Question
A newborn at a few months old has been noticed by the parents to have a reduced response to external stimuli, and by four months old, has not yet learned to roll over. The parents are concerned, have not yet sought medical attention, but suspect it may be cerebral palsy.
Answer
The main manifestations of pediatric cerebral palsy include increased muscle tone, particularly an increase in flexor tone, with the adductor muscle groups of the lower limbs being particularly apparent. The child finds it difficult to abduct the thighs, and the knees are not easily bent or straightened due to the contraction of the gastrocnemius muscles. When the child is upright, both lower limbs appear straight, adducted, and internally rotated, resembling a scissor-like shape. While walking, a ‘scissor gait’ is present with the toes touching the ground. The features of the upper limbs include flexion of the elbows and wrists. The affected limb shows typical upper motor neuron spasticity, hyperreflexia, and pathological reflexes.