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Key Takeaways: The Diagnostic Journey of Cerebral Palsy with Dr. Edward Hurvitz

March 14th, 2023  | News


March is Cerebral Palsy Awareness Month, and who better to break down this topic than Dr. Edward Hurvitz, a Physical Medicine & Rehabilitation Physician/Physiatrist at the University of Michigan? He recently joined Hope for HIE LIVE to discuss the diagnostic journey of cerebral palsy, the multiple pathways of care available to those with CP, and the integral role a PM&R plays throughout the patient’s life experience! 

Missed the live Q&A? Don’t sweat it! Like any trusty sidekick, we’ve gathered the key takeaways from the discussion so you don’t miss a beat.

Key Takeaway 1: Cerebral palsy has many types and levels of severity

When you simplify the term, cerebral means “involving the brain,” and palsy means “involving movement.” Depending on the area of the brain impacted, there are four main types of cerebral palsy, all with their own defining features of movement and motor function:

  • Spastic: affecting nearly 80% of patients, this is the most common type of cerebral palsy and is defined by stiff or tight muscles. 
  • Dyskinesia: also known as athetoid cerebral palsy, this type occurs in less than 10% of people with CP and is characterized by involuntary or uncontrollable movements. 
  • Ataxia: poor balance and incoordination characterize this type of CP, which is seen in less than 10% of CP patients. 
  • Mixed: some people have symptoms of more than one of the above types of cerebral palsy due to multiple injury points in the brain.

The movement types above affect a specific number of limbs, as well. This is where the following classifications come into play:

  • Monoplegia: affects one limb
  • Hemiplegia: affects two limbs on one side of the body [right-side hemiplegia affects the right arm and leg; left-side hemiplegia affects the left arm and leg].
  • Diplegia: affects two limbs [legs]
  • Triplegia: affects three limbs [1 arm and two legs]
  • Quadriplegia: affects four limbs

A Gross Motor Function Classification System [GMFCS] is a great way to visualize the various levels of severity. Consisting of 5 levels, it ranges from Level I, in which a child with CP can perform gross motor skills such as walking, running, or climbing without much [or any] assistance, to Level 5, in which the child has minimal mobility and uses a wheelchair in all settings.

Dr. Hurvitz says the GMFCS is just a description, and while it is good to know, it is not necessarily a disadvantage to not receive a rating on that scale. He assures that it is never too late to receive a rating, as it can improve the quality of conversations and clarity of information when speaking with your child’s medical team.

Key Takeaway 2: Not every child who experiences HIE develops cerebral palsy

HIE is not a guaranteed precursor of cerebral palsy; in fact, only about 40% of those experiencing HIE receive an official CP diagnosis. Looking at the whole picture, HIE is just one cause of cerebral palsy out of many and makes up 10-15% of all cases. Most cerebral palsy cases are caused by other types of brain injuries, like those associated with prematurity, brain bleeds, etc. 

Dr. Hurvitz made it a point to note that cerebral palsy does not always affect cognition and that most children with CP experience a lot of success in school and beyond! Building awareness and gaining access to trustworthy information is essential for refuting incorrect or hurtful stigmas of CP and improving levels of accessibility and inclusion in all settings!

Key Takeaway 3: Providers look out for these early signs and symptoms of CP

While cerebral palsy differs in type and severity from one person to the next and may change over time, providers typically look out for the following early signs and symptoms:

  • Poor or slow development of movement patterns
    Examples include a lack of muscle coordination, crawling on the belly instead of using the arms or legs, and/or a crouched or scissored gait. Monthly motor skill milestones, while not always a strict set of criteria to follow, are often used as guides to help parents and providers understand a typical range of development.
  • An increased or decreased muscle tone or level of spasticity
    Hypotonia, or a decreased muscle tone, can make babies appear floppy or relaxed. In contrast, hypertonia, an increased muscle tone, can make them appear stiff, rigid, or tense. Spasticity is often used interchangeably with hypertonia but is also associated with an exaggerated response or reflex [which just so happens to be common in a lot of babies.]
  • Potential difficulties with eye tracking, drooling, and/or swallowing

Key Takeaway 4: There are several pathways of care when it comes to receiving a CP diagnosis

Depending on accessibility and patterns of practice in your area, a pediatrician can refer your child to other providers for an official CP diagnosis and plan of care:

  • Pediatric Neurologist
    This is the most common referral, for pediatric neurologists can assist in assessing the child’s motor skills development and muscle tone. They can also administer an MRI, or brain-imaging scan, to ascertain the area of injury to the brain.
  • Physical Medicine & Rehabilitation Physician [PM&R] / Physiatrist
    There for the patient’s lifelong experience with cerebral palsy, a physiatrist can also diagnose CP and has the tools and resources needed to provide and recommend various therapies, medicines, and courses of treatment. 
  • Orthopedic Surgeon
    While they can assist with surgeries to help improve motor function in a patient’s joints or limbs, orthopedic surgeons can also provide a CP diagnosis.

