What are the essential components of a routine checkup for an adult with cerebral palsy (CP)?

Essential Components of a Routine Checkup for Adults with Cerebral Palsy

Adults with cerebral palsy require comprehensive neurologic surveillance to monitor for new conditions, prevent complications, and optimize quality of life. 1 The routine checkup should focus on identifying both CP-related complications and general health issues that may be exacerbated by the underlying condition.

Neurological Assessment

• Motor Function Evaluation:

  • Document changes in spasticity, dyskinesia, ataxia, or mixed movement patterns 2
  • Assess for new-onset neurological symptoms that could indicate secondary complications like stroke or myelopathy 1
  • Evaluate for signs of deterioration in functional abilities compared to baseline

• Pain Assessment:

  • Systematically evaluate for chronic pain (affects up to 75% of adults with CP) 2
  • Document location, intensity, frequency, and impact on daily activities
  • Distinguish between musculoskeletal pain and neuropathic pain

• Cranial Nerve Examination:

  • Assess for visual field changes or sixth cranial nerve (abducens) dysfunction that could indicate increased intracranial pressure 3
  • Evaluate pupillary responses and check for anisocoria 3
  • Screen for signs of facial weakness or asymmetry that might indicate Bell's palsy 4

Musculoskeletal Assessment

• Joint Evaluation:

  • Assess range of motion in all major joints, particularly hips, knees, and ankles 5
  • Document contractures and compare to previous examinations
  • Check for hip pain or signs of dislocation, which are common secondary problems 2

• Spine Assessment:

  • Evaluate for scoliosis, kyphosis, or lordosis
  • Check for signs of spinal cord compression or tethering
  • Document any changes in posture or trunk control 5

• Functional Mobility:

  • Assess current mobility status and any changes since last visit
  • Document use of assistive devices and their appropriateness
  • Consider formal functional classification using standardized tools 2

Associated Conditions Screening

• Seizure Evaluation:

  • Document seizure frequency, type, and medication efficacy
  • Assess for new-onset seizures, which may require neuroimaging 2

• Cognitive Assessment:

  • Screen for changes in cognitive function
  • Evaluate for signs of depression or anxiety, which are common comorbidities 2

• Gastrointestinal Evaluation:

  • Assess nutritional status and weight changes
  • Screen for dysphagia, gastroesophageal reflux, and constipation
  • Evaluate feeding methods and their effectiveness

• Respiratory Assessment:

  • Check for signs of aspiration or recurrent respiratory infections
  • Evaluate breathing patterns and respiratory muscle strength
  • Screen for sleep disorders, which affect 23% of individuals with CP 2

Sensory System Evaluation

• Vision:

  • Comprehensive eye examination including visual acuity, pupil defect assessment, and fundus examination 3
  • Screen for visual field defects and strabismus 4

• Hearing:

  • Screen for hearing impairment (affects approximately 4% of individuals with CP) 2
  • Assess impact of hearing issues on communication

Functional Assessment

• Activities of Daily Living:

  • Evaluate independence in self-care activities
  • Assess for changes in functional abilities that might indicate deterioration
  • Document equipment needs and home modifications

• Communication:

  • Assess speech and language abilities
  • Evaluate effectiveness of augmentative communication devices if used
  • Screen for changes in communication abilities

Preventive Care

• Bone Health:

  • Screen for osteoporosis, which is common in adults with CP
  • Consider bone density testing based on risk factors 2

• Skin Integrity:

  • Examine for pressure ulcers, particularly in non-ambulatory patients 2
  • Assess skin care routines and equipment needs

• Cardiovascular Health:

  • Monitor blood pressure (note that values may be lower than in the general population) 4
  • Screen for cardiovascular risk factors

Diagnostic Testing Considerations

• Neuroimaging:

  • Consider MRI if there are new neurological symptoms or significant changes in function 4
  • MRI is preferred over CT for detecting most neurological conditions in CP 3

• Laboratory Testing:

  • Avoid routine laboratory testing without specific indications 4
  • Consider targeted testing based on symptoms and risk factors

Follow-up Planning

• Referral Guidelines:

  • Refer to specialists for new or worsening neurological findings 4
  • Consider referral for incomplete recovery from acute conditions after 3 months 4
  • Establish multidisciplinary care coordination as needed

• Monitoring Schedule:

  • Annual comprehensive evaluations at minimum
  • More frequent assessments during periods of rapid change or after interventions 5
  • Establish clear communication channels for new or concerning symptoms

Common Pitfalls to Avoid

1. Attributing all symptoms to CP: New neurological symptoms should not be automatically attributed to the underlying CP diagnosis; they may indicate new, treatable conditions 1

2. Overlooking pain: Pain is often underreported and undertreated in adults with CP despite affecting a majority of patients 2

3. Focusing only on motor issues: Non-motor aspects of CP (cognitive, sensory, gastrointestinal) significantly impact quality of life and require equal attention

4. Inadequate transition from pediatric to adult care: Ensure continuity of specialized care into adulthood, as many adults with CP lose access to appropriate neurological care after transition 1

5. Missing secondary complications: Proactively screen for common secondary issues like osteoporosis, contractures, and mental health conditions rather than waiting for symptoms to develop

By systematically addressing these components during routine checkups, clinicians can help adults with cerebral palsy maintain optimal function, prevent complications, and improve quality of life.