Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy

Iona Novak, Cathy Morgan, Lars Adde, James Blackman, Roslyn N. Boyd, Janice Brunstrom-Hernandez, Giovanni Cioni, Diane Damiano, Johanna Darrah, Ann-Christin Eliasson, Linda S. de Vries, Christa Einspieler, Michael Fahey, Darcy Fehlings, Donna M. Ferriero, Linda Fetters, Simona Fiori, Hans Forssberg, Andrew M. Gordon, Susan Greaves & 20 others Andrea Guzzetta, Mijna Hadders-Algra, Regina Harbourne, Angelina Kakooza-Mwesige, Petra Karlsson, Lena Krumlinde-Sundholm, Beatrice Latal, Alison Loughran-Fowlds, Nathalie Maitre, Sarah McIntyre, Garey Noritz, Lindsay Pennington, Domenico M. Romeo, Roberta Shepherd, Alicia J. Spittle, Marelle Thornton, Jane Valentine, Karen Walker, Robert White, Nadia Badawi

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Importance Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months’ corrected age.

Objectives To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy–specific early intervention that should follow early diagnosis to optimize neuroplasticity and function.

Evidence Review This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument.

Findings Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months’ corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months’ corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence.

Conclusions and Relevance Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.
Original languageEnglish
Pages (from-to)897-907
Number of pages11
JournalJAMA pediatrics
DOIs
Publication statusPublished - Sep 2017

Fingerprint

Cerebral Palsy
Early Diagnosis
Neurologic Examination
Magnetic Resonance Imaging
Guidelines
Neuronal Plasticity
Live Birth
Intelligence
Neuroimaging
MEDLINE
Caregivers
Libraries
Signs and Symptoms
Meta-Analysis
Referral and Consultation
Sensitivity and Specificity

Keywords

  • Child
  • Cognition
  • Cognition: physiology
  • Female
  • Humans
  • Hyperkinesis
  • Infant
  • Longitudinal Studies
  • Male
  • Motor Activity
  • Motor Activity: physiology
  • Motor Skills
  • Motor Skills: physiology
  • Neurologic Examination
  • Prognosis

Cite this

Novak, I., Morgan, C., Adde, L., Blackman, J., Boyd, R. N., Brunstrom-Hernandez, J., ... Badawi, N. (2017). Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy. JAMA pediatrics, 897-907. https://doi.org/10.1001/jamapediatrics.2017.1689

Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy. / Novak, Iona; Morgan, Cathy; Adde, Lars; Blackman, James; Boyd, Roslyn N.; Brunstrom-Hernandez, Janice; Cioni, Giovanni; Damiano, Diane; Darrah, Johanna; Eliasson, Ann-Christin; de Vries, Linda S.; Einspieler, Christa; Fahey, Michael; Fehlings, Darcy; Ferriero, Donna M.; Fetters, Linda; Fiori, Simona; Forssberg, Hans; Gordon, Andrew M.; Greaves, Susan; Guzzetta, Andrea; Hadders-Algra, Mijna; Harbourne, Regina; Kakooza-Mwesige, Angelina; Karlsson, Petra; Krumlinde-Sundholm, Lena; Latal, Beatrice; Loughran-Fowlds, Alison; Maitre, Nathalie; McIntyre, Sarah; Noritz, Garey; Pennington, Lindsay; Romeo, Domenico M.; Shepherd, Roberta; Spittle, Alicia J.; Thornton, Marelle; Valentine, Jane; Walker, Karen; White, Robert; Badawi, Nadia.

In: JAMA pediatrics, 09.2017, p. 897-907.

