Cerebral palsy early recognition and classification — formative SAQs

SAQ 1 (10 marks)

An ex-preterm infant is reviewed at 4 months corrected age. Parents report stiffness when dressing. A trained clinic documents abnormal fidgety-quality movements and a low HINE score. MRI shows white-matter injury. [1] [11]

1. Define cerebral palsy using consensus language. (3) [2] [3]
2. Outline the early-detection approach that supports a high-probability formulation in this infant. (4) [1] [10] [11]
3. List three reasons not to delay early intervention until age two years. (3) [1] [13]

Model answer — SAQ 1

Definition (3): Permanent disorders of movement and posture due to non-progressive disturbance in the developing fetal/infant brain; often accompanied by epilepsy, sensory, cognitive, communication and secondary musculoskeletal problems. Clinical description, not a single disease. [2] [3]

Early detection (4): Combine perinatal risk, standardised neurological examination (HINE), movement-quality assessment (GMA principles/trained observation), and neuroimaging pattern. Formulate high probability when tools converge; name emerging motor type/topography; do not wait for independent walking. [1] [10] [11]

Do not delay therapy (3): High plasticity window; evidence supports early motor intervention; delayed labelling delays services and family planning; investigations can run in parallel. [1] [13]

SAQ 2 (10 marks)

A 6-year-old with spastic unilateral cerebral palsy walks community distances without a mobility device, needs two hands with difficulty for buttons, speaks clearly, and coughs with thin fluids. [4] [6] [8]

1. Explain why motor type alone is insufficient classification. (3) [3] [4]
2. Name the most appropriate functional systems for mobility, hand use and eating/drinking in this child. (3) [4] [6] [8]
3. Give two progressive-disease red flags that would make you question a static CP label in another child. (4) [19]

Model answer — SAQ 2

Motor type insufficient (3): Type/topography describe movement disorder distribution, not day-to-day function across domains; children with the same motor type can have very different mobility, hand and feeding needs. [3] [4]

Systems (3): Mobility — GMFCS; hands — MACS; eating/drinking — EDACS (CFCS if communication were the issue). [4] [6] [8]

Red flags (4): True developmental regression after acquired skills; continuously progressive weakness; markedly rising CK/neuromuscular family history; multi-system features suggesting metabolic/genetic progressive disease rather than non-progressive early brain injury. [19]