Our orthopaedic surgeons are dedicated to improving the lives of children with cerebral palsy. Our team includes multiple fellowship-trained pediatric orthopaedic surgeons committed to providing quality care for our patients. We partner closely with our Physical Medicine and Rehabilitation (PM&R) colleagues in the management of our patients’ orthopaedic concerns. 

We also work in tandem with both our PM&R and Neurosurgery colleagues to provide a personalized approach to orthopaedic interventions before and after tone management through our Surgical Tone Intervention & Rehabilitation (STIR) Clinic. We are also committed to advancing research to improve the lives of children with cerebral palsy through the Cerebral Palsy Research Network (CPRN). Our goal is to provide a compassionate, personalized, multidisciplinary approach to treating our patients. 

If you are interested in an appointment, please reach out to our team to schedule with one of our pediatric orthopaedic surgeons. At your first appointment we will start with a comprehensive history and physical exam as well as screening diagnostic imaging (if indicated). 

Since cerebral palsy can present on a spectrum, the signs that prompt diagnosis are variable. The hallmark feature of cerebral palsy is a delay in the development of a child’s normal milestones such as sitting up (3-4 months), rolling (5-6 months), crawling (9 months), and walking (up to 18 months). For children who are more severely affected, prenatal screening ultrasounds may have identified abnormalities in the developing baby. For less severely affected children, families may notice that the child may have learning disabilities or speech delays; they may prefer using one side of the body more than the other, they may not keep up with their peers, or they have difficulties going up and down stairs. If you notice any of these signs it may be best to bring it to the attention of your child’s pediatrician.

Early diagnosis is key to getting children the appropriate resources and therapies. With early interventions, some of the milder forms of cerebral palsy can have improvements in their motor function due to the amazing capability of the developing infant brain to adapt and change in response to external stimuli – this is called neuroplasticity. 

The diagnosis of cerebral palsy oftentimes is clinical and can be identified by delays in the development of gross and fine motor milestones. For children with prenatally identified congenital malformations, they may present at birth with abnormalities in their tone. For children with milder forms and risk factors for cerebral palsy, they may have mild delays in milestones but not be able to keep up with their peers. If a clinical diagnosis of cerebral palsy is suspected but there are no risk factors identified an MRI can be obtained to look for periventricular leukomalacia (i.e. “soft” spots in the brain) or a structurally abnormal brain (i.e. congenital anomaly).  If your child is suspected of having cerebral palsy, referral to a Neurodevelopmental Pediatrician or a Physical Medicine and Rehabilitation doctor may be indicated. 

Once diagnosed, your child will be followed through their growth to identify musculoskeletal manifestations of their cerebral palsy. This could include tightness in the joints (contractures), abnormal hip development (neuromuscular hip dysplasia), and curvature of the spine (scoliosis). Contractures can be identified by physical exam. Hip dysplasia screening often requires a physical exam with x-rays performed at specific intervals depending on the severity of your child’s diagnosis. Scoliosis oftentimes can be identified on physical exam and requires routine surveillance once diagnosed to check for any increase in the size of the curve as the children grow.

Specific treatment will depend on the manifestations and how they are impacting the child’s quality of life. For young children with problems affecting their hips, knees and ankles, treatment usually starts conservatively with physical therapy and bracing. Physical therapy is helpful to stretch the tight muscles and teach children how to use their arms and legs more effectively. If physical therapy is not successful in regaining the motion in the joint applying a series of stretching casts on a weekly or biweekly interval (either with a physical therapist or their orthopaedic surgeon) may be recommended. As children get older or if the previously mentioned conservative treatments are not effective, surgery can be considered. The choice of surgery is personalized to the patient, the family, and their specific goals.

Our team has cared for many children with cerebral palsy. We have specialized expertise in both the non-surgical and surgical management of these complex patients and take a multidisciplinary approach to both treatment and research projects. We are committed to providing appropriate screening for hip dysplasia to decrease the amount of salvage procedures performed in this patient population. 

• OrthoKids - Cerebral Palsy 
• American Academy of Cerebral Palsy and Developmental Medicine 
• Cerebral Palsy Research Network