Cerebral palsy is the collective name used to describe a spectrum of chronic movement disorders affecting body and muscle coordination. These disorders are usually caused by damage to one or more areas of the brain. The movement problems can vary from barely noticeable to extremely severe. Cerebral palsy is not an inherited disorder, and as of now there is no way to predict which children will be affected by the condition. Cerebral palsy is also not diagnosable at birth but usually within the first three years of life. No two people with cerebral palsy are the same; it is as individual as the people themselves.
The name stems from “cerebral” referring to the brain and “palsy” to poor muscle control or muscle weakness. The parts of the body that provide movement, such as the muscles, nerves, and spinal cord are normal. The brain, which is responsible for sending messages to those parts of the body that coordinate movement, is unable to do so. The affected muscles can become rigid or excessively loose, or the person may exhibit loss of muscle control, or have balance and coordination problems. Cerebral palsy is a condition, not a disease, and therefore is not communicable.
Cerebral palsy usually occurs during fetal development before, during, or shortly after birth, or during infancy. Seventy percent of cerebral palsy cases occur in the womb. The other 30 percent occur due to delivery complications or post birth trauma. Although its symptoms may change over time, cerebral palsy is primarily not a progressive condition, as brain damage does not get worse. However, secondary conditions associated with cerebral palsy, such as muscle tightness, tend to change with age, most likely deteriorating due to physical stress. It is possible, with proper treatment, for conditions to improve or, at least, stay the same.
Cerebral Palsy Treatment and Therapy
The numbers on cerebral palsy patients are growing every year. With each case being as unique as the individual it affects, the type of cerebral palsy treatment a patient requires will vary from person to person.
A multidisciplinary team of healthcare professionals can develop an individualized plan for cerebral palsy treatment based on the patient’s needs and problems. It is important to involve patients, families, teachers, and caregivers in all phases of planning, decision- making, and treatment.
Physical therapy is considered one of the mainstay therapies for cerebral palsy treatment. It is used to decrease spasticity, strengthen underlying muscles, and teach proper or functional motor patterns. A good physical therapist will also teach the family and caregivers how to help the patient to help themselves.
How physiotherapy can help?
Physiotherapy plays a central role in managing the condition, often from birth. After problem is identified, physiotherapist will assess the child and record their development. As part of a tailored treatment plan he will teach the child how to control their head movements and how to sit, roll over, crawl and walk, as well as trying to inhibit abnormal reflexes and patterns of movement as well as teaching and guiding the parent.
Although it is a lifelong disability, much can be done to reduce the impact of cerebral palsy. It is important for children to receive support from an early age to ensure they have every opportunity to reach their full potential
1. Passive stretching exercises to prevent muscles shortening and losing their normal range of movement.
To stretch the muscles, the arms and legs must be moved in ways that produce a slow, steady pull on the muscles to keep them loose. Do it one joint at a time. Always protect the joint and move gentle but firm. Move 10 repetitions and hold for 30 second each repetition. The effect of stretching depends on tension applied to the soft tissue, duration, repetition in session, and daily frequency. Slowly sustained stretch managed painful contractures.
2. Balance training in sitting and standing
3. Upper limb activity
Train patient to do active exercises for upper limb in sitting position without support.
Effective use of the upper limb can impact on educational outcomes, participation in activities of daily living and vocational options for many children with cerebral palsy. Making exercises as functional as possible will make it easier for them to be incorporated into daily life.
The role of parents and support measures that can be done at home
Exercises with the child regularly
Exercises with A child can maintain/improve the skills gained during therapy if the skills are practiced regularly during their daily life. Making exercises as functional as possible will make it easier for them to be incorporated into daily life.
Many children cerebral palsy will experience difficulty moving around in their environment. This can range from problems turning over in bed to not being able to move on the floor or difficulties with walking. The child may need more time to get around, or need to use a walking aid or a wheelchair. As the child becomes older, adaptations to the house may become necessary.
Make sure activities include able-bodied children and adults.
It’s great to participate in activities that include other children with disabilities because it helps children realize that they’re not alone. But as they grow up, more able-bodied people will enter their world.
Encourage a child to share his or her story
A child with a disability may not feel comfortable talking about the nature of his or her disability. And, there may be subjects they may never speak about. But sharing how or why they have a disability, and showing that they are capable of speaking and relating to other children, shows everyone that a person who has disabilities is more like everyone else than different.
The majority of children survive into adulthood, with a 30 year survival rate of about 87%.
Motor impairment is variable among the different subtypes of cerebral palsy, but studies have helped improve prognostication in this regard.
Azhar is a registered physiotherapist with degrees from BPT, faculty of Medicine, DU (NITOR) and Masters in speech and language pathology, Department of communication disorders (DU).He has worked in a variety of settings, encompassing orthopedics, neurology, pain, paralysis and sports physiotherapy through Mayfair Wellness Clinic.