Screenings for adults with cerebral palsy
Cerebral palsy is a group of neurologic disorders that cause problems with movement, balance and posture. It can range from mild to severe. (MedlinePlus) The original problem with the brain does not get worse over time, but the condition can put strain on the body and cause problems such as painful joints in later life. (NHS) The NICE guideline for adults adds some checks to the usual adult schedule. This page covers screening only, not therapy, surgery or medicines for muscle tone.
The main guideline
NICE published its guideline on cerebral palsy in adults, NG119, in January 2019 and last reviewed it in September 2024. It lists conditions to look for at regular reviews, and says reviews are also a chance to deal with general health issues that come with getting older. (NICE NG119) It asks services to remove barriers to care, such as making sure there are hoists and wheelchair weighing scales and offering longer appointments if needed. (NICE NG119) A 2023 review of 64 studies of adults with cerebral palsy found pain in about 56%, and obesity, high blood pressure, asthma, epilepsy, depression and anxiety each in more than 20%. It concluded that accessible screening is needed and is not yet common practice. (Sattoe 2023) See screenings for people with disabilities.
Checks the guideline lists for adults
| Check | When | Source |
|---|---|---|
| Fracture risk check | Consider for adults with cerebral palsy | (NICE NG119) |
| DXA bone density scan | Consider with 2 or more risk factors, especially a past low-impact fracture | (NICE NG119) |
| Hip and spine X-rays | Not routinely; only with pain or a change in posture or function | (NICE NG119) |
| Weight and BMI or another body measurement | Regularly | (NICE NG119) |
| Eating, swallowing and bowel questions | At every review | (NICE NG119) |
| Breathing symptoms; spirometry | Watch for symptoms; consider spirometry if at high risk | (NICE NG119) |
| Hearing, speech and communication | Ask about changes at every review | (NICE NG119) |
| Mood, sleep and behaviour | At every review | (NICE NG119) |
| Pain | Assess with a suitable pain scale | (NICE NG119) |
| Blood pressure | As for all adults 18 and older | (USPSTF blood pressure, 2021) |
| Breast, bowel and cervical cancer screening | National programs, made accessible | (NICE NG119) |
Bones and joints
NICE says low bone mineral density is common in adults with cerebral palsy, especially in people with reduced mobility or weight bearing, people taking anticonvulsants or proton pump inhibitors, and people who have had a previous low-impact fracture. It suggests considering a check of fracture risk, looking at needing help to move or being hoisted, a history of falls, low BMI, past low-impact fractures and other medical factors. (NICE NG119) It suggests considering a DXA scan for adults with 2 or more of these risk factors, and notes that the scans can be uncomfortable and harder to read in people with cerebral palsy. (NICE NG119) See bone density test: how often and osteoporosis screening.
Bone and joint problems such as osteoarthritis, a curved spine and partly dislocated hips are more likely because of how the bones developed. NICE says not to offer X-rays to check the hips or spine unless the person is in pain or their posture or function is affected, since ongoing checks are not needed once growth is complete. (NICE NG119)
Weight, eating and swallowing
NICE says to offer a regular weight check, with BMI or another body measurement, to find people at risk of undernutrition or obesity. At every review it asks about changes in appetite, the ability to feed oneself, constipation, coughing or choking when eating, refusing food, more chest infections and longer meal times. (NICE NG119) See screenings for people with disabilities.
Blood pressure, cholesterol and blood sugar
The NICE guideline does not set a separate schedule for blood pressure, cholesterol or blood sugar in cerebral palsy. (NICE NG119) A 2023 review found high blood pressure and obesity in more than 1 in 5 adults with cerebral palsy, with high blood pressure the most often studied condition. (Sattoe 2023) The USPSTF recommends blood pressure screening for all adults 18 and older. (USPSTF blood pressure, 2021) See blood pressure readings: what they mean, cholesterol test by age and A1C and blood sugar test results.
Breathing and sleep
NICE says adults with cerebral palsy are at higher risk of breathing failure. Signs can include breathlessness, daytime drowsiness, headaches on waking, more chest infections, poor sleep and sleep apnea. It suggests considering spirometry, a breathing test, for adults thought to be at high risk. (NICE NG119) See sleep apnea screening.
