Cerebral palsy: a clinical approach.

Spastic cerebral palsy remains a therapeutic challenge. Diagnosis, usually possible within the first year of life, is straightforward. However, its uncertain etiology frustrates attempts at prevention and its poorly defined prognosis defies attempts to evaluate therapeutic effectiveness. Treatment must be directed toward both medical and habilitation issues. The syndrome of spastic cerebral palsy includes an increased risk of multiple medical problems. These must be followed and treated as needed. Habilitation needs are more difficult to define, thus demanding open communication between families and physicians for goal setting. Once goals are defined a comprehensive management program must be devised, choosing from several available approaches. No "right" answers exist; the only overriding concern remains to promote optimal independence through the developmental years and on into adulthood.