Cerebral palsy

May come up as a long case; it is unlikely as a short case. If unlucky, you will be shown a video of the gait of a cerebral palsy patient near the end of the paediatric oral and asked to describe it.

Try to minimize moving backwards and forwards from the couch to reduce distress to the patient and look as though you have a system:

• General

• Standing

• Walking

• Supine on couch

• Lateral position on couch

• Prone on couch

General

Comment on the presence of wheelchairs, walking aids, gastrostomies, nappies, braces and orthotics, e.g. KAFOs, AFOs, spinal braces.

Look at pattern of involvement

• Monoplegic

• Hemiplegic

• Diplegic (lower limbs affected more than upper)

• Paraplegic (arms not affected)

• Quadriplegic

• Total body

Cerebral palsy can also be classified according to type:

• Spastic (60%)

• Athetoid (20%)

• Ataxic

• Hemiballismic

• Hypotonic

• Combination

Standing

• Ask whether the patient is able to stand first

• Look from behind, from the side and from the front for obvious deformities, e.g. obvious joint contractures, adduction of the hip, shortened leg, equinus and varus or valgus feet

• Note stability when the child is gently pushed forwards, backwards and from side to side (predicts the need for support when walking)

• Spine: is there a fixed scoliosis? Adams' test (bending over)

• Pelvic obliquity: if there seems to be a limb length discrepancy, use blocks to even up the pelvis and look from behind

Walking

• Look and describe walking in three planes

1. Sagittal: from the side

2. Transverse: from the front

3. Coronal: imagine looking from above