What is Cerebral palsy?
Cerebral palsy is a term which is used to describe a set of neurological conditions that affect the body’s ability to move and maintain balance or posture. It occurs as a result of non-progressive disturbances that occurs in infant’s brain or at the stage when the fetal is developing. It is among the most common form of motor disability in children.
As cerebral palsy is a lifelong condition, cerebral palsy physiotherapy can be beneficial throughout a person’s life. Physiotherapists can provide expert advice regarding transition into school or working life, or even assist if daily activities such as walking become more difficult in later life.
8 facts you should know about cerebral palsy
- About 2.1 per 1000 children suffer from it all over the world.
- 3 children out of 1000 in India suffer from this disorder.
- Cerebral palsy occurs due to brain damage that control movement, balance and posture, which is caused by injury or abnormal development of the brain during its development.
- It appears in the early childhood and the signs vary from child to child.
- Children suffering from this disorder might have different problems, someone may suffer from total paralysis and other might have slight movement tremors or feel difficulty in breathing.
- This condition is not life threatening and the disorder does not aggravate but it is important to know that it’s incurable, hence becomes permanent.
- Many children with CP have one or more additional conditions or diseases along with CP. For example, some children develop epilepsy while others develop autism spectrum disorder.
- A small percentage of CP is caused by brain damage that happens more than 28 days after a baby is born, which is called acquired CP.
There are some factors that can increase the risk for acquired cerebral palsy. They include:
- Brain infection, such as meningitis
- Serious head injury
Early signs of CP
From the time a baby is born to the time it turns 5 years of age, the child should reach certain movement goals, which are also known as milestones. These milestones include rolling over, sitting up, standing, and walking. If there’s a delay in reaching these milestones, it could indicate a sign of cerebral palsy.
Note: Some children without CP also might have some of these signs. So, consult with a doctor to confirm the condition.
There are some other signs of possible cerebral palsy, which are:
In a baby of 3 to 6 months of age:
- Head falls back when you pick the baby while lying on back
- Stiff muscles
- Feels floppy
- Seems to overextend their back and neck when cradled in someone’s arms
- Legs get stiff and cross/scissor when picked up by someone
In a baby who’s older than 6 months of age:
- Doesn’t roll over in any direction
- Cannot bring hands together
- Difficulty bringing hands towards mouth
- Uses only one hand to reach out while keeping the other fisted
In a baby who’s older than 10 months of age:
- Crawls in a lopsided manner
- Doesn’t crawl properly, scoots around on buttocks or hops on knees
Identification of the disorder
If the infant is suffering from cerebral palsy, they would have difficulty in rolling over, crawling, walking or sitting. There is also trouble in thinking or reasoning, which occurs only in one third of children.
When does the problem develop?
The condition mostly develops during pregnancy but in some cases it can happen during childbirth or shortly after that. A child is more prone to suffer from cerebral palsy if:
– It is a premature birth
– Twins are born
– There are infections during pregnancy
– Head trauma that might have occurred in the first few years of life
However, it is believed that 2% cases are because of an inherited genetic cause.
What is the prevention?
Prevention of cerebral palsy includes immunization of the mother and also the efforts that are to be made to prevent head injury. This can partly prevent the condition, but there is no permanent cure for it.
However, physiotherapy for cerebral palsy, medications and surgery have found to have helped a lot of children lead a normal healthy life and progress into adulthood with ease.
Treatments for Cerebral Palsy:
To lessen the stiffness of muscles, treat pain and manage other complications related to cerebral palsy, medications may be used.
Drug treatments can include the following:
- Isolated spasticity – When spasticity is isolated to one muscle group, the doctor may recommend injections of onabotulinumtoxinA (Botox), injected directly into the muscle, nerve or both. These botox injections may help to improve drooling. These injections should be given to the child about every three months.
Side effects of the drug may include pain, bruising or severe weakness. Other more-serious side effects can be difficulty in breathing and swallowing.
- Generalized spasticity – If the whole body is affected, oral muscle relaxants may relax stiff and contracted muscles. The drugs for this include diazepam (Valium), dantrolene (Dantrium) and baclofen (Gablofen).
- Diazepam is not recommended for long-term use as it has some major risk factors involved. The side effects include drowsiness, weakness and drooling.
- Side effects of dantrolene – sleepiness, nausea and/or diarrhea.
- Baclofen may also be pumped directly into the spinal cord with a tube. The pump is implanted surgically under the skin of the abdomen. Side effects of baclofen – sleepiness, confusion and nausea.
Your child also may be prescribed other medication to reduce drooling. Medications such as trihexyphenidyl, scopolamine (Scopace) or glycopyrrolate (Robinul, Robinul Forte) might also be helpful.
Note: It’s important to talk about the risk of drug treatments with your doctor and discuss whether medical treatment is appropriate for your child’s needs.
There are a variety of non-drug therapies that can help a child with cerebral palsy to enhance functional abilities. These can include the following:
Physiotherapy – Cerebral palsy physiotherapy treatment includes muscle training and exercises that can help your child gain strength, flexibility, balance and mobility. The physiotherapist will also teach you to safely care for your child’s everyday needs at home, such as bathing and feeding.
In cerebral palsy physiotherapy, braces/splints might be recommended for your child. Some of these supports are used to help with everyday function of life, such as improved walking. Others may stretch muscles to help prevent stiff muscles.
Occupational therapy – Occupational therapists train your child to resume their day-to-day tasks, using alternative strategies and adaptive equipment.
They might use adaptive equipment such as walkers, quadrupedal canes, seating systems or electric wheelchairs to make your child independent.
Speech and language therapy – Speech-language therapists help improve your child’s ability to communicate using sign language.
They also teach your child to use communication devices, such as a computer and voice synthesizer, if communication is difficult for your child.
Recreational therapy – Some children can also get benefitted from recreational therapies, such as therapeutic horseback riding. This type of therapy helps improve your child’s motor skills, speech as well as emotional well-being.
Surgical or other procedures
Surgery might be needed to lessen muscle tightness or even correct bone abnormalities, which have been caused by spasticity. The surgical treatments include:
- Orthopedic surgery – Children with severe deformities may need surgery on bones or joints to place their arms, hips or legs in correct positions.
Surgical procedures can also lengthen muscles and tendons, which are proportionally too short because of severe contractures. These corrections can lessen pain and improve mobility. These procedures make it easier to use a walker, braces or crutches.
- Severing nerves – In some severe cases, when other treatments haven’t helped, surgeons may cut the nerves serving the spastic muscles in a procedure known as selective dorsal rhizotomy. This would relax the muscle and reduce the pain, and can also cause numbness.
Cerebral palsy physiotherapy in children:
For children, treatment for cerebral palsy majorly aims to:
- Increase mobility as well as promote physical development like sitting, crawling and walking.
- Decrease muscles tightness and spasms through special stretching programs
- Increase muscle strength as well as activation
- Improve physical development through plays and everyday activities
- Improve mobility by using different aids
- Increase independence and also quality of life
- Reduce the risk of falls through balance work and training
HCAH: always by your side!
Cerebral palsy physiotherapy treatment should be started early and should continue on a regular basis to promote independence in your child. We, at HealthCare atHOME, understand that every child with cerebral palsy is different and has different needs. Our specialist physiotherapists will tailor a treatment program specific to your child’s needs and help them lead a normal life.
Get a free consultation from our team of expert physiotherapists by calling us on our toll free number 1800-102-4224.