Physical Therapy for Cerebral Palsy

What Is Cerebral Palsy?

Cerebral Palsy is a group of motor impairment syndromes changing as the nervous system develops. Patients present with muscles spasms, abnormal limb movements, even loss of body control, along with other developmental dysfunctions developing over time.

Causes

The incidence of CP is 2/1000 live births, without racial predominance, and where premature born children have a higher incidence then full term.

Rather then cause to disease, it is classified by movement disorder symptoms that are present.

1. Spastic: muscles spasms
2. Dyskinetic: abnormality in controlled movements
3. Ataxic: Loss of full control of bodily movements

Along with the movement disorders, a patient may also display signs of the following:

1. Mental retardation
2. Growth development delays
3. Sensory deficits
4. GI dysfunction
5. Respiratory issues
6. Visual disorders
7. Hearing Loss
8. Hearing loss

Diagnosis

The diagnosis is based on finding a pattern of abnormalities, not a single deficit. Therefore, CP is attributed to multifactorial causes, injuries sustained pre/post pregnancy, and often of unknown causes.

1. Multifactorial Causes include:
   1. Perinatal Asphyxia (lack of oxygen within the body due to problems with breathing)
   2. Prematurity (multiple causes)
   3. Intracranial Malformations (brain bleeds, strokes, incomplete brain development)
   4. Encephalopathy (toxins and infections affecting brain)
   5. Congenital Anomalies (condition at birth results in developmental delays)
   6. Intrauterine infection
2. Fetal injury
   1. Prenatally (before pregnancy)
   2. Perinatally (during pregnancy)
   3. Postnatally (after delivery)
3. Unknown Causes

Diagnostic testing include MRI, metabolic testing, Genetics Studies, hearing and vision evaluations, EMG and EEG studies.

Treatment

Optimal benefit is realized with early intervention and when the physician is an advocate in collaborative work with service agencies throughout entire process. Preventive measures include appropriate prenatal care to reduce preterm labor, and avoiding any potential body insults that will effect pregnancy or cause premature delivery.

1. Physiotherapy
   1. Mainstay of management
   2. Stretching
   3. Range of motion activities
   4. Keeping balance
   5. Walking
   6. Sitting
   7. Alternative modes of movement
2. Speech Therapy
   1. Directed at improving communication skills
3. Medication and Surgery
   1. Goal is to reduce symptoms and to increase function and learning capabilities
      1. Medications to reduce spasticity include:
         1. Baclofen, Dantrolene, Diazepan, Botulinum toxin
      2. Special Equipment
         1. Braces, custom splints, adaptive toys, walkers, wheelchairs
         2. Electrical stimulation used to increase muscle strength.

Prognosis

Prognosis for survival and motor function in children is variable, however, most survive until adulthood. It is difficult to predict later abilities on basis of early development. Nearly all children with hemiplegia (paralysis of one side of body) will walk. Poor head balance by 20 months, and those with primitive reflexes by 24 months, have poor prognosis for walking. Goal of care is to improve quality of life. Early intervention with social services and physiotherapy are supportive. During periods of functional disability physiotherapy is still recommended for maintaining muscle tone, improving contractures, and increases blood flow.