Cerebral Palsy Diagnosis
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Testing for cerebral palsy is never a simple undertaking, but if you understand beforehand what to expect and prepare yourself for the fact that your child may undergo a series of tests and exams, the process will be a bit easier on all of you.
How is Cerebral Palsy Diagnosed?
Although there isn’t one single exam or test that can confirm cerebral palsy, a series of observations, screenings, and tests over the first months to years of life will be used to make a diagnosis. Testing can include physical examination, measuring growth, developmental screening and monitoring, brain imaging, and ruling out other conditions.
In some instances, cerebral palsy symptoms are severe enough that a physician will make the diagnosis shortly after birth. In any case, early diagnosis is vital as the sooner intervention and treatment begin, the more they can impact the child’s ongoing quality of life.
All infants receive an APGAR (activity, pulse, grimace, appearance, and respiration) score at birth. This gives a measurement of the infant’s status and prognosis in the first 5 minutes of life. If there are problems with breathing, circulation, or neurologic function, the APGAR score will be low, indicating that further evaluation should be considered.
There are examinations and tests performed in the first few days after birth that help uncover disorders early in life so they can be treated. For example, all states in the U.S. routinely screen newborns with a blood test checking for diseases such as sickle cell anemia, PKU (phenylketonuria), hypothyroidism, and galactosemia. Other types of screening may include hearing and tests of cardiac and respiratory function.
Although these screenings will not diagnose cerebral palsy, they are a significant step in determining if further tests are needed to diagnose other medical conditions, some of which may be associated with cerebral palsy.
Developmental screenings are performed at all well baby visits to determine if the child is growing and developing appropriately and evaluate for any delays. These include a review of milestones, the development of skills such as using the hands and sitting up, along with the making of sounds and response to language. At 6 to 9 months of age, abnormalities in an infant’s movements and the meeting of milestones are noticed more readily. This is due to the increased complexity of skills expected as the child grows. Cerebral palsy may be suspected at this stage, but physicians generally refer to specialists and run additional tests to make the diagnosis.
These developmental screenings are critical so your child’s physician can refer, diagnose, and begin interventions as soon as possible. Early intervention services are available in most states to assist both children and families. Interventions include speech therapy, physical therapy, occupational therapy, assistive technology, nutritional counseling, and family training.
Specific testing is more conclusive than screenings. It can assist physicians in diagnosing cerebral palsy and rule out other conditions. As mentioned earlier, there is no single test to diagnose cerebral palsy, but if a doctor suspects the disorder, a series of evaluations will be conducted.
The most common studies ordered when considering a diagnosis of cerebral palsy include:
Cranial ultrasound is a type of neuroimaging test used in infants to capture images of the brain via soundwaves. Cranial ultrasound is a preferable method in the first month of life, as it is the least invasive of the neuroimaging techniques.
Cranial ultrasound uses reflected sound waves to create pictures of the brain and the inner chambers. A radiologist performs the study by moving a transducer across the top of the baby’s head over the soft spot (fontanelle), and images of the brain and its inner fluid chambers are displayed on a monitor.
Aside from the gel feeling cool on the infant’s head when applied, there’s usually no discomfort involved in a cranial ultrasound, and the entire process only takes about 20 to 30 minutes.
Although cranial ultrasound is not used to diagnose cerebral palsy directly, the study can evaluate for other medical conditions that may impact neurologic status and lead to cerebral palsy, including brain hemorrhage and excessive fluid in the brain.
A CAT scan or CT scan, short for computerized tomography, is a test involving a special X-ray machine that can be used to take pictures of the baby’s brain, skull, and vessels in the brain. The infant is placed into the scanner, which will then take the images. The process generally lasts around 10 to 15 minutes, or sometimes longer, depending on whether sedation is needed and how many images are being taken.
MRI (magnetic resonance imaging) is a type of neuroimaging that uses magnetic fields to take pictures of the infant’s brain and spine. MRI scans will look at the structures in more detail and generate more definitive results than ultrasound or CT.
The MRI scanner is a machine that uses a strong magnet. Like a CT scan, the baby’s head is placed into the scanner in order to take images of the brain. It’s safe and painless, but an MRI takes more time, and the infant has to be completely still during the scan. This is usually a difficult task for babies. Sedation is generally required to help babies remain calm and still during this more lengthy scan.
For more detailed information on imaging tests and cerebral palsy, refer to our article, Cerebral Palsy Imaging Tests.
Numerous other tests and evaluations that aid in the diagnosis of cerebral palsy, or associated conditions, may include:
- Blood tests to check for genetic and metabolic abnormalities
- Speech and language testing
- Hearing testing
- Vision testing
- Oral motor tests, including feeding and swallowing evaluations
- Neurological evaluations, including neuromuscular testing
- Tests of cognitive functioning
- Gait testing, which evaluates any problems with walking
- Physical and occupational therapy evaluations
What Happens After Diagnosis?
Once your child is diagnosed with cerebral palsy, medical professionals will begin considering the best treatment options while taking into consideration any associated conditions.
Generally, comprehensive treatment plans come from a group of medical professionals who work together to ensure your child gets the best combination of therapies. This group, which are often referred to as a patient care team, usually consists of a general or developmental pediatrician, nurse case manager, neurologist, counselor, dietitian, physical therapist, occupational therapist, speech/language therapist, orthopedic specialist, and more, depending on your child’s needs.
Importance of Early Screenings and Diagnosis
Keep in mind that getting proper routine screenings for your child is crucial. Not only will it help you understand your child’s health needs, but it will assist in obtaining a diagnosis, early intervention, and treatment.
Early screening and diagnosis can also help you secure benefits and compensation more quickly, which can significantly help with the medical costs for a child with cerebral palsy.
Remember, however, that a cerebral palsy diagnosis can take months to years. There may be a period of time during which your child is diagnosed with developmental delay, and a more specific diagnosis may come later. There are many elements that contribute to the diagnosis, so it usually takes time and repeated evaluations to rule out or confirm the condition. This is very often the case with neurodevelopmental disorders, in general. Aside from severe cases of cerebral palsy, which are typically diagnosed at birth, most diagnoses happen somewhere around two years of age.