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Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment
Open accessAbstract
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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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]
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“A growing body of literature suggests that infant movement behaviors can reveal rich information about the developing central nervous system.”
From Miniaturized wireless, skin-integrated sensor networks for quantifying full-body movement behaviors and vital signs in infants (2021) · cites this paper as [4]
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A bibliometric analysis of cerebral palsy from 2003 to 2022
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Toma, A. I., Dima, V., Alexe, A., Bojan, C., Nemeş, A. F., Gonț, B. F., Arghirescu, A., Necula, A. I., Fieraru, A., Stoiciu, R. P., et al. (2024) · Life · doi:10.3390/life14040480 · Cited by 11
Merino‐Andrés, J., Muñoz, P. L., Palomo‐Carrión, R., Martín‐Casas, P., Ruiz‐Becerro, I., & Hidalgo‐Robles, Á. (2024) · Child Care Health and Development · doi:10.1111/cch.13262 · Cited by 11
Identifying Opportunities for Early Detection of Cerebral Palsy
Hornby, B., Paleg, G., Williams, S. A., Hidalgo‐Robles, Á., Livingstone, R., Wright, P. E. M., Taylor, A., & Shrader, M. W. (2024) · Children · doi:10.3390/children11050515 · Cited by 11
Neural Correlates of Mobility in Children with Cerebral Palsy: A Systematic Review
Sudati, I. P., Damiano, D. L., Rovai, G., & de Campos, A. C. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21081039 · Cited by 13
Self-citationForlì, F., Capobianco, S., Berrettini, S., Bruschini, L., Lorenzoni, F., Fiori, S., & Lazzerini, F. (2024) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2024.112070 · Cited by 11
Self-citationXue, Z., Zhang, W., Zhou, N., Ma, P., Yuan, K., Zheng, P., Li, J., & Chang, J. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1483370 · Cited by 13
Jiang, H., Liu, H., Huang, T., Wu, L., Wu, F., Liu, C., Wang, M., Jin, C., Yang, J., & Li, X. (2020) · Brain Imaging and Behavior · doi:10.1007/s11682-020-00295-6 · Cited by 11
Barnes, F. P., Graham, L., Loganathan, P. K., & Nair, V. (2020) · The Indian Journal of Pediatrics · doi:10.1007/s12098-020-03365-1 · Cited by 11
Is Stem Cell Therapy the New Savior for Cerebral Palsy Patients? A Review
Vankeshwaram, V., Maheshwary, A., Mohite, D., Omole, J. A., & Khan, S. (2020) · Cureus · doi:10.7759/cureus.10214 · Cited by 11
Richard, C., Kjeldsen, C. P., Findlen, U. M., Gehred, A. P., & Maitre, N. L. (2021) · Journal of Child Neurology · doi:10.1177/08830738211004519 · Cited by 13
Self-citationUsing the PODCI to Measure Motor Function and Parent Expectations in Children With Cerebral Palsy
Scott, K., Barbosa, G. D. O., Pan, J., & Heathcock, J. (2021) · Physical Therapy · doi:10.1093/ptj/pzab215 · Cited by 11
Aman, A. A., Baharoon, B., Idrees, H. J., Taj, A. M., Alzahrani, B. A., & Muthaffar, O. Y. (2021) · Pharmacophore · doi:10.51847/umxb9osg54 · Cited by 11
Cerebral Palsy in Child Neurology and Neurodevelopmental Disabilities Training: An Unmet Need
Wilson, J. L., Kim, Y.-M., O’Malley, J. A., Gelineau‐Morel, R., Gilbert, L. A., Bain, J., & Aravamuthan, B. R. (2022) · Journal of Child Neurology · doi:10.1177/08830738211072711 · Cited by 11
Luke, C. R., Benfer, K. A., Mick‐Ramsamy, L., Ware, R. S., Reid, N., Bos, A. F., Bosanquet, M., & Boyd, R. N. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-053646 · Cited by 15
Self-citationPreeclampsia and Cerebral Palsy in Offspring
Badagionis, M. N., Sergentanis, T. Ν., Pervanidou, P., Kalampokas, E., Vlahos, N., & Eleftheriades, M. I. (2022) · Children · doi:10.3390/children9030385 · Cited by 11
