Cerebral palsy early recognition — branching viva

Branch A — Definition

Examiner: What is cerebral palsy?
Candidate: A group of permanent disorders of the development of movement and posture attributed to non-progressive disturbances in the developing fetal or infant brain, often with associated impairments such as epilepsy, sensation, cognition and communication difficulties. [2] [3]

Branch B — Early detection

Examiner: This high-risk infant is only four months corrected. Can you talk about CP yet?
Candidate: Yes — I use high-probability language when risk history, movement quality, HINE and imaging converge. I do not wait for independent walking if tools already point strongly to CP. [1] [10] [11]

Branch C — Examination tools

Examiner: Which tools help?
Candidate: Structured neurological examination with HINE in trained settings, General Movements Assessment principles for movement quality, and clinical observation of tone, asymmetry and functional play. Formal GMA needs training. [1] [10] [11]

Branch D — Classification

Examiner: How do you classify?
Candidate: Motor type (spastic, dyskinetic, ataxic, mixed), topography (unilateral versus bilateral patterns), and function with domain systems — GMFCS for gross motor, MACS for hands, and others as relevant. I assign function from real-world performance, not as a quiz for parents. [3] [4] [5] [6]

Branch E — Imaging

Examiner: Must MRI be abnormal?
Candidate: MRI pattern classification supports counselling and research communication, but clinical CP can stand with variable imaging. Unexpected progressive features reopen the differential. [18] [19]

Branch F — Management start

Examiner: Therapy now or later?
Candidate: Start early intervention when probability is high. Evidence supports early motor intervention; investigations and specialist review continue in parallel. [1] [13]

Branch G — Communication

Examiner: Counsel the family.
Candidate: I explain what we see, what high probability means, what we will do this week, and that labels refine over time. I use plain language, check understanding, and avoid both false reassurance and catastrophic certainty. [1]

Examiner traps

• Waiting until walking age despite high-probability tools.
• Collapsing GMFCS with motor type.
• Missing progressive disease red flags.
• Withholding therapy until every test is complete. [1] [4] [19]