Paeds Cases · growth-development-and-behaviour
High-probability CP counselling — OSCE station
OSCE on early CP recognition, classification language and family counselling.
osce communication and clinical reasoning
On this page & tools
Target exams
MRCPCH ClinicalRACP DCE
Prompt
Parents of a 5-month corrected-age preterm graduate with abnormal movement quality and low HINE scores.
Station brief
You are in neonatal follow-up. The infant is 5 months corrected age after extreme prematurity. Movement quality is abnormal. HINE is low in a trained assessment. MRI shows white-matter injury. Parents ask: “Is this cerebral palsy? How bad will it be? Should we wait?” [1] [11]
Tasks
- Take a focused interval history of motor skills and caregiver concerns.
- Explain high-probability cerebral palsy in plain language. [1] [2] [3]
- Outline classification ideas (type/topography/function) without false precision on final GMFCS. [4] [5] [17]
- Agree an immediate plan: early intervention, reviews, safety-net. [1] [13] [15]
Expected performance
- Defines CP accurately and distinguishes non-progressive injury from progressive disease. [2] [3]
- Uses “high probability” language supported by tools rather than “we must wait until two”. [1] [11]
- Separates motor type from GMFCS and avoids a single global severity number. [4] [17]
- Starts early intervention in parallel with ongoing assessment. [1] [13]
- Checks understanding and invites questions; offers written plan and review date. [15]
Examiner prompts
- “Could this still be normal prematurity?” — discuss serial findings and tool combination. [1]
- “What is GMFCS?” — explain real-world gross motor performance levels and age caveats. [4] [5]
- “Do we need more tests before physiotherapy?” — therapy can start while investigations continue. [1] [13]
Common fails
- False reassurance without structured review.
- Final GMFCS declaration in early infancy as if fixed forever.
- Withholding therapy for absolute certainty.
- Jargon without teach-back. [1] [17]
References
- [1]Novak I Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA pediatrics, 2017.PMID 28715518
- [2]Bax M Proposed definition and classification of cerebral palsy, April 2005. Developmental medicine and child neurology, 2005.PMID 16108461
- [3]Rosenbaum P A report: the definition and classification of cerebral palsy April 2006. Developmental medicine and child neurology. Supplement, 2007.PMID 17370477
- [4]Palisano R Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental medicine and child neurology, 1997.PMID 9183258
- [5]Palisano RJ Content validity of the expanded and revised Gross Motor Function Classification System. Developmental medicine and child neurology, 2008.PMID 18834387
- [10]Romeo DM Hammersmith Infant Neurological Examination in infants born at term: Predicting outcomes other than cerebral palsy. Developmental medicine and child neurology, 2022.PMID 35201619
- [11]Fehlings D The Hammersmith Infant Neurological Exam Scoring Aid supports early detection for infants with high probability of cerebral palsy. Developmental medicine and child neurology, 2024.PMID 38818710
- [13]Morgan C Effectiveness of motor interventions in infants with cerebral palsy: a systematic review. Developmental medicine and child neurology, 2016.PMID 27027732
- [15]Te Velde A Age of Diagnosis, Fidelity and Acceptability of an Early Diagnosis Clinic for Cerebral Palsy: A Single Site Implementation Study. Brain sciences, 2021.PMID 34439692
- [17]Rosenbaum P Classification in childhood disability: focusing on function in the 21st century. Journal of child neurology, 2014.PMID 24810083