Medical History: Twins born at 26 weeks. At 5 weeks corrected; the twins are discharged home, with twin 2, the male twin, on nasogastric feeding.
Prior to discharge from the Neonatal Intensive Care, the Occupational Therapists assesses twin 2 to have abnormal General Movements (ie,
poor quality of spontaneous movement), with a profile predictive of cerebral palsy. This is despite having a normal head ultrasound, mildly
abnormal neurologic exam and no hypertonia present. At 12 weeks corrected, the General Movements assessment is repeated (since that is the
most accurately predictive time window) and twin 2 is found to have persistent abnormal General Movements, with a profile 98% predictive of
cerebral palsy. The parents are informed that twin 2 is at high risk of cerebral palsy and early intervention was recommended. The neurologist
however, reassures the mother that twin 2, had a normal head ultrasound, is growing normally, feeding well and is smiling and therefore might
not have cerebral palsy and to ‘‘wait and see.’’ The mother embraces the ‘‘good news’’ and declines early intervention. At age 2, twin 2 is
diagnosed with diplegic cerebral palsy following failed motor milestones and a magnetic resonance imaging (MRI) confirming white matter injury.
A subsequent hip radiograph reveals twin 2’s hips are both subluxing, secondary to the untreated bilateral spastic cerebral palsy.