Preparing for your appointment
While you might first discuss your child's symptoms with your family
doctor, he or she will probably refer you to a neurologist for further
evaluation.
What you can do
Because appointments can be brief, plan ahead and write a list that
includes:
Detailed descriptions of your child's symptoms
Questions you want to ask the doctor
What to expect from your doctor
In addition to a physical exam, your doctor may also check your
child's neurological health by testing his or her:
Reflexes
Muscle strength
Muscle tone
Senses of touch and sight
Coordination
Balance Your child may also be screened for:
Mental retardation
Vision problems
Hearing impairment
Speech and language disorders
Tests and diagnosis
Early signs of cerebral palsy may be present from birth. But if signs
and symptomsare mild, it may be difficult to make a definite diagnosis
before the age of 4 or 5. In most cases, cerebral palsy is diagnosed by
age 1 or 2.Diagnostic tests may include:
Brain scans
If your baby is born prematurely and is at high risk of cerebral palsy,
your doctor may suggest a cranial ultrasound because it is the least
intrusive of the imaging techniques used to visualize the brain. Cranial
ultrasound, however, provides a less detailed image than does a CT
scan or an MRI. An MRI reveals the most details, which help
determine a cause and a prognosis.
Cranial ultrasound.
This test uses high frequency sound waves to obtainimages of the soft
tissues inside the skull. Cranial ultrasound is painless andtakes
between 15 and 30 minutes to complete.
CT scan.
This test uses a computer to combine X-ray images taken from
manydifferent angles to produce cross-sectional views of your child's
brain.
Scanning is painless and takes about 30 minutes. If your child can't
hold still for the scanning, he or she may be given a light sedative.
MRI.
Using radio waves and a powerful magnet, an MRI can produce
detailedimages of the brain. This test is painless, but it is noisy and
can take up to anhour to complete. If your child can't hold still long
enough for this test, he or she may be given a sedative.
Electroencephalogram (EEG)
If your child has had seizures, your doctor may recommend an
electroencephalogram(EEG) to check for epilepsy. In an EEG test, a
series of electrodes must be affixed toyour child's scalp. The
procedure is painless and records the electrical activity insideyour
child's brain.
Lab tests
Your child's blood may need to be checked to help rule out other
conditions — suchas blood-clotting disorders that can cause strokes —
that may mimic cerebral palsysigns and symptoms. Lab tests may also
screen for genetic or metabolic problems.
Treatments and drugs
The brain abnormality or damage that underlies cerebral palsy doesn't
worsen withtime, but children with cerebral palsy often require long
term care. The type andamount of treatment depend on how many
problems your child has and how severethey are.
Medications
Muscle relaxants.
Oral medications — such as diazepam, baclofen,dantrolene and
tizanidine — are usually the first option to relax stiff,contracted
muscles. Side effects may include drowsiness and upset
stomach.Baclofen can also be delivered directly to the fluid
surrounding the spinal cordvia a pump surgically implanted into the
abdomen.
Botulinum toxin type A (Botox).
Injections of botulinum toxin directly intospastic muscles also can
help relieve the muscle spasms and contracturescommon to cerebral
palsy. However, these injections have, in rare instances,caused serious
problems with swallowing and breathing, particularly inchildren with
cerebral palsy.
Therapies
Physical therapy.
Muscle training and exercises may help your child'sstrength,
flexibility, balance, motor development and mobility. Braces or splints
may be recommended for your child. Some of these supports are
usedto help with function, such as improved walking. Others may
stretch stiff muscles to help prevent contractures.
Occupational therapy.
Using alternative strategies and adaptive equipment,occupational
therapists work to promote your child's independent participationin
daily activities and routines in the home, school and community. They
mayalso address difficulties with feeding and swallowing.
Speech therapy.
Speech therapists help improve your child's ability to speak clearly or
to communicate using sign language. They can also teach your childto
use special communication devices — such as a board covered with
picturesof everyday items and activities. Sentences can be constructed
by pointing tothe pictures.
Surgical or other procedures
Orthopedic.
Children with severe contractures or deformities may need surgery on
tendons, bones or joints to place their arms and legs in their
correct positions. This can make it easier to use a walker, braces or
crutches.
Severing nerves.
In some severe cases, when other treatments haven't helped,surgeons
may cut the nerves serving the spastic muscles. This relaxes the
muscle and reduces pain, but can also cause numbness.
Coping and support
When a child is diagnosed with a disabling condition, the whole
family faces new challenges. Here are a few tips for caring for your
child and yourself:
Foster your child's independence.
Encourage any effort at independence, no matter how small. Just
because you can do something faster and quicker doesn't mean you
should.
Be an advocate for your child.
You are an important part of your child'shealth care team. Don't be
afraid to speak out on your child's behalf or to ask tough questions of
your physicians, therapists and teachers.
Find support.
A circle of support can make a big difference in helping you cope with
cerebral palsy and its effects. As a parent, you may feel grief and guilt
over your child's disability. Your doctor can help you locate support
groups, organizations and counseling services in your community.
Your child may benefit from family support programs, school
programs and counseling.
Prevention
Most cases of cerebral palsy can't be prevented, despite the best efforts
of parents and doctors. But, if you're pregnant, you can take these
steps to keep healthy and minimize the possibility of pregnancy
complications:
Make sure you're immunized.
Immunization against diseases such as rubella may prevent an
infection that could cause fetal brain damage.
Take care of yourself.
The healthier you are heading into a pregnancy, the less likely you'll
be to develop an infection that may result in cerebral palsy.
Seek early and continuous prenatal care.
Regular visits to your doctor during your pregnancy are a good way to
reduce health risks to you and your unborn baby. Seeing your doctor
regularly can help prevent premature birth,low birth weight and
infections.