No matter the pathway of care, Dr. Hurvitz explains that most cases of cerebral palsy are diagnosed by the time a child reaches 12-24 months. While rare, diagnoses can and do occur later in life and are often associated with more mild cases or a lack of access to brain-imaging devices and evaluative tests.

Key Takeaway 5: There are pros to receiving an early diagnosis of cerebral palsy

Simply put, an earlier diagnosis leads to more opportunities for early interventions. While cerebral palsy does not have a cure, therapeutic options can improve the child’s motor functioning and quality of life over time! There is no standard procedure of care, but most options involve one or more of the following:

  • Physical Therapy
    Physical therapists can assign specific exercises that maintain or improve muscle strength, motor skills, and balance.
  • Occupational Therapy
    Occupational therapists work on improving mobility and can help patients meet everyday motor needs.
  • Speech + Language Therapy
    Speech and language pathologists can help with communication and with problems associated with eating or drooling, especially if the patient has difficulty controlling the muscles of their mouth, jaw, or tongue. 

Key Takeaway 6: A PM&R Physician/ Physiatrist offers a wide range of support and services

Physiatrists can treat children with CP from diagnosis through the rest of their lives! Dr. Hurvitz likes to refer to them as quarterbacks, as they can play an integral role in creating an effective care plan for each patient. This plan covers a range of services:

  • Interventions and Treatments
    For instance, physiatrists can work with various therapists to establish exercises that improve long-term motor outcomes.
  • Mobility and Accessibility
    Physiatrists analyze all aspects of mobility: they work with you to decide what type of equipment best suits your child and which medicines, injections, surgeries, or alternative therapies can provide the most successful long-term outcomes.
  • Cognitive Performance
    Once at school age, a child with CP may benefit from an Individualized Education Plan. Physiatrists have experience coordinating with school personnel to create a plan emphasizing inclusion and accessibility in a classroom setting.
  • Mental Health and Behavior
    If needed, physiatrists also have experience working with psychologists or psychiatrists to improve behavioral and mental health outcomes, especially if a child with cerebral palsy develops anxiety, depression, or other illness.
  • Inclusion Opportunities
    Last but certainly not least, they can work to find local, inclusive opportunities in sports and other activities that encourage physical activity!

Key Takeaway 7: Many treatments are available to improve mobility and quality of life

While there is no cure for cerebral palsy, there are many courses of treatment that providers may recommend to improve motor function and development. Medicines are one such route – some are taken orally, some are injected directly into the impacted muscle area, and others are delivered through surgically-implanted pumps that can be upgraded every few years. Of course, as with any medication, it is always wise to discuss the pros and cons of each with your child’s medical team to determine the best fit!

While therapies are often helpful, depending on the severity of the case, many patients look to orthopedic and neurosurgeons to provide treatment. In the orthopedic world, surgeons can improve mobility by lengthening muscles and tendons, while neurosurgeons can perform a procedure called selective dorsal rhizotomy, or SDR, in which they locate and cut overactivated nerves at the base of the spine to relax muscles and reduce spasticity.  

There is no standard therapy or surgery that works for every person with cerebral palsy, so it is of the utmost importance to converse with the medical team about a treatment plan that is both safe and effective.

Key Takeaway 8: Look to these tools and resources to build a better understanding of cerebral palsy!

Dr. Hurvits warns against a simple google search of cerebral palsy because that may yield results flooded with inaccurate information. As a result, he recommends the following trustworthy resources to begin your quest for knowledge:

  • Cerebral Palsy Research Network
    This site aims to optimize the health and wellness of people with cerebral palsy through high-quality research, education, and community programming.
  • Cerebral Palsy Research Network: MyCP
    As one of their educational resources, the Cerebral Palsy Research Network offers a free, private, and personal portal called MyCP that can connect you with a community of people with cerebral palsy who are committed to improving outcomes through research!
  • Cerebral Palsy Alliance Research Foundation
    They aim to foster a broad and balanced portfolio to help the CP community in as many ways as possible. That includes pilot programs for transformative ideas at an early stage, funding to get revolutionary ideas over the finish line and into the world, and small ideas that can make a huge difference.

If you found this blog helpful, watch the full recording on our YouTube channel to listen to Dr. Hurvitz respond to poignant questions from our community!



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