Understanding Cerebral Palsy Treatment
The purpose of treatment for cerebral palsy is to promote the most normal, manageable and healthy life possible.
This is accomplished through treatments that allow people with cerebral palsy to maximize their independence in daily life.
The type of treatments used depends on the patient’s:
- Type of cerebral palsy
- Location of movement problems
- Level of disability
- Co-occurring conditions
No two people receive the same treatment for cerebral palsy. Treatment encompasses short-term and management approaches to all the specific conditions that a child may face. This could involve medications, physical therapy, surgery and more.
Considerations Before Starting Treatment
The needs of a child with cerebral palsy aren’t solely based on correcting their physical disabilities. There are also social and emotional aspects of living a more fulfilling life. These aspects shouldn’t be ignored when considering treatment and therapy.
Many children are content with their disabilities. As a parent, it’s important to consider their feelings. Some treatments can be stressful and uncomfortable, and may not be in the best interest of the child. It’s important to discuss the physical and emotional impacts of all treatments with specialists and most importantly, the child.
Knowing the Specialists
Managing all aspects of a child’s unique diagnosis is essential for successful comprehensive treatment. Well-rounded treatment approaches require a team of multidisciplinary specialists, usually with a pediatrician at the center of the group.
Pediatricians are generalists who manage the treatment plan, recognize specific issues and recommend specialists who can treat those issues. Each specialist uses ongoing treatment and assessments to ensure that all areas of the child’s development are proceeding as normally as possible.
Types of specialists a child with cerebral palsy may require include:
- Developmental pediatrician
- Physical therapist
- Occupational therapist
- Behavioral therapist
- Speech and language therapist
- Ophthalmologist (eye specialist)
- Otolaryngologists (ear, nose and throat specialist)
Physical therapy is typically the first, and most important, step toward treating cerebral palsy. It usually begins at a young age and is geared toward improving independent motor function. The types of physical therapies used for children depend on their specific movement problems and symptoms that coincide with cerebral palsy.
Physical therapy can improve:
Before physical therapy begins, the therapist takes an assessment of the child’s motor capabilities. This helps determine the most appropriate measures for therapy. After evaluating the child, the therapist will prescribe strength training exercises, stretches and muscle relaxing techniques based on the child’s needs.
Exercise equipment includes weights, resistance bands, balance balls and machines to improve muscle tone. Hot and cold packs are often used to help relax and heal muscles.
Scoliosis (spinal curvature) and shortened achilles tendons are some specific movement and posture issues that are treated with physical therapy. Physical therapy is an important prevention measure, as these issues can get worse over time. Proper treatment of the above conditions can also improve the chance of a child walking independently.
Many specialists recommend starting physical therapy as early as possible to prevent future complications like contractures—a shortening of muscles and tendons that can be painful and is common in spastic cerebral palsy. Strength training exercises are also helpful for children with dyskinetic cerebral palsy who have loose muscles and may experience atrophy.
Orthotics are devices used to train major muscle groups and are often a part of physical therapy. Splints, braces and casts may be used to assist children with high or low muscle tone. For example, children with scoliosis are often fitted with a plastic brace to correct curvature of the spine as they grow. These devices encourage mobility, balance and proper growth.
Occupational therapy helps children with cerebral palsy improve fine motor skills. In general, physical therapy is used to improve gross motor function, but it doesn’t focus on fine motor function. People with cerebral palsy struggle with coordinating these skills for tasks such as grasping a spoon and bringing it to their mouth. But occupational therapists often work with physical and speech therapists to build a complete therapy plan.
Occupational therapists evaluate a child’s needs by testing his or her fine motor skills, perception and oral motor skills. By observing how the child responds to touch and movements, the therapist can determine a treatment plan. The treatment plan typically involves positioning, reaching, grasping and releasing.
Occupational therapy can help with activities such as:
- Picking up small objects
- Fastening zippers
- Opening jars
- Using scissors
These skills are important for a child to develop the ability to be independent. Occupational therapy for children usually involves a form of play to keep them motivated.
Many children with cerebral palsy have sensory impairments that make movement difficult. Our senses help us recognize changes in temperature, feel pain and to be aware of the space around us. Senses, such as touch and balance, are important for motor skills like picking up objects and walking.
Other senses, such as proprioception, allow people to know the location of their own body parts; being able to touch your finger to the tip of your nose is an example of the proprioceptive sense. Sensory impairments make it hard to develop movement skills, and occupational therapists help children work through these impairments.
Birth injuries can also affect the parts of the brain that control speech and the muscles that allow us to speak. Many children with CP have issues with speech due to their birth injury. Speech therapy can teach children how to pronounce certain words and communicate more effectively.
Speech therapists can diagnose speech issues and help improve language skills. They can also help with other skills, such as breathing and eating, because these issues involve the muscles in the mouth and face.
Speech therapy also tackles problems that affect a child’s ability to eat. Many children with CP struggle to maintain a healthy weight because it’s hard to chew or swallow food. Oral motor exercises can improve the ability to chew and swallow food effectively.
Speech therapists also work with other therapists. For example, a speech therapist and an occupational therapist can help children with drooling problems due to low muscle tone in the face and mouth.
People with cerebral palsy are often prescribed various medications to help manage their condition. Medications can help manage both movement issues and secondary conditions that develop due to cerebral palsy. The types of medications to treat these conditions range from antidepressants for seizures to nerve blocks for spasticity. To prevent unnecessary side effects, doctors weigh the pros and cons of these medications before prescribing them.
Common conditions treated with medication include:
- Involuntary movement
- Gastroesophageal (acid) reflux
There are multiple surgical treatments that can help correct movement problems in children with cerebral palsy. However, parents should keep in mind that surgery isn’t right for every child with cerebral palsy.
Surgery is most commonly prescribed for those with spastic cerebral palsy because their increased muscle tone can be reduced to relieve restricted movement. For example, a child who walks on their toes due to high muscle tone in their legs can have those muscles or tendons lengthened, allowing for more normal walking.
Surgeries that can improve mobility in children with high muscle tone include:
- Muscle and tendon lengthening – A procedure used to correct contracted muscles or tendons, freeing up movement to walk or use hands.
- Tendon transfer – Transferring tendons from one bone to another is intended to give better alignment and motor control, especially in the feet and ankles.
- Tenotomy/myotomy – Cutting the tendon/muscle can relieve pain and restrictive movement caused by contractures—a permanent tightening of tendons or muscles.
- Neurectomy – Cutting the nerve that controls a specific muscle group can reduce spasticity or rigidity in that area. It is generally used to correct hip dislocations.
- Osteotomy – A procedure to realign joints by removing part of the bone.
- Arthrodesis – Fusing two bones together can produce stability in some cases.
- Selective dorsal rhizotomy – This aggressive procedure involves cutting specific nerves in the spinal column to correct spasticity in various muscle groups throughout the body.
Surgery is most effective when the child is old enough that doctors can determine where their movement issues are stemming from but young enough that there is still time to correct movement. This window is usually between 3-8 years of age.
Surgery may also be used to treat other conditions associated with cerebral palsy, such as hearing impairment and difficulties with feeding.