Cerebral palsy in under 25s: assessment and management

Context

Cerebral palsy is the most common cause of physical disability in children and young people in the developed world, with a prevalence of around 2 to 2.5 per 1,000. The term describes a group of permanent, non-progressive abnormalities of the developing fetal or neonatal brain that lead primarily to disorders of movement and posture, causing 'activity limitation' and 'functional impact'.

The interaction of primary neurological and secondary physiological factors leads to challenges in terms of both early recognition of cerebral palsy and lifelong management for the person and their families. Children with cerebral palsy generally present to services in 1 of 2 ways: either by identification of atypical motor patterns in those considered at high risk because of antenatal or perinatal complications, or because of atypical motor development picked up during background population assessment.

Recognition of clinical risk and management for people with cerebral palsy change throughout their lives. Understanding the aetiology of the condition, and so minimising the risk and early impact on the brain, may directly affect lifelong outcomes.

The management of cerebral palsy is a two-pronged approach, and is provided by a variety of multidisciplinary services with a focus on maximising individual function, choice and independence. The first of these is optimising movement and posture while minimising potential secondary musculoskeletal deformity. This is dealt with by NICE guideline on spasticity in under 19s, which concentrates on the motor disorder of cerebral palsy.

The second aspect of management is recognising and intervening to address the many developmental and clinical comorbidities that are associated with cerebral palsy. This is the subject of this guideline, with particular focus on where there may be variation in practice and in patient and family experience across England and Wales. It looks at practical areas of management that are important to children and young people with cerebral palsy, their families and carers, and a wide variety of healthcare and other professionals. These include causation and recognition of cerebral palsy, prognosis and the associated developmental and clinical comorbidities.