Research output: Contribution to journalArticle

Novak, I, Morgan, C, Adde, L, Blackman, J, Boyd, RN, Brunstrom-Hernandez, J, Cioni, G, Damiano, D, Darrah, J, Eliasson, A-C, de Vries, LS, Einspieler, C, Fahey, M, Fehlings, D, Ferriero, DM, Fetters, L, Fiori, S, Forssberg, H, Gordon, AM, Greaves, S, Guzzetta, A, Hadders-Algra, M, Harbourne, R, Kakooza-Mwesige, A, Karlsson, P, Krumlinde-Sundholm, L, Latal, B, Loughran-Fowlds, A, Maitre, N, McIntyre, S, Noritz, G, Pennington, L, Romeo, DM, Shepherd, R, Spittle, AJ, Thornton, M, Valentine, J, Walker, K, White, R & Badawi, N 2017, 'Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy', JAMA pediatrics, pp. 897-907. https://doi.org/10.1001/jamapediatrics.2017.1689
Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J et al. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy. JAMA pediatrics. 2017 Sep;897-907. https://doi.org/10.1001/jamapediatrics.2017.1689
Novak, Iona ; Morgan, Cathy ; Adde, Lars ; Blackman, James ; Boyd, Roslyn N. ; Brunstrom-Hernandez, Janice ; Cioni, Giovanni ; Damiano, Diane ; Darrah, Johanna ; Eliasson, Ann-Christin ; de Vries, Linda S. ; Einspieler, Christa ; Fahey, Michael ; Fehlings, Darcy ; Ferriero, Donna M. ; Fetters, Linda ; Fiori, Simona ; Forssberg, Hans ; Gordon, Andrew M. ; Greaves, Susan ; Guzzetta, Andrea ; Hadders-Algra, Mijna ; Harbourne, Regina ; Kakooza-Mwesige, Angelina ; Karlsson, Petra ; Krumlinde-Sundholm, Lena ; Latal, Beatrice ; Loughran-Fowlds, Alison ; Maitre, Nathalie ; McIntyre, Sarah ; Noritz, Garey ; Pennington, Lindsay ; Romeo, Domenico M. ; Shepherd, Roberta ; Spittle, Alicia J. ; Thornton, Marelle ; Valentine, Jane ; Walker, Karen ; White, Robert ; Badawi, Nadia. / Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy. In: JAMA pediatrics. 2017 ; pp. 897-907.
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T1 - Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy

AU - Novak, Iona

AU - Morgan, Cathy

AU - Adde, Lars

AU - Blackman, James

AU - Boyd, Roslyn N.

AU - Brunstrom-Hernandez, Janice

AU - Cioni, Giovanni

AU - Damiano, Diane

AU - Darrah, Johanna

AU - Eliasson, Ann-Christin

AU - de Vries, Linda S.

AU - Einspieler, Christa

AU - Fahey, Michael

AU - Fehlings, Darcy

AU - Ferriero, Donna M.

AU - Fetters, Linda

AU - Fiori, Simona

AU - Forssberg, Hans

AU - Gordon, Andrew M.

AU - Greaves, Susan

AU - Guzzetta, Andrea

AU - Hadders-Algra, Mijna

AU - Harbourne, Regina

AU - Kakooza-Mwesige, Angelina

AU - Karlsson, Petra

AU - Krumlinde-Sundholm, Lena

AU - Latal, Beatrice

AU - Loughran-Fowlds, Alison

AU - Maitre, Nathalie

AU - McIntyre, Sarah

AU - Noritz, Garey

AU - Pennington, Lindsay

AU - Romeo, Domenico M.

AU - Shepherd, Roberta

AU - Spittle, Alicia J.

AU - Thornton, Marelle

AU - Valentine, Jane

AU - Walker, Karen

AU - White, Robert

AU - Badawi, Nadia

PY - 2017/9

Y1 - 2017/9

N2 - Importance Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months’ corrected age.Objectives To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy–specific early intervention that should follow early diagnosis to optimize neuroplasticity and function.Evidence Review This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument.Findings Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months’ corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months’ corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence.Conclusions and Relevance Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.

AB - Importance Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months’ corrected age.Objectives To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy–specific early intervention that should follow early diagnosis to optimize neuroplasticity and function.Evidence Review This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument.Findings Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months’ corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months’ corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence.Conclusions and Relevance Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.

KW - Child

KW - Cognition

KW - Cognition: physiology

KW - Female

KW - Humans

KW - Hyperkinesis

KW - Infant

KW - Longitudinal Studies

KW - Male

KW - Motor Activity

KW - Motor Activity: physiology

KW - Motor Skills

KW - Motor Skills: physiology

KW - Neurologic Examination

KW - Prognosis

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DO - 10.1001/jamapediatrics.2017.1689

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JO - JAMA pediatrics

JF - JAMA pediatrics

SN - 2168-6211

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