Improving Outcomes in Cerebral Palsy 

How early recognition and coordinated specialty care optimize outcomes for children with cerebral palsy 

Cerebral palsy (CP) is the most common cause of childhood physical disability and represents a group of permanent disorders of movement and posture resulting from nonprogressive injury to the developing brain. Although the underlying brain injury is static, the musculoskeletal and functional consequences evolve over time, making early recognition and longitudinal management essential. Use of standardized neurological assessments and early intervention strategies allow for earlier diagnosis and management of CP, including timely access to therapies that can optimize function, reduce complications and support families.

What Is Cerebral Palsy?

Cerebral palsy is a group of permanent disorders of movement and posture that cause activity limitation and are attributed to nonprogressive injury to the developing brain.

Key features of CP include: 

• Permanent, nonprogressive injury to the brain

• Affects movement, posture and motor development

• Results from injury to the developing brain (fetal, infant
or toddler up to 3 years)

• Often accompanied by other neurologic or systemic conditions like epilepsy, cognitive impairment, dysphagia, poor growth and orthopedic issues like scoliosis and spastic hip dislocation.

It is important to note that CP results from a nonprogressive injury to the brain, but common associated conditions and musculoskeletal complications evolve over time as the child grows.

Causes and Classification of Cerebral Palsy 

Common causes of CP include prematurity-related intraventricular hemorrhage with subsequent white matter injury, hypoxic-ischemic encephalopathy, perinatal stroke, infection, genetic or congenital brain malformations, abusive head injury and other traumatic brain injuries during infancy and toddlerhood. Incidence is highest among infants born prematurely. Understanding the underlying brain injury helps guide prognosis, surveillance and anticipatory management, as certain causes have higher risk for associated medical conditions like epilepsy and intellectual disability.

Clinical classification of CP is based on motor type and topographic distribution. Spastic CP is the most common subtype and may present as unilateral (hemiplegic) or bilateral (quadriplegic or diplegic) involvement.  Dyskinetic CP is characterized by dystonia and choreoathetosis. Ataxic CP involves impaired coordination and balance. Many children demonstrate mixed motor patterns. Functional classification systems — including the Gross Motor Function Classification System (GMFCS) — are essential tools for describing abilities, guiding care planning and facilitating interdisciplinary communication.

When to Refer 

Early referral improves access to services and family education. Timely referral to pediatric physical medicine and rehabilitation and appropriate therapy services is one of the most impactful actions that primary care clinicians can take. Referral should occur as soon as concerns regarding tone, movement quality, asymmetry or delayed milestones are identified and should not be delayed while awaiting imaging or diagnostic certainty.  Referral is appropriate when:

• Motor delay with abnormal tone is identified

• There is concern for CP in a high-risk infant

• Gait abnormalities interfere with function

• Spasticity that causes pain, hygiene issues or functional limitation

Children’s Wisconsin has a multidisciplinary approach to the diagnosis and care of patients and an array of specialty clinics available. 

Early Diagnosis of Cerebral Palsy (CP): DREAM Clinic

The Developmentally Ready: Engagement for Achievement of Milestones (DREAM) Clinic focuses on management of NICU graduates with known neurologic disorders who are at high risk to develop cerebral palsy.

Early identification of CP is critical as diagnosis can now be made with high accuracy within the first six months of life in infants with identifiable risk factors. Infants born prematurely, those with neonatal encephalopathy, stroke, intracranial hemorrhage or abnormal neuroimaging findings are at particularly high risk. The use of validated tools such as the Hammersmith Infant Neurological Examination (HINE), supplemented by MRI, improves diagnostic accuracy and reduces reliance on prolonged observation alone. This approach allows early CP-specific intervention to begin without delay and avoids the harms associated with a “wait and see” approach. Early diagnosis has been shown not only to improve motor outcomes but also to reduce parental stress and improve engagement with therapy services during a period of heightened neuroplasticity.

Key services provided in DREAM clinic:

• Advanced neuroimaging: Performed by pediatric neuroradiology with clinical input from pediatric neurology and pediatric neurosurgery

• Hydrocephalus and neonatal hemorrhage: Managed by pediatric neurosurgery

• Sensory, motor and cognitive evaluations: Provided by pediatric neuropsychology and HINE testing at 3 and 6 months of age by neonatology

• Early diagnosis of CP: Provided in collaboration with pediatric neurology and pediatric rehabilitation medicine to support timely therapy, family guidance and care planning

• Management of epilepsy: Provided by pediatric neurology

• Whole-child, whole-family support: Provided by palliative care and psychology, focusing on quality of life, symptom management and overall well-being

• Genetic counseling: Provided by genetic counselors who guide families through testing, interpretation and personalized risk assessments for genetic conditions that predispose newborns to neurologic injury

Comprehensive Management: CP Clinic, Spasticity Clinic and Equipment Clinic

There is no cure for CP, but early multidisciplinary management significantly improves outcomes.

Children with CP are at increased risk for hip displacement, contractures, scoliosis and pain. Early identification and proactive management of these conditions can reduce long-term morbidity and improve outcomes. Care is typically managed by pediatric rehabilitation medicine and orthopedic specialists. 

Spasticity Clinic

Spasticity and dystonia management may include enteral medications, injectable treatments such as botulinum toxin, intrathecal therapies and orthopedic and neurosurgical surgeries when indicated. Pediatric Rehab Medicine, Orthopedics and Neurosurgery work together to identify appropriate interventions.

• Enteral medications (Baclofen, Dantrolene, etc.)

• Injectable treatments (Botulinum toxin; Ethyl alcohol
nerve blocks)

• Intrathecal therapy (Baclofen pumps)

• Muscle and tendon lengthening surgeries

• Selective dorsal rhizotomy (sdr) for specific candidates

Equipment Clinic

Orthoses, assistive technology and adaptive equipment play a critical role in promoting mobility and independence.  Physical and occupational therapy, pediatric rehab medicine and assistive technology professionals from area durable medical equipment companies work together to identify appropriate durable medical equipment to improve function.

Cerebral palsy is a lifelong condition with evolving clinical needs, but early recognition and coordinated, multidisciplinary care can significantly improve function and quality of life. Prompt referral, accurate classification and proactive management allow providers to support children and families during critical periods of development.