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Pediatric neurologic disorders present unique challenges. At a very young age, bone is highly plastic. Imbalance of muscle forces (spasticity and weakness) acting on bones and joints results in musculoskeletal complications such as excessive femoral anteversion, hip subluxation and dislocation, and flexion contractures of hips, knees, and ankles. Unlike adults, children's brains are still developing, especially in the first 2 years of life, during which dendritization and synaptogenesis are highly active. Additionally, children may be learning new functional skills for the first time with the added challenge of compensating for an acquired neurologic condition.1


Cerebral palsy (CP) is a heterogeneous condition with varied etiologies and degrees of severity. It is characterized by “disorders of the development of movement and posture, causing activity limitation, attributed to non-progressive disturbances in the developing fetal or infant brain”2 before the age of 3 years.3 The motor disorders are often accompanied by disturbances of sensation, cognition, communication, perception, and/or behavior and/or by a seizure disorder.4

CP is classified by limb involvement—hemiplegia, diplegia, and quadriplegia—as well as motor disorder—spastic, dyskinetic (dystonia, chorea, and athetosis), ataxic, and mixed (a combination of the preceding). The Gross Motor Function Classification System (GMFCS) is commonly used (Table 58–1), and an expanded and revised age-specific version is now available.5

Table 58–1Three Major Classifications for Cerebral Palsy


The prevalence estimates of CP range from 1.5 to more than 4 per 1,000 live births, making it the most common motor disability in childhood.6 Approximately 80% is due to prenatal causes (i.e., prematurity, maternal infection, and low birth weight), 10% is due to perinatal events (asphyxia), and 10% is due to postnatal causes (trauma, meningitis).7


CP is a clinical diagnosis based on a characteristic and consistent history and examination. The history should include a detailed birth history, especially gestational age, weight at birth, and any complications of pregnancy, labor, or delivery, including hypoxia, jaundice, and infections....

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