Evidence map›Paper›PMID 39193394›Full record

ArticleNeurology. Clinical practice2024

Uncertainties Regarding Cerebral Palsy Diagnosis: Opportunities to Clarify the Consensus Definition.

Bhooma R Aravamuthan, Darcy L Fehlings, Iona Novak, Paul Gross, Noor Alyasiry, Ann H Tilton, Michael I Shevell, Michael C Fahey, Michael C Kruer

Abstract read
In one paragraph

Article in Neurology. Clinical practice, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

  1. Article
  2. Characteristics of Cerebral Palsy in the Midwestern US.Annals of clinical and translational neurology · 2026
    Article
  3. Observational
  4. Article
  5. Article
  6. Article
  7. Article
  8. Article
  9. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Bhooma R AravamuthanDivision of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine.ORCID https://orcid.org/0000-0003-0205-2149
Darcy L FehlingsDivision of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine.ORCID https://orcid.org/0000-0003-2680-1028
Iona NovakDivision of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine.ORCID https://orcid.org/0000-0001-6001-4867
Paul GrossDivision of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine.ORCID https://orcid.org/0000-0001-9833-169X
Noor AlyasiryDivision of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine.ORCID https://orcid.org/0000-0001-5262-1536
Ann H TiltonDivision of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine.ORCID https://orcid.org/0000-0002-3829-971X
Michael I ShevellDivision of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine.ORCID https://orcid.org/0000-0002-6383-7946
Michael C FaheyDivision of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine.ORCID https://orcid.org/0000-0003-0811-4785
Michael C KruerDivision of Pediatric Neurology (BRA, NA), Department of Neurology, Washington University School of Medicine; Holland Bloorview Kids Rehabilitation Hospital (DLF), Department of Paediatrics, University of Toronto; Faculty of Medicine and Health (IN), and Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Australia; The Cerebral Palsy Research Network (PG) Louisiana Health Science Center New Orleans (AHT), Children's Hospital of New Orleans; Departments of Pediatrics and Neurology/Neurosurgery and Montreal Children's Hospital (MIS), McGill University; Department of Paediatrics (MCF), Monash University; and Barrow Neurological Institute (MCK), Phoenix Children's, AZ; Departments of Cellular & Molecular Medicine, Child Health, Neurology and Program in Genetics, University of Arizona College of Medicine.ORCID https://orcid.org/0000-0002-1373-7891

Funding

Genomic Insights into the Neurobiology of Cerebral PalsyR01NS106298 · NINDS · UNIVERSITY OF ARIZONA · PI KRUER, MICHAEL C · 2019 to 2023
$3.7M
Genomic analysis of the Multiplex, Autozygous Populations in Cerebral Palsy (MAP CP) cohort: a focused approach to a complex diseaseR01NS127108 · NINDS · UNIVERSITY OF ARIZONA · PI Michael C Kruer · 2023 to 2026
$2.6M
NINDS NIH HHS R01 NS106298NINDS NIH HHS R01 NS127108
6 · The paper itself

Abstract

Background and Objectives: We have established that physicians, including neurologists, variably diagnose cerebral palsy (CP) when using the most recent CP definition from 2006. We also know that child neurologists and neurodevelopmentalists view themselves to be optimally suited to diagnose CP based on their training backgrounds. Therefore, to reduce variability in CP diagnosis, our objective was to elucidate uncertainties child neurologists and neurodevelopmentalists may have regarding practical application of the 2006 definition. Methods: We conducted a cross-sectional survey of child neurologists and neurodevelopmentalists built into a discussion seminar at the 2022 Child Neurology Society (CNS) Annual Meeting, the largest professional meeting of these specialists in North America. Seminar attendees were provided the 2006 definition and asked whether they had any uncertainties about the practical application of the definition across 4 hypothetical clinical vignettes. A group of national and international CP leaders then processed these data through iterative discussions to develop recommendations for clarifying the 2006 definition. Results: The seminar was attended by 50% of all conference attendees claiming CME (202/401). Of the 164 closing survey respondents, 145 (88%) expressed uncertainty regarding the clinical application of the 2006 definition. These uncertainties focused on 1) age, both regarding the minimum and maximum ages of brain disturbance or motor symptom onset (67/164, 41%), and 2) interpretation of the term "nonprogressive" (48/164, 29%). Almost all respondents (157/164, 96%) felt that we should revise the 2006 consensus definition of CP. Discussion: To address the most common CP diagnostic uncertainties we identified, we collectively propose 4 points of clarification to the 2006 definition: 1) motor symptoms/signs should be present by 2 years old; 2) CP can and should be diagnosed as early as possible; 3) the clinical motor disability phenotype should be nonprogressive through 5 years old; and 4) a CP diagnosis should be re-evaluated if motor disability is progressive or absent by 5 years old. We anticipate that clarifying the 2006 definition of CP in this manner could address the uncertainties we identified among child neurologists and neurodevelopmentalists and reduce the diagnostic variability that currently exists.

Identifiers

PMID39193394
PMCPMC11347036

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.