Treatment for cerebral palsy
Unfortunately, there is no cure for cerebral palsy.
However, there are various treatments available that can help children reach their maximum potential in terms of growth and development.
Treatment for cerebral palsy is an interdisciplinary, team-based exercise. Specialists from multiple fields will define specific goals, both physical and psychological, and work with the patient continuously to improve their condition.
Although cerebral palsy is a static condition (where damage to the brain does not progress over time), there should be a constant focus on promoting healthy brain development. This is because up until around the age of eight, a child’s brain has the ability to reorganise and reroute many of the signal paths that may have been affected by the initial damage.
In general, as with most injuries, the earlier the treatment for cerebral palsy begins, the better the outcome is likely to be. Ideally, treatment should begin when the child is still in the neonatal intensive care unit (NICU).
Then, as the child grows and develops, new physical challenges will arise. This means that there must be regular reassessments of the types of therapy being offered. Treatment for cerebral palsy will be a lifelong, multi-dimensional process, with the focus on helping the person live as independently as possible.
Types of therapy
There are several different types of therapy available for people with cerebral palsy, and as serious injury lawyers, we have helped to put in place a very wide range of treatments for our clients. Read on to find out more.
The two main goals of physiotherapy are:
- To prevent the weakening of muscles that would not normally be used
- To prevent muscle contracture (muscles becoming stuck in a rigid position), which can lead to deformities and cause pain and discomfort
Physiotherapy is considered to be one of the most important types of treatment for people with cerebral palsy, particularly because their muscles will often develop at a slower rate than their bones. Routine physiotherapy will continuously stretch and strengthen these muscles as they grow.
Physical aids such as arm and leg braces (and other orthotic devices), rolling walkers and standing frames are typically used to help reduce spasticity (tightness of the muscles) and where necessary, can help improve the range of motion in the limbs for children who are wheelchair-dependent.
Sometimes, as a means of offering reprieve after the often strenuous and tiring aspects of physiotherapy, massage therapy may also be undertaken in order to relieve the tension within the muscles and where possible, offer relaxation.
Though similar to physiotherapy, massage therapy differs in that it aims to be comforting whilst also reducing any discomfort felt where muscle tissue has been damaged. Best working in tandem with physiotherapy, research into massage therapy has shown that it may help to reduce stiffness and improves motor skills.
Occupational therapy assists the child by fully utilising their mobility skills and also helps to improve their posture. For example, an occupational therapist will demonstrate and help the patient practice day-to-day routines such as self-care, grooming and leisure activities so that they can feel confident and independent, particularly useful as the child grows older.
The occupational therapist can also provide recommendations to improve the living or play areas for the child as there may be some necessary adaptations required, and occupational therapy can also provide techniques that maximise the child’s learning experiences.
Speech therapy assists with any communication difficulties that may arise as a result of cerebral palsy through a learning process that involves a series of repetitive exercises.
Some children with severe cerebral palsy may experience significant difficulties with speech so it may be more beneficial to adopt alternative methods of communication such as sign language; embrace augmentative written communication systems such as Blissymbols; or perhaps even make use of such specialist equipment as a computer connected to a voice synthesiser.
A relatively new treatment is Hyperbaric Oxygen Treatment (HBO). Although historically used to treat slow-healing burns and wounds, it has recently been used as a treatment for cerebral palsy.
For this treatment, a person with cerebral palsy receives a dosage of oxygen at a much higher level than the amount found naturally in the atmosphere. Whilst inside a pressure chamber, they receive 100% oxygen for intervals lasting between 60 and 90 minutes.
Depending on the level of treatment required, in some cases HBO therapy can increase the amount of oxygen in the blood by up to 2000%, which in turn drastically increases the amount of oxygen at a cellular level.
This is beneficial because brain trauma often causes swelling, which reduces blood flow, and this means that some brain cells become dormant due to a lack of oxygen. Therefore, HBO therapy can help people with cerebral palsy by constricting the blood vessels to reduce brain tissue swelling and also stimulate the dormant and oxygen-starved brain cells.
Constraint-induced movement therapy (CIMT)
The focus of CIMT is to combine restraint of the unaffected limb with intensive use of the affected limb. Types of restraint can typically include a sling or a triangular bandage, splint or a glove.
