Cerebral palsy surveillance and multidisciplinary management — formative SAQs

SAQ 1 — Classification and hip surveillance (10 marks)

A 6-year-old with bilateral spastic cerebral palsy is GMFCS IV. The parent asks why “another hip X-ray” is needed when the child is not complaining of pain. No orthopaedic appointment is booked. ^{[3] [8] [10]}

Questions

1. Define cerebral palsy in one consensus sentence and name three classification layers you will state in a viva. (3 marks) ^{[1] [3]}
2. Explain why hip surveillance intensity rises with GMFCS and what population programmes have shown. (4 marks) ^{[8] [9]}
3. Outline three actions that close the loop after today’s visit. (3 marks) ^{[10] [18]}

Model answer

Definition and layers (3). Cerebral palsy is a permanent disorder of movement and posture causing activity limitation, attributed to non-progressive disturbances in the developing fetal or infant brain, often with associated sensory, cognitive, communication, behavioural, epilepsy and secondary musculoskeletal problems. State motor type, topography and GMFCS (add MACS/CFCS/EDACS when relevant). ^{[1] [3]}

Hip risk and programmes (4). Hip displacement risk increases as GMFCS level rises; non-ambulant children (especially IV–V) are highest risk and may be asymptomatic until late. Population surveillance with timely surgery (Hägglund) reduces dislocation. Australian hip surveillance guidelines stratify radiographic follow-up by GMFCS and age — absence of pain does not cancel surveillance. ^{[8] [9] [10]}

Close the loop (3). Obtain or schedule the indicated radiograph; name an owner and review date; refer orthopaedics if migration or exam is deteriorating; update the medical-home problem list and safety-net new pain or reduced abduction. ^{[10] [18]}