Cerebral palsy surveillance and multidisciplinary management — formative SAQs

SAQ 1 — Classification and hip surveillance (10 marks)

A 6-year-old with bilateral spastic cerebral palsy is GMFCS IV. The parent asks why “another hip X-ray” is needed when the child is not complaining of pain. No orthopaedic appointment is booked. [3] [8] [10]

Questions

1. Define cerebral palsy in one consensus sentence and name three classification layers you will state in a viva. (3 marks) [1] [3]
2. Explain why hip surveillance intensity rises with GMFCS and what population programmes have shown. (4 marks) [8] [9]
3. Outline three actions that close the loop after today’s visit. (3 marks) [10] [18]

Model answer

Definition and layers (3). Cerebral palsy is a permanent disorder of movement and posture causing activity limitation, attributed to non-progressive disturbances in the developing fetal or infant brain, often with associated sensory, cognitive, communication, behavioural, epilepsy and secondary musculoskeletal problems. State motor type, topography and GMFCS (add MACS/CFCS/EDACS when relevant). [1] [3]

Hip risk and programmes (4). Hip displacement risk increases as GMFCS level rises; non-ambulant children (especially IV–V) are highest risk and may be asymptomatic until late. Population surveillance with timely surgery (Hägglund) reduces dislocation. Australian hip surveillance guidelines stratify radiographic follow-up by GMFCS and age — absence of pain does not cancel surveillance. [8] [9] [10]

Close the loop (3). Obtain or schedule the indicated radiograph; name an owner and review date; refer orthopaedics if migration or exam is deteriorating; update the medical-home problem list and safety-net new pain or reduced abduction. [10] [18]

SAQ 2 — Tone, evidence and coordination (10 marks)

A. A registrar plans “botulinum toxin for whole-body tone” in mixed dystonia-spasticity without goals. B. Therapy is passive stretching only. C. The family has five uncoordinated specialist letters. [13] [17] [18]

Questions

1. Distinguish spasticity from dystonia for management choice. (3 marks) [17]
2. State the Novak traffic-light principle for choosing therapies. (3 marks) [13]
3. Describe a medical-home coordination response to fragmented care. (4 marks) [18]

Model answer

Tone distinction (3). Spasticity is velocity-dependent resistance to passive stretch; dystonia is fluctuating involuntary posturing often triggered by intention or emotion. Wrongly treating dystonia as pure spasticity leads to ineffective or sedating escalation; use specialist dystonia pathways when dystonia dominates. [17]

Evidence lights (3). Prefer green-light goal-directed and activity-based interventions that train real tasks; many passive or non-specific modalities are yellow or red. Botulinum toxin is for focal functional goals within protocol, not “whole-body tone” without targets. [13]

Medical home (4). Create one shared problem list and goal list; assign owners for hips, tone, epilepsy, therapy and school; schedule review of open referrals; communicate a single plan to family and teams; start transition planning when age-appropriate. [18]