I. Definition of early diagnosis of cerebral palsy.
The opinions of scholars in various countries are not yet unified as to when the diagnosis of cerebral palsy is considered early diagnosis. Some scholars believe that those diagnosed within 0-6 months (or 9 months) of birth are considered early diagnosis. Among them, those diagnosed at 0 to 3 months of age are considered ultra-early diagnosis.
(A) Clinical manifestations before 42 days.
1, crying: newborn period that there is easy to cry, cry sharp not easy to comfort performance. Or from not crying.
2, laughing: 42 days of young infants can smile at the face, but no laughter. If the expression is dull, parents should be alerted if they have never seen the child smile.
3.Sleep disorder.
(1) Significantly less sleep (less than 20 hours, or even less than 15 hours): or difficult to fall asleep, some children hold only to sleep, put down to wake up or alarm.
(2) too much sleep: poor mental response, continuous sleep state, not easy to wake up.
(4) Feeding difficulties: slow, little milk intake, weak sucking or uncoordinated sucking and swallowing, feeding difficulties are often accompanied by milk overflow at the corners of the mouth and easy choking.
5. Easy to be frightened, convulsions, jerking (severe cases may be manifested as corns or often scurrying out of the swaddling clothes). Or too quiet with little activity.
6, abnormal posture: head tilted back, hands thumbs inward double fist clenched, can not lie down.
7, abnormal muscle tone.
(1) elevated muscle tone: hard limbs, difficulty changing diapers or dressing.
(2) Hypotonia: limbs are flaccid.
8.Poor response: poor response to loud sounds, will not chase after hearing and red ball.
(2) Clinical manifestations of infants with cerebral palsy from 1 to 3 months of age.
Children with cerebral palsy at this stage show no gaze, poor response to loud sounds and will not chase after the eyes. The head circumference is small (less than 40 cm), the head is unstable, shaking from side to side, difficult to hold upright, and cannot lift the head in prone position or even in hip-high-head-low position. The thumbs are inward, the hands are tightly clenched and not easily opened. Hypotonia or enhanced muscle tone, manifested as generalized tenderness, asymmetrical posture; or generalized stiffness, hard trunk extension or double lower extremities do not support weight when holding upright.
(C) Clinical manifestations of infants with cerebral palsy from 4 to 5 months of age.
Children with cerebral palsy at this stage show inattention to people, do not follow objects in front of them, and have inflexible eyes. Their expressions are indifferent and dull, they do not respond when teased, and they do not laugh. Some children move slowly, do not turn over, and cannot reach 90 degrees while lying prone. The child’s thumbs are still inward, clenched fists, hands are not open, forearms rotate forward, and hands do not reach out to grasp objects when they see them or only use one hand to grasp objects. The body gradually becomes stiff, and the pelvis tilts forward when supporting standing, pointed feet, and double lower limbs cross phenomenon.
(iv) Clinical manifestations of infants with cerebral palsy from 6 to 7 months old.
The infant with cerebral palsy at this stage will not reach out to grasp objects, and we cannot see the posture of mutual coordination of hand, mouth and eye in which the infant grasps objects with his hands and then sends the grasped objects into his mouth with both hands. The child often has an asymmetrical position of both limbs and has difficulty turning over. When raising the head in the prone position, the trunk and limbs cannot be fully extended, and it is difficult to support forearm abduction with the elbow joint. The child may have dorsiflexion of the head, posterior extension of the shoulders, scissor-like posture with extension of the lower limbs or toe standing posture. Some children have increased muscle tone in the upper extremities and have stiff hands, especially when dressing, the upper extremities are difficult to enter the cuffs, etc.
(E) Clinical manifestations of infants with cerebral palsy from 8 to 12 months of age.
Children with cerebral palsy at this stage cannot sit or sit unsteadily and have difficulty crawling. Because of the increased muscle tone of both lower limbs, the child has difficulty standing alone. When the child is held vertically, the two lower limbs are straight and the legs are crossed in a scissor-like manner; if the child is placed on the ground, the heels are suspended and the toes are on the ground. In some cases, the elbows of the upper limbs are flexed and placed in front of the chest, or the upper limbs are rotated and stretched inward or backward, the thumbs are inward, and the remaining four fingers hold the thumbs tightly, and it is difficult to do the movement of pinching and grasping objects.
The difficulty of early diagnosis of cerebral palsy
Since the pediatric nervous system is in a stage of continuous development, the early movements of infants are controlled by subcortical centers and governed by reflexes, and most of the spontaneous movements are influenced by primitive reflexes, and although the brain tissue is damaged at this time, the symptoms are not obvious. Therefore, except for those with obvious etiology and typical symptoms, early diagnosis is generally difficult. It is especially difficult to make early diagnosis within 3 months of birth. It often requires careful examination by a specialized physician with professional training to make a careful diagnosis. In addition, most parents do not know enough about cerebral palsy, and even if symptoms appear early, they are often not noticed by parents. Some parents, influenced by certain traditional concepts, even if they find that their child is lagging behind in motor development compared to their peers at an early stage, they take it for granted that the child will reach normal after a period of time or when he or she grows up, and do not go to the hospital for examination, and wait until the child’s symptoms become obvious after the age of 1 to 2 before going to the hospital.
III. The concept of central coordination disorder
In order to diagnose early more effectively, German scholar Dr. Vojta, after years of research, firstly proposed a synonym for early diagnosis of cerebral palsy in the world, namely the concept of central coordination disorder (ZKS), which was soon recognized by scholars from various countries and widely used in many countries.
The coordinating role of the central nervous system is to produce the correct response to external stimuli in children. When the central nervous system is damaged, the summation and regulation of various stimuli by the central nervous system will be impaired, which will inevitably lead to abnormalities in postural reflexes and movements, and this is the central coordination disorder. This abnormality can be used clinically as an indicator to determine postural and motor abnormalities, and it can be said that children with central coordination disorder are children with abnormal postural reflexes, that is, children with cerebral palsy. As a synonym for early diagnosis of cerebral palsy, central coordination disorder is easily understood and accepted by parents, which not only facilitates early diagnosis, but also early initiation of treatment and follow-up during treatment, and when the symptoms become obvious, the diagnosis of cerebral palsy is made. Therefore, within the early 6 months of infancy, unless the high-risk factors are clear and the child has abnormalities in posture, reflexes, movement, muscle tone and Vojta postural reflexes, the diagnosis of cerebral palsy should be made in general, except for central coordination disorder.