Exams and Tests

Diagnosing cerebral palsy

Signs of cerebral palsy (CP) may not be present or detected at birth. A doctor may closely monitor a newborn or child for signs of CP if he or she has known risk factors. These factors may be related to problems during pregnancy or birth, being born early (premature birth), or problems that occur within the first 2 or 3 years of life.

Doctors use caution in diagnosing CP too early because some babies who have motor skill abnormalities soon after birth never develop CP.

Sometimes symptoms may not appear until the nervous system matures with the continual growth of the brain, nerves, and muscles. It can take up to a few years before doctors determine whether a baby with body movement and posture (motor) problems has CP.

Cerebral palsy is diagnosed based on observations of a baby's or young child's physical development delays or irregularities, medical history, a physical exam, screening tests, and other tests, such as MRI. Specifically, these tests include:

• Asking questions about the child's medical history, including details about the mother's pregnancy. Developmental delays are often reported by parents or observed by a doctor during routine well-baby checks. These visits are also an opportunity for doctors to watch your baby and ask details about his or her sensory and motor skills, especially those that are expected to occur during the first year or second year.
• A physical exam to look for signs of CP. During a physical exam, a doctor evaluates whether a child retains newborn reflexes longer than normal, which can be an indication of CP. Postures and basic muscle function, hearing, and vision are usually also assessed.
• Screening tests. Your doctor will recommend developmental questionnaires and other tests to help determine the extent of developmental delays and whether they should be further evaluated.
• Magnetic resonance imaging (MRI) of the head, which may be done to identify brain abnormalities.

Taken together, results of these tests can point toward a diagnosis of CP.⁶

If diagnosis is unclear, additional tests may be done to evaluate the brain and possibly rule out other conditions. Sometimes, results from these tests can also be useful in evaluating the severity of CP. Tests may include:

• Additional developmental questionnaires.
• Computed tomography (CT) scan of the head.
• Ultrasound of the brain.

Evaluating and monitoring cerebral palsy

After CP is diagnosed, a child will also be screened for other medical conditions that can occur with cerebral palsy, such as:

• Other developmental delays in addition to those that have already been identified. Developmental abilities will be assessed periodically to find out whether new symptoms, such as speech and language delay, appear as a child's nervous system matures.
• Intelligence testing, to identify below-normal intelligence (mental retardation).
• Seizures. An electroencephalography (EEG) is used to check for abnormal activity in the brain if a child has a history of seizures.
• Problems with feeding and swallowing.
• Vision or hearing problems.
• Psychological evaluation, for any behavioral problems.

Most of the time, a doctor can predict many of the long-term physical effects of CP when a child is between 1 and 3 years old. But sometimes such predictions are not possible until a child reaches school age when learning, communication skills, and other abilities can be measured. The amount of help and supervision needed depends on the number of problems and how bad the problems are.

Some children need repeated testing that may include:

• X-rays, to check for loose or dislocated hips. Children with CP are usually X-rayed several times between ages 2 and 5. A child will also have an X-ray any time he or she complains of hip pain or has other signs of dislocated hips, such as unusual leg or knee movements. Spinal X-rays also are done to look for curves in the child's spine (scoliosis).
• Gait analysis, which helps identify problems and guide treatment decisions.

Additional tests may be needed, depending on the child's symptoms or other conditions that are present.