Li Zizhong


Cerebral palsy is a non-progressive brain damage caused by various factors during the period from antenatal life to one month after birth. An early diagnosis and treatment within 6 months after birth can expect a very different prognosis.
Clinically, it is marked by retarded motor development, muscular tension and abnormal posture, paleokinetic reduction and reflex abnormality. Generally an infant affected with cerebral palsy is difficult to diagnose, only in the affected infant with more serious spastic cerebral palsy can the diagnosis be made in neonatal period, as manifested by extensor hypertonia (generally flexor predominates in normal new-borns), straightened lower limbs in supine position, difficulty in abduction, sometimes opisthotonos position, elbow flexion, and tight grasp of both hands. But most of the affected infants with spastic cerebral palsy have hypomyotonia and hypoactivity in varying degrees. The occurrence of dysthelasia, poor reaction to looking for food, overquietness or high liability to cry and make a noise and a long-time cry needs to bring to people's attention.
Infants with cerebral palsy within 6 months of their life have a period of transition from hypomyotonia to hypermyotonia (which increases with month for normal infants and their flexor tension gradually becomes normal from the higher state), the examination of adductor angle, popliteal angle, dorsal flexor angle of feet and heel-ear touch test may help to understand the muscular tension of lower

Author's unit: Guangdong Gaoming Medical and Medicinal Institute of Encephalopathy, Gaoming, Guangdong 528500

limbs, the examination of muffler sign may help to understand the muscular tension of upper limbs, and the muscular tension can also be assessed according to the infant's posture
in space. A normal 2-3 months old infant can
raise his (her) head, whereas the cervical hypomyotonia of a same old infant with spastic cerebral palsy causes him (her) to hang down his (her) head. When in upright position by holding his (her) axillary fossa, a normal infant has flexible lower limbs, whereas an affected infant with hypermyotonia has straightened, adducted and scissors-like lower limbs.
When lying in bed, a normal infant 3-5 months old often raises his (her) both hands to somewhere before his (her) eyes to play with his (her) hands repeatedly; but an affected infant with cerebral palsy has no such an action. If an infant shows a hand open and makes the other hand tightly grasped, the tightly grasped side indicates abnormality. A 3-month-old normal infant can raise his (her) head in prone position and when in 6 months of his (her) life, he (she) can sit alone for a short while; however, the infant affected with cerebral palsy can accomplish neither of the both. In addition, the infant affected with cerebral palsy shows abnormalities in tonic labyrinthine reflexes, asymmetrical neck-limb reflexes and passive supporting reflexes. The affected infant is marked by over excitation to external stimulation, continuous cry and shout, and difficulty in falling asleep; by fright reaction to sudden appearance of sound or postural change; and by difficulty in breaking off hands at taking a bath and the instant stiff opisthotonos posture on touching the bathtub or water with lower limbs. When in upright position, a normal infant can hold up his (her) head in one month of his (her) life and keep median position as far as possible with left or right inclination of body in 4 months of life; whereas an infant affected with cerebral palsy does not show the above-mentioned protective reflex.
The diagnosis of cerebral palsy can also be based on the examination of CT and magnetic resonance imaging (MRI) to understand the presence or absence of structural abnormalities in brain. The etiological factors of cerebral palsy are very complicated, and yet there is no way to make a definite diagnosis based on cause of disease.