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The signs of cerebral palsy usually appear before 3 years of age, so that parents often are the first to suspect that their infant is not developing normal motor skills. Frequently, infants with cerebral palsy are slow to reach developmental milestones, such as learning to roll over, sit, crawl, smile, or walk. Sometimes this is called developmental delay.
Some affected children have abnormal muscle tone. Decreased muscle tone is called hypotonia and caused a baby to seem flaccid and relaxed, even floppy. Increased muscle tone is called hypertonia and causes the child to seem stiff or rigid. In some cases, a newborn baby has an early period of hypotonia that progresses to hypertonia after 2 to 3 months. Affected children also may have unusual posture or favor one side of the body.
Parents who are concerned about their baby's development for any reason should contact their physician, who can help distinguish normal variations in development from a developmental disorder.
Doctors diagnose cerebral palsy by testing an infant's motor skills and looking carefully at the infant's medical history. In addition to checking for the symptoms described above -- slow development, abnormal muscle tone, and unusual posture -- a physician also tests the infant's reflexes and looks for early development of hand preference.
Reflexes are movements that the body makes automatically in response to a specific cue. For example, if a newborn baby is held on its back and tilted so the legs are above its head, the baby will automatically extend its arms in a gesture, called the Moro reflex, that looks like an embrace. Babies normally lose this reflex after the age of 6 months. However, those with cerebral palsy may retain it for much longer. This is just one of several reflexes that a physician may check.
Doctors also look for hand preference -- a tendency to use either the right or left hand more often. When the doctor holds an object in front and to the side of the infant, a child with hand preference will use the favored hand to reach for the object, even when the object is closer to the opposite hand. During the first 12 months of life, babies do not usually show hand preference. But infants with spastic hemiplegia, may develop a preference much earlier, because the hand on the unaffected side of the body is stronger and more useful.
The next step in diagnosing cerebral palsy is ruling out the other disorders that may cause movement problems. Most importantly, doctors must determine that the child's condition is not getting worse. Although its symptoms may change over time, cerebral palsy by definition is not progressive. If a child is continuously losing motor skills, the problem is more likely to spring from other problems, like genetic diseases, muscle diseases, metabolism disorders, or tumors in the nervous system. The child's medical history, special diagnostic tests, and, in some cases, repeated check-ups can help a physician determine whether or not disorders are at fault.
The doctor may also order special tests to learn more about the possible cause of cerebral palsy in an individual child. One test is computed tomography, or CT, which is a sophisticated imaging technique that uses x-rays and a computer to create an anatomical picture of the brain tissues and structures. A CT scan may reveal brain areas that are underdeveloped, abnormal cysts (sacs often filled with liquid) in the brain, or other physical problems. With the information from CT scans, doctors may be better equipped to judge the long-term outlook for an affected child.
Magnetic resonance imaging, or MRI, is a brain imaging technique used to identify brain disorders. This technique uses a magnetic field and radio waves, rather than x-rays. An MRI gives better pictures of structures or abnormal areas located near bone than a CT scan.
Another test that exposes problems in brain tissue is ultrasonography, or ultrasound. This technique bounces sound waves off the brain and uses the pattern of echoes to form a picture, or sonogram, of its structures. Ultrasonography can be used with infants before the bones of the skull harden and close. Although it is less precise than CT and MRI scans, this test can detect cysts and structures in the brain, is less expensive, and does not require long periods of immobility.
If the doctor suspects a seizure disorder, he or she may order an electroencephalogram, or EEG. During this test, special patches called electrodes are placed on the scalp and will record the natural electrical currents inside the brain. The recording can help the doctor see patterns in the brain's electrical activity which suggest a seizure disorder.
Intelligence tests are often used to determine if a child with cerebral palsy is mentally impaired. However, some children's intelligence may be underestimated because problems with movement, sensation, or speech due to cerebral palsy make it difficult for them to perform well on these tests.
Physicians will look for other conditions linked to cerebral palsy, including seizure disorders, mental impairment, and vision or hearing problems.
For potential vision problems, the doctor may recommend an examination by an ophthalmologist. If the treating physician suspects a hearing impairment, he or she may refer the patient to an otologist.
Identifying these accompanying conditions is important and is becoming more accurate as ongoing research yields advances that make diagnosis easier. Specific treatments may address many of these conditions, to improve the long-term outlook for those with cerebral palsy.
If your child or grandchild has been diagnosed with cerebral palsy that you believe may have been caused by a doctor or hospital's mistake, talk with a lawyer experienced in cerebral palsy law. Submit a simple, free and confidential legal consultation form today.
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