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Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy
Published on: January 11, 2016
Evaluation of the child with cerebral palsy
Barry S Russman1, Stephen Ashwal
1Department of Pediatrics and Neurology, Oregon Health Sciences University, Portland, OR, USA.
Insights
Cerebral palsy (CP) diagnosis involves assessing motor development and neurological signs. Neuroimaging, like MRI, is crucial for identifying brain abnormalities, guiding prognosis, and exploring potential causes in children with CP.
Area of Science:
- Neurology
- Pediatrics
- Medical Imaging
Background:
- Cerebral palsy (CP) affects 2-2.5 per 1000 live births.
- Diagnosis relies on non-progressive abnormal motor development and specific neurological examination findings.
- Identifying brain abnormalities is key for etiology and prognosis.
Purpose of the Study:
- To outline recommended diagnostic approaches for children with cerebral palsy.
- To emphasize the role of neuroimaging and other investigations in CP assessment.
- To guide clinicians in evaluating potential underlying causes and associated deficits.
Main Methods:
- Clinical assessment of motor development and neurological signs.
- Neuroimaging, with a preference for Magnetic Resonance Imaging (MRI) over Computed Tomography (CT).
- Consideration of metabolic, genetic, and coagulation studies based on clinical presentation.
Main Results:
- Neuroimaging is recommended to confirm brain abnormalities in CP.
- Metabolic/genetic studies may reveal underlying etiologies if atypical features are present.
- Coagulation disorder testing is suggested for hemiplegic CP due to high cerebral infarction rates.
- Electroencephalogram (EEG) is not routinely recommended unless epilepsy is suspected.
Conclusions:
- Neuroimaging is essential for diagnosing cerebral palsy and understanding its neurological basis.
- Further investigations should be tailored to individual patient histories and examination findings.
- Comprehensive screening for associated deficits is crucial for holistic CP management.
Abstract:
Cerebral palsy (CP) is a common problem, occurring in about 2 to 2.5 per 1000 live births. The diagnosis of CP is based upon a history of abnormal motor development that is not progressive coupled with an examination (e.g. hypertonicity, increased reflexes, clonus) "placing" the lesion in the brain. In order to establish that a brain abnormality exists in children with CP that may, in turn, suggest an etiology and prognosis, neuroimaging is recommended with magnetic resonance imaging preferred to computed tomography. Metabolic and genetic studies should be obtained if there are atypical features in the history or on the examination. Detection of a brain malformation in a child with CP might suggest an underlying genetic or metabolic etiology. As cerebral infarction is high in children with hemiplegic CP, diagnostic testing for coagulation disorders should be considered. However, there is insufficient evidence at present to be precise as to what studies should be ordered. An electroencephalogram is not recommended unless there are features suggestive of epilepsy or a specific epileptic syndrome. As children with CP may have associated deficits of mental retardation, ophthalmologic and hearing impairments, speech and language disorders and oral-motor dysfunction, screening for these conditions should be part of the initial assessment.
