2.4.1. Groups that will be covered

This guideline covers the following groups:

• Children and young people, from birth up to their 25th birthday, who have cerebral palsy.
• Subgroups to be considered:

  • recognised subgroups within the cerebral palsy population, depending on level of cognitive disability and functional disability (for example, Gross Motor Function Classification System levels I to V), and age ranges will be considered where appropriate.

2.4.2. Key clinical issues that will be covered

The following clinical issues are covered in this guideline:

• Diagnosis and assessment
  • Determining the key clinical and developmental manifestations of cerebral palsy at first presentation in order to help with early recognition.
  • Identifying risk factors for cerebral palsy that may:

    • inform the need for enhanced surveillance
    • help in diagnosing the underlying cause of cerebral palsy
    • facilitate early intervention.
  • Identifying the key information to be obtained from history and examination, including developmental screening to help in determining the underlying cause of cerebral palsy.
  • Identifying ‘red flags’ that might suggest a neurodevelopmental disorder other than cerebral palsy, such as progressive neurological or neuromuscular disorders.
  • Determining the potential value of MRI of the brain in cerebral palsy.
  • The prognosis for children and young people with cerebral palsy in relation to:

    • ability to walk
    • ability to talk
    • life expectancy.
  • Identifying common and important comorbidities associated with cerebral palsy and the subgroups most at risk of these comorbidities.
  • Determining an effective approach to investigating difficulties with eating, drinking and swallowing in children and young people with cerebral palsy, including:

    • clinical observation
    • videofluoroscopic swallow studies and fibroscopic endoscopy.
• Interventions
  • Managing mental health problems in children and young people with cerebral palsy.
  • Determining the effectiveness of interventions in tackling communication difficulties in children and young people with cerebral palsy.
  • Determining the effective management of difficulties with eating, drinking and swallowing in children and young people with cerebral palsy.
  • Determining the effective management of difficulties with saliva control (drooling) in children and young people with cerebral palsy.
  • Nutritional management in children and young people with cerebral palsy.
  • Assessing and managing pain, discomfort, distress and sleep disturbance in children and young people with cerebral palsy.
  • Interventions to reduce the risk of reduced bone mineral density and low-impact fractures in children and young people with cerebral palsy.
  • Managing difficulties associated with the processing of sensory and perceptual information in children and young people with cerebral palsy.
  • Identifying social care needs that are specific to children and young people with cerebral palsy and their family members and carers.
  • Communication, information and support needs that are specific to children and young people with cerebral palsy and their family members and carers.
  • The role of the multidisciplinary team in the care of children and young people with cerebral palsy.
  • Aspects of the transition from paediatric to adult health services that are specific to the needs of young people with cerebral palsy and their family members and carers.

Note that guideline recommendations will normally fall within licensed indications. Exceptionally, and only if clearly supported by evidence, use outside a licensed indication may be recommended. This guideline will assume that prescribers will use a drug’s summary of product characteristics to inform decisions made with individual patients.

For further details please refer to the scope in Appendix A and review questions in Appendix D.

2.5.1. Groups that will not be covered

This guideline does not cover:

• Adults 25 years and older.
• Children and young people with a progressive neurological or neuromuscular disorder.

2.5.2. Clinical issues that will not be covered

This guideline does not cover:

• Management of spasticity and co-existing motor disorders.
• Skin care, including management of pressure ulcers.
• Laboratory investigations for progressive neurological and neuromuscular disorders.
• Management of cognitive impairment and learning difficulties.
• Management of bladder dysfunction (urinary retention and incontinence) and bowel dysfunction (constipation and soiling).
• Management of gastro-oesophageal reflux disease.
• Management of respiratory complications such as pulmonary aspiration.
• Management of visual and hearing impairment.
• Management of epilepsy.

2.6.1. Related NICE guidance