Cerebral palsy surveillance — branching viva

Stem

The examiner starts with a GMFCS IV child in surveillance clinic, then adds dystonia, open-loop care and transition. [3] [8]

Branch 1 — Definition and classification

Examiner: Define cerebral palsy and how you classify this child at the bedside. [1] [3]

Strong answer: Permanent disorders of movement and posture causing activity limitation from non-progressive early brain disturbance, often with associated impairments and secondary musculoskeletal problems. I state motor type, topography and GMFCS, and add MACS, CFCS or EDACS when hands, communication or feeding are the issue. [1] [3]

Examiner: Why recheck GMFCS over time? [3]

Strong answer: Descriptors are age-banded and equipment needs change; relative stability after early childhood still requires re-documentation for service planning and hip risk. [3]

Branch 2 — Hip surveillance

Examiner: The child has no hip pain. Do you still X-ray? [8] [10]

Strong answer: Yes when GMFCS and age place them on a surveillance schedule. Displacement risk rises with GMFCS; pain is a late finding. Australian guidelines stratify by GMFCS and age; population programmes show prevention is possible with surveillance plus timely surgery. [8] [9] [10]

Branch 3 — Tone and therapy

Examiner: The registrar wants whole-body botulinum toxin for mixed tone. [13] [17]

Strong answer: Separate spasticity from dystonia. Use focal toxin for focal functional goals under protocol. Prefer green-light activity-based therapies. Escalate dystonia on specialist pathways rather than pure antispasticity stacking. [13] [17]

Branch 4 — System and transition

Examiner: Care is fragmented across five services. The child is 14. [18] [21]

Strong answer: Medical home holds one problem list, owners and dates. Close open loops. Begin structured transition per White: readiness, adult providers, legal decision-making, equipment funding and emergency plans. [18] [21]

Branch 5 — Red flags

Examiner: What would make you abandon routine surveillance paperwork today? [1] [17]

Strong answer: Skill loss suggesting progressive disease; status dystonicus or status epilepticus; respiratory failure; unexplained severe pain in a non-verbal child; safeguarding emergency. [1] [17]