The stronger limb is restrained for approximately 90% of waking hours, and a conscious effort is made to engage the weaker limb in day-to-day activities that can build up its function. These tasks are performed in an intensive schedule for approximately six hours per day over a ten-day period.
Generally, CIMT has been shown to have positive results on children with hemiplegic cerebral palsy (those where CP affects one side of the body).
Types of medication
There are various forms of medication that can be administered to people with cerebral palsy; however, much depends on how the condition affects the individual. The medication can only help to alleviate symptoms, it cannot provide a cure.
Provided here is a brief list of some of the medication available and their benefits:
Anticholinergics – can control some of the involuntary and unwanted movements of athetoid CP.
Phenobarbital or phenytoin – can prevent seizures.
Benzodiazepam – can help to control more severe seizures, alleviate pain or relax muscle spasms. Unfortunately, diazepam can have some unwanted side effects such as drowsiness, slurred speech, constipation, nausea and incontinence.
Botox (botulinum toxin) – used to relax contracting muscles by blocking signals from the brain to affected areas. It is administered as an injection and provides temporary relief for up to three months. It is considered to be most effective when combined with a program of stretching and physical therapy directly after receiving the injection.
There are several procedures that may benefit people with cerebral palsy; some may only be appropriate to a particular type of cerebral palsy, so the relevance depends on the individual’s experience and the specific effects of their own condition:
The purpose of orthopaedic surgery for people with cerebral palsy is to treat severe spasticity, should it be present. It also helps to prevent any secondary complications that may be a result of the spasticity, for example limb deformities, dislocations and pain relief.
Generally, the procedure works by locating the problematic muscles and cutting open the skin. Then, parts of the muscles are cut in order to decrease the level of tightness in the limb. Naturally, this can reduce the strength of the muscle, but it can loosen up the joints so that the limb can be moved much more easily.
Intrathecal phenol-baclofen therapy
This procedure is necessary for people with cerebral palsy that require a constant treatment of medication into the spinal column, particularly those that suffer from spasticity.
A small pump is surgically inserted into the abdomen and is then connected to the spinal cord. The pump delivers regulars doses of baclofen directly into the nervous system and provides a barrier against the nerve signals that can cause stiffness in the muscles.
A common problem faced by children with cerebral palsy is feeding and digestion. The act of swallowing food is a complex procedure dangerously hindered by any muscular problems in this region. There can be involuntary regurgitation of food and acid reflux, which is when digestive fluids from the stomach enter the windpipe causing pain. A knock-on effect of this lack of digestion could be malnutrition.
Gastroenterology surgery can help such problems via the following methods:
- Bladder augmentation – this procedure involves surgically modifying the bladder to improve performance; perhaps by increasing its volume capacity, reducing bladder pressure and so forth
- Fundoplication – this procedure adds a valve at the top of the stomach preventing acid reflux, but also prevents vomiting, chest infections and wheezing amongst others
- Gastrostomy tune – this tube supplies nutritional supplements via the abdomen
- Nasogastric tube – this is a short-term solution where food is introduced via a tube through the nose
Vision correction surgery
Corrective surgery to the eye(s) and retina for children with cerebral palsy not only improves sight, but can also promote their abilities to communicate, learn and live day to day life more comfortably.
There are various vision correction procedures available including laser eye surgery; implanting a lens over the eye’s natural lens; and even replacing the natural lens with a synthetic one. However, it is worth noting that if the child requires corrective surgery, the likelihood is that they will have to undergo repeat procedures as they grow older.
Selective dorsal rhizotomy
SDR is a surgical procedure that is normally only recommended when all other viable treatments have failed. The operation involves a neurosurgeon dividing each of the dorsal roots in the spine into three to five sections (or rootlets) before stimulating each rootlet electronically.
By examining the electrical responses from the muscles in the lower extremities, the rootlets that cause the spasticity can then hopefully be identified. The abnormal rootlets (usually 30-50% of sensory nerves) can then be cut, with a view to leaving the normal rootlets intact and reducing muscle stiffness in the legs, as well as cramps and spasms.
Extensive physiotherapy is required after any SDR procedure, however for some patients there have been post-surgery complications such as paraesthesia (a tingling ‘pins and needles’ sensation of the skin) as well as bladder and bowel problems. However, only an estimated 5% of SDR procedures are successful for people with cerebral palsy.
Read about how we help to put in place all of our clients’ vital treatment and care in our client stories.