Cerebral palsy (CP) is the most common childhood physical disability. But while it is typically diagnosed when a child is between 1 and 2 years old, many babies would benefit from much earlier interventions—especially in the first year, when the brain is best at forming new connections.
To foster this earlier treatment, a team at Children’s Hospital Los Angeles has launched a pilot program to better identify infants at high risk of CP. The program incorporates special assessment tools that help the team detect the signs of CP in babies as young as 3 months.
“These tools can’t specifically diagnose cerebral palsy in a baby that young,” says Hoda Karbalivand, MD, an Attending Neonatologist at Children’s Hospital Los Angeles. “But they can show us which babies are at high risk and in need of early therapies. That’s important because early intervention can make a big difference in a child’s functional abilities over the long term.”
Optimizing outcomes for babies
The pilot program, part of the Fetal and Neonatal Institute at CHLA, is focusing on a particularly vulnerable group of infants: those with bronchopulmonary dysplasia (BPD), a chronic lung disease that affects premature babies.
“Babies with BPD have an 8% to 40% risk for cerebral palsy, depending on their gestational age and other factors,” Dr. Karbalivand notes. “This is a population where we know the risk is high, so we want to look for signs as early as possible.”
The program aligns with early CP detection guidelines from the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM). It involves the use of two assessment tools, which are used by specially trained neonatologists, developmental-behavioral pediatricians, and physical and occupational therapists:
- General Movements Assessment (GMA). In this video test, providers observe a baby lying on his or her back while calm and alert. Providers look for abnormal spontaneous movements—such as cramped-synchronized movements or the absence of the typical “fidgety movements” babies make at 3 to 5 months of age.
- Hammersmith Infant Neurological Examination (HINE). This standardized neurological exam generates a score based on 26 measures evaluating a baby’s nerve function, movements, reflexes, reactions, posture, and tone.
The screenings begin before infants with bronchopulmonary dysplasia (BPD) even reach term-corrected age—often while they are still in the Steven & Alexandra Cohen Foundation Newborn and Infant Critical Care Unit (NICCU) at CHLA.
The team discusses each patient’s CP risk during its weekly multidisciplinary BPD rounds, part of CHLA’s Infant Chronic Lung Disease Program. Dr. Karbalivand evaluates testing alongside the team’s therapists and shares findings with families.
“It’s very helpful to have these discussions with families early on, before a baby even leaves the hospital,” Dr. Karbalivand says. “It allows us to not only optimize the child’s outcomes, but it also enables families to access the psychosocial support and resources they need.”
Comprehensive follow-up
The assessment tools are also integrated into the Newborn Follow-up Program, which provides ongoing, comprehensive care for babies who have been discharged from the NICCU.
Studies have shown that early interventions for CP can improve motor and cognitive outcomes for children and reduce complications such as hip dislocation and spasticity, says Douglas Vanderbilt, MD, MS, MBA, Chief of the Division of Developmental-Behavioral Pediatrics at CHLA.
He notes that the tools are one more enhancement to the Newborn Follow-up Program’s comprehensive, interdisciplinary approach to care, which includes social workers and psychologists who evaluate infant-family mental health after a baby’s hospitalization.
“This is part of a suite of evidence-based resources we provide to monitor a child’s development, enhance mental health, and connect families to community resources,” says Dr. Vanderbilt, who holds the Las Madrinas Chair of Developmental-Behavioral Pediatrics at CHLA.
The early CP monitoring tools have also been implemented in close collaboration with county and community partners. That effort has been led by Stacey Dusing, PhD, PT, FAPTA, of the Keck School of Medicine of USC, who began the project two years ago.
“This is a community-based approach, and we collaborate very closely with community programs that can supplement therapies and services for our patients,” Dr. Vanderbilt says, adding that the team also works closely with Beth Smith, PhD, DPT, Director of the Infant Neuromotor Control Laboratory, and with pediatric neurology and orthopedic specialists at CHLA.
“Together, we focus on the whole child and family, as well as the community perspective,” he adds. “The goal is to help each child develop to the fullest of their potential.”