Hearing, vision, mood and pain
NICE says to ask about any changes in hearing, speech and communication at every review. (NICE NG119) MedlinePlus says cerebral palsy can affect hearing and seeing, and lists a hearing screen and vision testing among the tests that may be done. (MedlinePlus encyclopedia) NICE also says to ask about mood, irritability, behaviour, social contact, sleep and general function at every review, and to adapt mental health checks to the person's communication. It says to assess pain with tools such as number or face scales and body maps, and to use observational scales when a person has difficulty communicating. (NICE NG119) See hearing tests by age, eye exams by age and mental health screenings by age.
Cancer screening
NICE says to give people with cerebral palsy information about national screening services, such as breast, bowel and cervical cancer screening, and encourage them to attend. It explains that screening services have to make arrangements so the tests are accessible, and notes barriers such as breast screening equipment for wheelchair users and cervical screening with leg spasticity. (NICE NG119) See cancer screenings by age, breast cancer screening, cervical cancer screening and colorectal cancer screening.
When to contact a provider
MedlinePlus, Cerebral palsy, when to contact a medical professional: (MedlinePlus encyclopedia)
Contact your provider if symptoms of CP develop, especially if you know that an injury occurred during birth or early infancy.
Where they differ:
- Bone density. NICE suggests considering a DXA scan for adults with cerebral palsy who have 2 or more fracture risk factors, of any sex, (NICE NG119) while the USPSTF recommends screening women 65 and older and younger postmenopausal women at higher risk, and finds the evidence insufficient for men. (USPSTF osteoporosis, 2025)
- Hip and spine X-rays. Children with cerebral palsy may have routine hip and spine X-rays, but NICE says these should stop in adults unless there are new problems with pain, posture or function. (NICE NG119)
- Heart and diabetes checks. NICE gives no extra schedule for cerebral palsy, (NICE NG119) while a 2023 review says the higher rates of these conditions call for more accessible screening. (Sattoe 2023)
- Who follows up. MedlinePlus says adults with CP should continue to follow up with a neurologist, (MedlinePlus encyclopedia) while NICE describes reviews with a GP, specialist nurse, rehabilitation specialist or therapist. (NICE NG119)
Your doctor decides what your result means for you.
Questions people ask
Should adults with cerebral palsy have a bone density scan?
NICE says low bone density is common in adults with cerebral palsy. It suggests considering a fracture risk check, and a DXA bone scan for people with 2 or more risk factors, such as needing help to move, falls, low BMI or a past fracture from a minor injury. (NICE NG119)
Are hip and spine X-rays still done every year as an adult?
No. NICE says not to offer an X-ray to check for hip displacement or a curved spine in adults with cerebral palsy unless there is pain or posture or function has changed. It notes that ongoing checks are not needed once growth is complete. (NICE NG119)
Do the usual cancer screenings apply?
Yes. NICE says to give people with cerebral palsy information about national screening such as breast, bowel and cervical cancer screening, encourage them to attend, and explain that screening services must make their tests accessible. (NICE NG119)
What is checked at a regular review?
NICE lists a regular weight check, questions about eating, swallowing and bowel changes, hearing, speech and communication, mood, sleep and behaviour, and pain, using pain scales that suit how the person communicates. (NICE NG119)
Is blood pressure checked more often?
NICE does not set a separate blood pressure schedule for cerebral palsy. A 2023 review found high blood pressure and obesity in more than 1 in 5 adults with cerebral palsy, and the USPSTF recommends blood pressure screening for all adults 18 and older. (Sattoe 2023) (USPSTF blood pressure, 2021)
Related
- Screenings for adults with muscular dystrophy
- Screenings for adults with hemophilia
- Screenings for adults with spina bifida
- Screenings for people with disabilities
- Screenings if you have epilepsy
- Bone density test: how often
- Hearing tests by age
- Cancer screenings by age
- Screenings by age and gender
- Questions to ask your doctor