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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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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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