Jahan, I., Imam, M. H. A., Muhit, M., Chhetri, A. B., Badawi, N. A., & Khandaker, G. (2022) · Disability and Rehabilitation · doi:10.1080/09638288.2022.2118871 · Cited by 11
Self-citationBedside tracking of functional autonomic age in preterm infants
Iyer, K. K., Leitner, U., Giordano, V., Roberts, J. A., Vanhatalo, S., Klebermaß-Schrehof, K., & Stevenson, N. J. (2022) · Pediatric Research · doi:10.1038/s41390-022-02376-2 · Cited by 11
Identification of risk factors in pre-term infants with abnormal general movements
Domagalska–Szopa, M., Szopa, A., Serrano-Gómez, M. E., Hagner–Derengowska, M., & Behrendt, J. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.850877 · Cited by 11
McNamara, L., Scott, K. M., Boyd, R. N., Farmer, E. S., Webb, A., Bosanquet, M., Nguyen, K., & Novak, I. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-063558 · Cited by 13
Self-citationLevel of Awareness and Attitude Toward Cerebral Palsy Among Parents in Al-Baha City, Saudi Arabia
Salih, E. M. M., Alghamdi, S., Alghamdi, R. A., Alghamdi, M. S., & Alzahrani, T. A. A. (2022) · Cureus · doi:10.7759/cureus.31791 · Cited by 11
Assessment Scales in Cerebral Palsy: A Comprehensive Review of Tools and Applications
Javvaji, C. K., Vagha, J. D., Meshram, R. J., & Taksande, A. M. (2023) · Cureus · doi:10.7759/cureus.47939 · Cited by 16
Swift, E., Gibbs, L. F., Reddihough, D. S., Mackinnon, A. J., & Davis, E. C. (2023) · Journal of Patient-Reported Outcomes · doi:10.1186/s41687-023-00656-x · Cited by 11
Etiology and Ontogeny of Cerebral Palsy: Implications for Practice and Research
Evans, M. I., Britt, D. W., & Devoe, L. D. (2023) · Reproductive Sciences · doi:10.1007/s43032-023-01422-6 · Cited by 11
Kashif, M., Albalwi, A. A., Kazmi, S. A. M., Alharbi, A. A., Bashir, K., Aslam, M., & Ghaffar, T. (2024) · Medicine · doi:10.1097/md.0000000000037214 · Cited by 11
Jonsson, H., Gaily, E. K., Stjerna, S., Joensuu, T. H., Johari, M., Lehesjoki, A., & Linnankivi, T. (2024) · Epilepsia Open · doi:10.1002/epi4.12966 · Cited by 11
Pierce, S. R., Skorup, J. C., Miller, A., Paremski, A. C., & Prosser, L. A. (2018) · Developmental Neurorehabilitation · doi:10.1080/17518423.2018.1523244 · Cited by 11
Kuint, J., Lerner‐Geva, L., Chodick, G., Boyko, V., Shalev, V., Reichman, B. L., & Israel Neonatal Network (2019) · Neonatology · doi:10.1159/000495702 · Cited by 11
Crowle, C., Loughran‐Fowlds, A., Novak, I., & Badawi, N. A. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8091286 · Cited by 11
Self-citationA Maternal-Administered Multimodal Neonatal Bundle in Hospitalized Very Preterm Infants
Letzkus, L., Alonzo, C. J., Connaughton, E., Kelly, N. L., & Zanelli, S. A. (2020) · Advances in Neonatal Care · doi:10.1097/anc.0000000000000786 · Cited by 10
Metadata
- 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)
- ORCID
- Novak, Iona
- Adde, Lars
- Blackman, James
- Boyd, Roslyn N.
- Brunstrom-Hernandez, Janice
- Cioni, Giovanni
- Damiano, Diane
- Eliasson, Ann-Christin
- Fahey, Michael
- Fehlings, Darcy
- Ferriero, Donna M.
- Fiori, Simona
- Forssberg, Hans
- Gordon, Andrew M.
- Greaves, Susan
- Guzzetta, Andrea
- Harbourne, Regina
- Karlsson, Petra
- Latal, Beatrice
- Maitre, Nathalie
- McIntyre, Sarah
- Noritz, Garey
- Pennington, Lindsay
- Romeo, Domenico M.
- Spittle, Alicia J.
- Valentine, Jane
- Walker, Karen
- White, Robert
- Badawi, Nadia
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2017-09-01
- Volume
- 171
- Issue
- 9
- Pages
- 897
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC9641643
- 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
- FWCI
- 13.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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 › Rehabilitation › 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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