Cited by 1,721Cerebral Palsy and Movement DisordersNeonatal and fetal brain pathologyFetal and Pediatric Neurological Disorders

Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment

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Novak, Iona, Morgan, Cathy, Adde, Lars, Blackman, James, Boyd, Roslyn N., Brunstrom-Hernandez, Janice, Cioni, Giovanni, Damiano, Diane +32 more·2017·JAMA Pediatrics

Abstract

Importance: Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age. Objectives: To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy-specific early intervention that should follow early diagnosis to optimize neuroplasticity and function. Evidence Review: This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. Findings: Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months' corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months' corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence. Conclusions and Relevance: Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.

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Crossref · 10.1001/jamapediatrics.2017.1689

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  • Recent international protocols recommend additional evaluations for at-risk infants early in life, including visual observations of the infant's general movements (GM) by an expert clinician throughout the preterm and term phase.

    “Recent international protocols recommend additional evaluations for at-risk infants early in life, including visual observations of the infant’s general movements (GM) by an expert clinician throughout the preterm and term phase (2, 4, 10).”

    From Miniaturized wireless, skin-integrated sensor networks for quantifying full-body movement behaviors and vital signs in infants (2021) · cites this paper as [4]

    The Conclusions recommend general-movements assessment alongside neonatal MRI for infants with newborn-detectable risks before five months’ corrected age. The Advances in Diagnosis section says experienced clinicians should conduct and interpret assessments, but the copy does not specify visual observations throughout both the preterm and term phases. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • Atypical patterns of infant movement can indicate underlying neuromotor pathologies that reflect or presage clinical conditions like cerebral palsy, autism spectrum disorder, or minor forms of other neurological dysfunctions.

    “Atypical patterns can indicate underlying neuromotor pathologies that reflect or presage clinical conditions like cerebral palsy, autism spectrum disorder, or minor forms of other neurological dysfunctions (1–4).”

    From Miniaturized wireless, skin-integrated sensor networks for quantifying full-body movement behaviors and vital signs in infants (2021) · cites this paper as [4]

    The Motor Dysfunction section describes atypical infant movements as signs relevant to cerebral palsy diagnosis. The False Positives and False Negatives section says some infants initially diagnosed with cerebral palsy were later diagnosed with another neurological disability, including autism. It does not establish that atypical movements predict autism specifically or minor forms of other neurological dysfunction. (LLM, conf=0.83)

    Experimental — accuracy not yet measured
  • New international clinical practice guidelines aim to shift detection of infants at high risk of CP earlier, to 12 to 24 weeks corrected age, which is significantly earlier than previous diagnosis windows in Australia at 19 months.

    “New international clinical practice guidelines exist for identifying infants at high risk of cerebral palsy (CP) earlier: between 12 to 24 weeks corrected age, significantly earlier than previous diagnosis windows in Australia at 19 months.”

    From Early Parenting Acceptance and Commitment Therapy ‘Early PACT’ for parents of infants with cerebral palsy: a study protocol of a randomised controlled trial (2020) · cites this paper as [2]

    The Methods section says the authors developed an international clinical practice guideline, and the Advances in Diagnosis section recommends diagnosis before 6 months’ corrected age rather than the historical 12–24-month window. Our copy does not specify a 12–24-week detection window or state that the previous diagnosis age in Australia was 19 months. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Infant movement behaviors can reveal rich information about the developing central nervous system.

    “A growing body of literature suggests that infant movement behaviors can reveal rich information about the developing central nervous system.”

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Authors
Novak, I., Morgan, C., Adde, L., Blackman, J., Boyd, R. N., Brunstrom-Hernandez, J., Cioni, G., Damiano, D., Darrah, J., Eliasson, A.-C., de Vries, L. S., Einspieler, C., Fahey, M., Fehlings, D., Ferriero, D. M., Fetters, L., Fiori, S., Forssberg, H., Gordon, A. M., Greaves, S., Guzzetta, A., Hadders-Algra, M., Harbourne, R., Kakooza-Mwesige, A., Karlsson, P., Krumlinde-Sundholm, L., Latal, B., Loughran-Fowlds, A., Maitre, N., McIntyre, S., Noritz, G., Pennington, L., Romeo, D. M., Shepherd, R., Spittle, A. J., Thornton, M., Valentine, J., Walker, K., White, R., & Badawi, N.
Affiliations
  • The University of Sydney (AU)
  • Norwegian University of Science and Technology (NO)
  • Cerebral Palsy Alliance Research Foundation (US)
  • The University of Queensland (AU)
  • Children's Medical Center (US)
  • University of Pisa (IT)
  • National Institutes of Health (US)
  • University of Alberta (CA)
  • Karolinska Institutet (SE)
  • University Medical Centre Utrecht, Utrecht, the Netherlands
  • Medical University of Graz (AT)
  • Monash University (AU)
  • University of Toronto (CA)
  • University of California, San Francisco (US)
  • University of Southern California (US)
  • Columbia University (US)
  • Royal Children's Hospital (AU)
  • Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
  • Duquesne University (US)
  • Makerere University, Kampala, Uganda
  • Karolinska Institutet, Stockholm, Sweden
  • University Children's Hospital Zurich (CH)
  • Children’s Hospital Westmead, The University of Sydney, Sydney, Australia
  • Nationwide Children's Hospital (US)
  • Newcastle University (GB)
  • Università Cattolica del Sacro Cuore (IT)
  • The University of Melbourne (AU)
  • The University of Western Australia (AU)
Venue
JAMA Pediatrics
Published
2017-09-01
Volume
171
Issue
9
Pages
897
ISSN
  • 1072-4710 (ISSN-L)
  • 2168-6203
OpenAlex
W2736255997
Cited by
1,721
References
78
Citations by year
2026: 235 · 2025: 233 · 2024: 299 · 2023: 230 · 2022: 194 · 2021: 198 · 2020: 145 · 2019: 103 · 2018: 67 · 2017: 11 · 2016: 2 · 2014: 1
FWCI
13.55
Type
journal article
Language
en
Open access
Locations
  • Archives of Pediatrics and Adolescent Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by-nc)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by-nc-sa)
  • Florence Research (University of Florence) (submittedVersion, other-oa)
  • UWA Profiles and Research Repository (UWA) (submittedVersion)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • eSpace (Curtin University) (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc)
  • Utrecht University Repository (Utrecht University) (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich)
Funders
  • University of Southern California
  • Ohio State University
  • Nationwide Children's Hospital
  • Duquesne University
  • University of Alberta
  • Newcastle University
  • Rijksuniversiteit Groningen
  • University of Sydney
  • Monash University
  • University of Toronto
  • Karolinska Institutet
  • Universitair Medisch Centrum Groningen
  • Università Cattolica del Sacro Cuore
  • Karl-Franzens-Universität Graz
  • Medizinische Universität Graz
  • National Institutes of Health (Z99CL999999)
  • University of California, San Francisco
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Cerebral Palsy and Movement Disorders
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Fetal and Pediatric Neurological Disorders
Keywords
cerebral palsy, early diagnosis, early intervention, infants, diagnostic accuracy, magnetic resonance imaging, Hammersmith Infant Neurological Examination, developmental assessment, neuroplasticity, risk prediction tools, corrected age, evidence-based recommendations, AGREE II appraisal
MeSH terms
Cerebral Palsy, Child, Humans, Infant, Infant, Newborn, Early Intervention, Educational, Early Diagnosis

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