- Strange eating habits such as a tendency of the infant to expel food with their tongue
At 6 months of age, it probably will be quite obvious to a parent that their child is developing slower than other children. Milestones in a child’s life such as walking, talking, crawling, sitting up etc. will come much slower to the child with Cerebral palsy, leaving parents exasperated and worried. At this stage, doctors will probably be alerted to the possibility of Cerebral Palsy but will not make the diagnosis. Rather, they will most likely begin intensively monitoring the child. Before diagnosing Cerebral Palsy, they will seek to eliminate the possibility of a variety of other kinds of diseases and disorders that could be the source of the child’s developmental delay. They may look for symptoms of the following types of disorders:
- Genetic diseases
- Muscle diseases
- Metabolism disorders
- Tumors
In ruling out the above disorders, they will look for signs that the child symptoms are worsening. A worsening of the symptoms is a clear indication that the child is not suffering from Cerebral Palsy. Cerebra Palsy is not a progressive disease. This means that unlike some other diseases, the symptoms do not get worse. Rather, the brain damage done to the child is finite and will not increase with age.
Basic Tests
Before launching into expensive and physically restrictive testing, most doctors will put together an interdisciplinary team of health care professionals to test the basic functions of the child. This team will comb over every aspect of the child’s medical history and examine every single movement to look for signs of Cerebral Palsy or other disorders. Not only will they look at the many symptoms mentioned above, such as abnormal posture and unusual muscle tone, but will also carefully examine the child’s reflexes and look for signs of hand preference.
Reflexes: Children with Cerebral Palsy often exhibit atypical reflex behavior. Reflexes are basically automatic physical responses to cues. For example, a typical reflex is the automatic withdrawal of one’s hand from a hot stove. Children with Cerebral Palsy exhibit a persistence of primitive reflexes that disappear in other children. A typical example is the Moro reflex which most children lose after 6 months but may be exhibited by a child with Cerebral Palsy for a much longer period of time. The reflex can be stimulated by holding the infant on its back and tilting the infant until his legs are over his head. Once this occurs a newborn will extend its arms in a sort of embrace called the Moro reflex.
Hand Preference: Many infants with Cerebral Palsy will demonstrate a hand preference once they reach about 12 months or so. To test for this symptom, healthcare professionals will hold a toy to the side and in front of the infant to see whether the infant clearly reaches for it with the hand not closest to the toy. The symptom is especially prevalent in those with spastic hemiplegia whose Cerebral Palsy clearly effects only one side of the body.
Specialized Tests
As mentioned above, a child that reaches six months of age and has not reached most normal developmental milestones will be considered a candidate for having Cerebral Palsy. A doctor who suspects that a child has Cerebral Palsy will not rush to a diagnosis. Doctors with experience in childhood developmental disorders know that children’s nervous systems have amazing regeneration capacity. At the early stages of development, a child’s brain can repair itself, albeit slowly. As the child develops, parts of the brain that were undamaged may grow to compensate for those that were damaged. While some motor skills may be forever damaged, they may be minor and the child will otherwise be completely normal and healthy. Doctors will want to watch the child over a period of time, sometimes years, using specialized tests to measure progress. The below section describes some of the tests a doctor may use to aid diagnosis of Cerebral Palsy.
- Computed Tomography Scans (CT or CAT scan) – This sophisticated machine takes a series of detailed pictures of inside the body from different angles. It consists of a computer linked to an X-Ray machine. The CT scan may show cysts in the brain, undeveloped areas of the brain, and a variety of other conditions that can lead to Cerebral Palsy.
- Magnetic Resonance Imaging – This noninvasive and painless diagnostic tool takes pictures of internal soft body tissues such as the brain and spinal cord by using powerful magnets and radio waves. The MRI may show abnormalities in the brain of a child that the CT scan was unable to demonstrate.
- Ultrasonography – This procedure bounces high energy sound waves off of internal tissues or organs leading to an echo that forms a picture of the body tissues or organs. The procedure is especially useful on infants at a period where the bones of the skulls have not yet hardened and closed. While less useful and sophisticated than CT scans and MRIs, the procedure is fairly cheap, can detect cysts, produce fairly detailed images of the brain, and does not require immobility like the CT scan and MRI.
- Electroencephalogram (EEG) – Used to look for seizure disorders that may be the cause of the Cerebral Palsy like symptoms. This device uses patches containing electrodes that are placed on the child’s head to determine an imbalance of the electrical activity of the brain.
- Intelligence and aptitude tests – These tests are used to determine whether the child is experiencing mental impairment, and if so, the degree of that impairment. Sadly, many children will score low on these tests not due to mental impairment, but due to the fact that many of the physical symptoms of Cerebral Palsy prevent them from demonstrating their mental acuity.
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