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Approaches to early recognition and diagnosis

There has always been a strong desire to identify infants and young children with CP at an early age. Early intervention programs can support parents, and enhance the development of their children with CP. Clinical assessments like the Hammersmith Infant Neurological Examination, and the evaluation of ‘General Movements’ of infants at three months of age, can alert service providers to the probability that an infant may be impaired. Such ‘case detection’ can allow service providers both to offer ideas for handling a baby and for early intervention. Early recognition of the risk for, or the presence of, CP allows everyone involved with the baby to watch early development even more carefully that is usually done with typically-developing infants.

  • A broader approach to assessing early child development – one the requires experience and judgment – involves paying attention to both the ‘quantity’ of development (as considered with ‘milestones’), and the ‘quality’ of how an infant is performing (in this case performing motor tasks). Quantity is usually associated with ‘milestones’; these can be helpful as a guide to when children are expected to acquire a host of skills, e.g., rolling, sitting, pulling to stand, taking steps on their own, and so on. The challenge with milestones is that there is almost always a considerable range of variation in when things happen. (A powerful example is the reality that girls can start their monthly periods anywhere for 9-17 years!)
  • What do we mean by ‘quality’ of functioning?

    We may find an infant whose parent reports they are ‘…very strong, Doctor… s/he loves to stand with support (at 8-10 months)’. This apparent developmental skill may well reflect excessive tone in the extensor muscles, and be evidence of the ‘spasticity’ often found in children with CP. A child below the age of 3 who is ‘…left-handed just like his dad’ probably has a hemisyndrome that is limiting the function of the low-use arm (and probably the leg as well).

  • Of course, the people who know the infant best are the parents, and by both listening to their account of what their baby does, and how, and watching carefully, we can acquire considerable information for free. And clinicians must always take parents’ concern seriously – they are either ‘correct’ (that something is amiss) or worried about something. Either perspective deserves our attention.