CP is a general term given to a wide variety of nonprogressive diseases and pathologies causing movement and balance disorder in the child. The clinical picture ranges from very mild to very severe depending on the extent of the CNS lesion. This wide spectrum of clinical findings makes it difficult to predict prognosis. Predicting prognosis forms the basis of management. The parents want to know about the prognosis of their child in order to shape their lives in the years to come. The physicians and therapists want to know about the prognosis in order to make sound treatment decisions.

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The natural history

The brain lesion is nonprogressive and cannot be cured; however, the clinical picture changes as the child grows. This change is caused by the growth and maturation of the CNS and the musculoskeletal system. A small percentage of children who show signs of neuromotor developmental delay in infancy outgrow their impairments and become completely normal gradually. Others are left with neurological impairments ranging from mild to severe. Early intervention programs with exercises directed to minimize the neurological impairment exist, but because of the changing nature of the condition and the potential for the CNS to heal, it is not possible to tell whether the improvement is because of therapy or the ongoing CNS development.

Predicting functional prognosis

It is easier to predict a functional prognosis once the clinical picture is established. Many factors affect function.

Factors affecting prognosis

• Reflexes (a,b)
• a. Absence of Landau, parachute sign
• b. Presence of Moro, ASTNR, STNR
• Timing of achievement of developmental landmarks
• Severity of involvement by the GMFCS
• Degree of intellectual involvement
• Sensory function, perception
• Motivation to move, interest to explore
• Family compliance
• Environmental factors
• Language/communication
• Body awareness
• Praxis (the planning and execution of movement)
• Behavior/cooperation
• Medical problems

Walking is usually possible between 2 to 7 years of age. Approximately 85% of partially involved children have the potential to become independent ambulators compared to only 15% of severely involved. Certain criteria help the physician determine prognosis in the young child.

Some major events in motor control have to occur in order for a child to walk. He must be able to hold his head before he can sit, and he must be able to sit independently before he can walk on his own. In children between 5 to 7 years of age it is easier to determine prognosis. The child with severe developmental delay who can not stand by age 5 to 6 is not going to walk. The Gross Motor Function Classification System is useful after age 2 years to determine prognosis.

Spastic hemiplegic and diplegic children with good cognitive function generally become independent walkers and productive members of the community. Most spastic hemiplegic children are able to become independent adults even without therapy. Diplegic children need treatment. Physiotherapy, bracing, and efficient spasticity anagement result in a more efficient gait with less contracture formation in diplegics. However, most of them still need orthopaedic surgery in childhood or adolescence. Approximately 85% of total body involved children are unable to walk even indoors. They remain fully dependent on a caregiver and require assistive devices, special housing arrangements and continuous care. Physiotherapy, bracing, and drug treatment do not result in functional gains in athetoid or dystonic patients. Mild cases use assistive devices and mobility aids to ambulate, and severely involved children remain totally dependent.