Counselling · Intermediate · Paediatrics

Parental Counselling on Cerebral Palsy Diagnosis

Practise this PLAB 2 counselling station on Cerebral Palsy. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in primary care. Mrs Mina Kwon has brought her three-year-old daughter Lily to discuss her cerebral palsy diagnosis. Lily was diagnosed with spastic diplegia cerebral palsy at age two. She is making good progress but the parents are still adjusting to the diagnosis. Please counsel the parent on the condition, management options, multidisciplinary support, and realistic prognosis.

Background notes: PMH: Nil significant

What this station tests

  • Non-progressive nature of CP: the brain injury does not worsen over time
  • Spastic diplegia prognosis: best mobility outcomes among CP types, many walk independently or with aids
  • Multidisciplinary team coordination: physio, OT, SALT, orthotics, neurology
  • EHCP and DLA as practical support mechanisms
  • Addressing parental grief for the expected child while celebrating the actual child

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, establish what patient already knows and understands.
  • 1-3 min — Explain Condition: Explain diagnosis or condition using chunk-and-check technique. Use simple language, avoid jargon.
  • 3-5 min — Management Options: Discuss treatment options. Shared decision-making. Risks, benefits, alternatives.
  • 5-7 min — Address Concerns: Explore and address specific concerns. Check understanding. Discuss lifestyle implications.
  • 7-8 min — Closing: Summarise agreed plan. Safety netting. Arrange follow-up. Written information offer.

Consultation approach

The opening

Counselling about cerebral palsy requires explaining a lifelong condition to a parent who is grieving the loss of the child they expected. Mrs Kwon's daughter Lily (3) has spastic diplegia diagnosed at 18 months. Open with: 'Mrs Kwon, I know Lily's diagnosis has been a difficult journey. How are you and the family managing, and what questions can I help with today?'

Core approach

Explain CP in accessible terms. 'Cerebral palsy is a condition that affects how the brain controls movement. In Lily's case, spastic diplegia means the muscles in her legs are stiffer than usual, which makes walking more difficult. The brain injury that caused it happened before or around birth and does not get worse over time.' This last point, non-progressive, is critical for the parent to understand.

Address her specific concerns. Will Lily walk? Spastic diplegia has the best prognosis for mobility among CP types: many children walk independently or with aids. Physiotherapy, orthotics, and potentially botulinum toxin injections or surgery (selective dorsal rhizotomy) can improve function. Education: most children with spastic diplegia have normal cognitive ability and attend mainstream school with support.

Multidisciplinary team: physiotherapy (core), occupational therapy, speech and language (if needed), orthotics, paediatric neurology. An Education, Health and Care Plan (EHCP) will support her school needs. Disability Living Allowance and carer support should be explored.

Closing and safety netting

Provide hope grounded in reality. 'Lily is the same child she was before the diagnosis. The diagnosis helps us give her the right support. Many children with spastic diplegia achieve great things with the right therapies.' Address the comparison with typically developing sister Emma: it is natural but can be painful.

Support: Scope charity, local parent support groups, respite care options. Safety net: 'If Lily develops any new symptoms like seizures, swallowing difficulties, or regression in her abilities, come back.' Follow-up with the CP multidisciplinary team.

How examiners mark this station

Examiners will assess your ability to explain cerebral palsy and its management in a patient-centred way. Domain 2 (Clinical Management) and Domain 3 (Interpersonal Skills) are equally weighted and primary. Expect marks for accurate information delivery, shared decision-making, chunk-and-check technique, and addressing the patient's specific concerns. Domain 1 (Data Gathering) is assessed through how well you establish the patient's baseline understanding and elicit their concerns.

Domain 1 (Supporting)

Scores well: Current functional status assessed. MDT involvement checked. Family context explored.

Costs marks: Not assessing current function. Not checking support.

Domain 2 (Primary focus)

Scores well: Non-progressive explained. Mobility prognosis given. MDT team outlined. EHCP and DLA mentioned. Therapies discussed.

Costs marks: Not explaining non-progressive. No MDT. No practical support.

Domain 3 (Primary focus)

Scores well: Acknowledging grief. Providing realistic hope. Celebrating the child. Supporting the whole family.

Costs marks: Being clinical without empathy. Overly pessimistic. Not addressing sibling comparison.

Common examiner feedback (and how to fix it)

Did not provide adequate explanation or plan to the patient

Fix: Use chunk-and-check: deliver one concept, check understanding, then move to the next. Offer all relevant treatment options with risks and benefits before helping the patient decide.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: Before and during counselling, explicitly ask what concerns the patient most. Respond to emotional cues with empathic statements before continuing with information.

Common mistakes in this station

  1. Being overly pessimistic: spastic diplegia has relatively good functional outcomes
  2. Not mentioning educational support: EHCP is essential for school-age children with CP
  3. Not addressing the emotional dimension: the parent is grieving the 'typical' child they expected

Resitting PLAB 2?

If counselling stations have been a challenge, the most common issue is information overload: delivering too much clinical detail without checking understanding. Practise the chunk-and-check technique until it becomes automatic. Remember that shared decision-making, not lecturing, is what scores highly in Domain 3.

Example opening

Hello, my name is Dr [Name]. I understand you've come in today to discuss [topic]. Before I explain things, could you tell me what you've been told so far, so I know where to start?

Frequently asked questions

How do I open and run a cerebral palsy counselling station in PLAB 2?

Counselling about cerebral palsy requires explaining a lifelong condition to a parent who is grieving the loss of the child they expected. Mrs Kwon's daughter Lily (3) has spastic diplegia diagnosed at 18 months. Open with: 'Mrs Kwon, I know Lily's diagnosis has been a difficult journey.

What does a strong performance look like to the examiner in this station?

Strong performances show: Current functional status assessed. MDT involvement checked. Family context explored. Weak performances: Not assessing current function. Not checking support.

What is the biggest pitfall in this cerebral palsy station?

Being overly pessimistic: spastic diplegia has relatively good functional outcomes. Another frequent error: Not mentioning educational support: EHCP is essential for school-age children with CP.

How should I prepare for cerebral palsy if I have never seen it in practice?

This station rewards process over personal experience. The skill being assessed: Spastic diplegia prognosis: best mobility outcomes among CP types, many walk independently or with aids. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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