Prediction of cerebral palsy and cognitive delay among high-risk children in a developing nation: A successful early detection programme

Abstract

Therapy for children with cerebral palsy (CP) and other developmental disabilities is most effective if started early in life. Targeting therapy early requires detection programs that are appropriate for the resources that are available. In high-income, predominantly western countries, it is recommended that brain MRI and serial examinations be used to predict CP. However, in low- and middle-income countries (LMICs), there is often limited access to MRI, and repeating developmental assessments over time is difficult. With the majority of children with CP and other developmental disabilities living in LMICs, it is important to perform early detection research in LMICs to provide practical recommendations, useful in various clinical settings.

We integrated the General Movements Assessment (GMA) and Hammersmith Infant Neurological Examination (HINE) in the routine follow-up of 201 Sri Lankan infants at risk for CP. In a busy neurology clinic, the GMA was done twice, at approximately term to assess for writhing movements and at 3 to 4 months to assess fidgety movements. The HINE was done at approximately 5 to 6 months. At 2 years of age, a neurological examination was done to determine whether the child had CP. In addition, the Bayley Scales of Infant and Toddler Development was also done at 2 to 3½ years of age to detect non-CP developmental disorders.