Cerebral palsy in children: early diagnosis and rehabilitation

Premature birth (especially before 32 weeks), low birth weight, lack of oxygen at birth (hypoxic-ischemic encephalopathy), severe infection or seizures in the newborn period, brain hemorrhage, multiple pregnancy, severe jaundice. Babies in a high-risk group are followed by a neurologist even if there are no complaints.

• Muscles that are very stiff or very floppy; a baby who “stiffens” or “slips through” when you pick them up
• Not holding the head up at 4 months, not rolling over at 6 months, not sitting at 9 months
• One side of the body used less; one hand constantly in a fist (clenched fists on both sides are normal in the first months)
• Primitive reflexes that persist after 6 months
• A change in the quality of spontaneous movements (see below)
• Feeding difficulty, extreme irritability or sluggishness

According to the current international approach (JAMA Pediatrics, 2017), three tools are used together for early, accurate diagnosis:

1. General Movements Assessment (Prechtl GMA): observing the baby's spontaneous movements on video. The absence of “fidgety” movements at 3–5 months has high predictive value for later CP — in a systematic review, sensitivity was 97% and specificity 89%.
2. Hammersmith Infant Neurological Examination (HINE): a standard scored exam for ages 2–24 months; it plays an important role in diagnosis and prognosis, and the scores help predict the type and severity of CP.
3. Brain MRI: shows the location and nature of the injury.

For premature babies, among the assessments performed up to 4 months, the Prechtl general movements method has the best predictive value. If the diagnosis cannot be made with certainty, intervention begins with a note of “high risk of CP” — not waiting.

Spastic (the most common; one side — hemiplegia, the legs — diplegia, the whole body — quadriplegia), dyskinetic (involuntary movements), ataxic (balance and coordination) and mixed. Motor function is classified on the international GMFCS scale from level I to V; this makes the plan and expectations concrete.

Rehabilitation starts early and favors goal-directed activities built around the child's daily life: physical therapy, occupational therapy and, when needed, speech-language therapy. For spasticity: medication and, when indicated, botulinum toxin injections; orthoses; orthopedic monitoring (watching the hip joint). Related conditions — epilepsy, feeding and swallowing difficulties, constipation, vision and hearing, pain, sleep — are part of the overall plan and affect quality of life as much as movement does.