Cerebral palsy (CP) refers to a group of neurological disorders that affect movement and co-ordination. CP is caused by brain damage or abnormalities in brain development before, during, or after birth.
Physiotherapy is one of the most important therapies for CP to help restore muscle strength, range of motion, balance, and mobility depending on the severity of symptoms. Physiotherapy also helps children with CP become independent and perform daily activities on their own while ensuring that physical discomfort and pain is reduced as much as possible.
Occupational therapy is often combined with physiotherapy to enhance the ability of children with CP to carry out daily activities. The therapists address both cognitive and motor impairments, and can teach children how to perform daily activities such as writing, grasping objects, holding and reading books, and interacting with others.
Sensory impairments can make activities such as movement and balance difficult for children with CP. Occupational therapy helps with proprioception (kinesthesia) or the sense that allows the perception of body position, movement, and balance.
Speech therapy, performed by a certified speech-language pathologist (SLP), can help children with CP to speak more clearly and also address issues with breathing and swallowing of food. SLPs use a variety of methods to improve the strength of oral muscles to allow for better communication and feeding.
When a child is non-verbal, SLPs may employ augmentative and alternative communication methods such as sign language or computer aids to help with communication.
Medications can help relax muscle stiffness and reduce involuntary movements. Before prescribing medications, doctors consider several factors such as the child’s age, overall health, and whether the therapy should be short or long term, depending on the severity of symptoms. Common CP symptoms that are treated with medications include seizures, involuntary movements, spasticity, pain, and depression.
Seizures can be treated with anticonvulsants such as topiramate, carbamazepine, and phenobarbital. Each anticonvulsant works differently and comes with its own set of side effects. Usually, physicians have a trial and error period before figuring out the best anticonvulsant for each child.
For involuntary movement
Involuntary and uncontrollable movements are treated with anticholinergic medications, which work by blocking the area of the brain controlling muscle movement. Commonly used anticholinergic medications include Robinul, Sinemet, and Cogentin.
Muscle spasticity and stiffness can be treated with muscle relaxants that are administered either by mouth, injection, or a pump that is implanted into the abdomen. Commonly used muscle relaxants used by patients with CP include baclofen, diazepam, dantrolene, and cyclobenzaprine.
Pain, a common symptom of CP, can affect a wide range of activities, mobility, behavior, and sleep. Pain killers such as steroids and non-steroidal anti-inflammatory drugs are usually prescribed to CP patients. Pain associated with muscle spasms may be treated using botulinum toxin, which paralyzes specific muscles for a few months for temporary pain relief.
Surgery may be needed to correct severe mobility issues and pain. Common orthopedic surgical interventions for CP include:
- Muscle and tendon lengthening.
- Tendon transfer from one bone to another.
- Tenotomy (cutting the tendon) to relieve pain caused by contractures.
- Neurectomy (cutting the nerve to a specific muscle group) to reduce spasticity and rigidity.
- Osteotomy (realignment of bones and joints to prevent dislocation).
- Arthrodesis (fusion of adjacent bones into a single, immovable structure) to reduce pain and improve walking.
- Selective dorsal rhizotomy (cutting sensory nerves in the lower spine, which serve spastic muscles). Nerves that help in leg muscle contraction are not cut. This procedure requires long-term physiotherapy and may require relearning the ability to walk.
Last updated: March 3, 2020
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