Cerebral Palsy Prognosis

The first questions usually asked by parents after they are told their child has cerebral palsy are "What will my child be like?" and "Will he walk?" Predicting what a young child with cerebral palsy will be like or what he will or will not do (called the prognosis) is very difficult.

Any predictions for an infant under six months of age are little better than guesses, and even for children younger than one year it is often very difficult to predict the pattern of involvement. By the time the child is two years old, however, the physician can determine whether the child has hemiplegia, diplegia, or quadriplegia. Based on this involvement pattern, some predictions can be made. It is worth saying again that children with cerebral palsy do not stop doing activities once they have begun to do them. Such a loss of skills, called regression, is not characteristic of cerebral palsy.

If regression occurs, it is necessary to look for a different cause of the child's problems. In order for a child to be able to walk, some major events in motor control have to occur. A child must be able to hold up his head before he can sit up on his own, and he must be able to sit independently before he can walk on his own. It is generally assumed that if a child is not sitting up by himself by age 4 or walking by age 8, he will never be an independent walker. But a child who starts to walk at age 3 will certainly continue to walk and will be walking when he is 13 years old unless he has a disorder other than Cerebral Palsy.

It is even more difficult to make early predictions of speaking ability or mental ability than it is to predict motor function. Here, too, evaluation is much more reliable after age 2, although a motor disability can make the evaluation of intellectual function quite difficult. Sometimes "motor-free" tests which can assess intellectual ability without, the person being tested, needing to use his hands are administered by psychologists who have expertise in their use. Overall, the intellectual ability of the person, far more than their physical disability, will determine the person's prognosis. In other words, mental retardation is far more likely than cerebral palsy to impair a child's ability to function.