Intended for healthcare professionals

Practice Guidelines

Cerebral palsy in adults: summary of NICE guidance

BMJ 2019; 364 doi: (Published 19 March 2019) Cite this as: BMJ 2019;364:l806
  1. Nathan Bromham, senior systematic reviewer1,
  2. Katharina Dworzynski, guideline lead1,
  3. Paul Eunson, chair of Guideline Committee and consultant paediatric neurologist2,
  4. Charlie Fairhurst, clinical advisor1 3
  5. on behalf of the Guideline Committee
  1. 1National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London NW1 4RG, UK
  2. 2Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK
  3. 3Evelina London Children’s Hospital, London SE1 7EF
  1. Correspondence to: P Eunson

What you need to know

  • Offer an annual review by a healthcare professional with expertise in neurodisabilities (who might be an advanced nurse practitioner, rehabilitation physician, physiotherapist, or other) to people with cerebral palsy and complex needs

  • Consider referral to speech and language therapy services and/or occupational therapy services for an assessment of functional needs and individualised support

  • Discuss factors that may exacerbate spasticity or dystonia, such as bladder problems, constipation, emotional distress, pain, and medication changes

  • Assess for risk of fractures secondary to osteoporosis in adults with cerebral palsy and specific risk factors, such as a history of falls or low body mass index (BMI)

  • Offer a regular weight check and BMI measurement due to risk of both obesity and undernutrition

Cerebral palsy is a non-progressive (though not unchanging) disorder of movement and posture pathology associated with an impairment of the developing fetal or infant brain (up to 2 years old)—when the maturation of the brain is most rapid and therefore most at risk from damage from, for example, prematurity, hypoxia, or infection. The prevalence remains at around 2-3 per 1000 live births, and most affected children live well into adult life.1 It is described in terms of topography (unilateral or bilateral), predominant motor subtype (usually spasticity and/or dyskinesis/dystonia), and severity (such as the Gross Motor Functional Classification System (GMFCS) see box 1).

Box 1

Gross Motor Function Classification System (GMFCS)2

This five-level clinical classification system describes the gross motor function of people with cerebral palsy based on their self-initiated movement abilities. People assessed as level I are the most able, and people assessed as level V are dependent on others for all their mobility needs:

  • Level I—Walks without restrictions; limitations in more advanced gross motor skills

  • Level II—Walks without assistive devices; limitations walking outdoors and in the community

  • Level III—Walks with assistive devices; limitations walking outdoors and …

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