By Dr Ananya Mandal, MD
There is no cure for cerebral palsy. However, there are numerous treatments available that may treat conditions associated with cerebral palsy and also help improve life span and quality of life of individuals with cerebral palsy. These therapies may help by easing symptoms such as spasticity, improving communication skills and improving self care and independence.
Who treats cerebral palsy?
Treatment is usually provided involving therapists and specialists from multiple fields. Therapy needs to be goal directed as well. Developmental neurologists or pediatric neurologists are physicians who help in diagnosis and planning therapy for a child with cerebral palsy. They regularly monitor the child for development of skills and improvement.
Physiotherapists are one of the most important therapists involved in cerebral palsy. Others include speech and language therapists, occupational therapists, psychologists, a social worker, educational psychologists and recreational therapists.
Physiotherapy, occupational therapy and speech therapy can all play an important part. Treatment should begin at an early stage ideally. The brain develops a lot in the early few years of life. It can be thus difficult to assess the extent or severity of the condition initially. According to experts most babies may be assessed for deficits at about nine to 12 months.
Physiotherapy is normally started as soon as the diagnosis is made. There are two main goals of physiotherapy. One of them is to prevent the weakening of muscles that are not normally used and the other is to prevent muscles getting stuck in a rigid position, known as contractures. Contractures occur in children with spastic cerebral palsy. Physiotherapists teach the children several exercises that they can carry out every day to strengthen and stretch their muscles. In addition arm or leg braces may also be used to help stretch their muscles.
Conductive education and speech therapy
Another treatment approach is conductive education. Conductive education was developed in Hungary from 1945 based on the work of András Pető. This can help them to overcome movement problems and gain some control through special education and rehabilitation. Conductive education can also be used in Parkinson's disease and multiple sclerosis, amongst other conditions. It improves mobility, self-esteem, stamina and independence.
Children with the condition also need speech and language therapy that also helps them develop the facial muscles. These therapies also help in eating, drinking, and swallowing and improve feeding. These speech and language therapies help the child to speak clearly. If their communication difficulties are severe, the therapist may be able to teach them an alternative method of communication, such as sign language. Speech therapies may require special equipments like a computer connected to a voice synthesizer.
Medication can reduce muscle tone and excessive unwanted movements. Baclofen is helpful in relieving muscle spasm. It is usually given orally as pills. It may also be given as injections in the spine.
Dantrolene is another agent that can reduce muscle spasm. Diazepam is an alternative for severe muscle spasm. Botulinum toxin is sometimes injected into spastic muscles to relieve spasticity for 3-6 months. Phenol injections are used for larger muscles, where botulinus would be ineffective.
Medications may also be needed for treatment of associated problems like epilepsy.
Surgical therapy is needed at times to correct deformities and contractures. These surgeries help in easing the tight muscle tone and restore normal structure. Orthopaedic procedures are commonly the last resort for children with severe spasticity and deformities. Surgeries that are undertaken include:
repair of hip dislocation and deformities of spine (scoliosis)
lengthening of tendons and muscles to reduce muscle spasticity and contractures
removal of part of the bone to position and realign a limb
selective posterior rhizotomy that involves operating on nerve roots coming from the spinal cord to easy muscle spasms - this is used less commonly these days
Occupational therapy helps individuals with epilepsy develop skills to perform everyday tasks and encourages them to lead independent lives. These include activities like dressing oneself, using the toilet etc.
Several mobility aids are used to improve movement and mobility. This includes orthotic devices, wheelchairs and powered mobility walkers. Physical methods of spasticity relief include heat, cold and vibration. Splinting can help to improve the range of movement of a joint. This helps in ankle joint movement.
Treatment of complications
Treatment of gastrointestinal symptoms and complications like reflux disorders, malnutrition, dental problems and constipation, are part of treating cerebral palsy patients. Other complications like lung problems of aspiration pneumonia and bronchopulmonary dysplasia need to be treated.
Hyperbaric oxygen therapy (HBOT)
This utilizes oxygen in a hyperbaric chamber. It has been used in therapy of cerebral palsy. Its use to treat cerebral palsy is controversial. A 2007 systematic review concluded that the effect of HBOT on cerebral is not significantly different from that of pressurized room air. In addition HBOT may lead to complications like ear problems and seizures.
This is one of the newer approaches to cerebral palsy. It is based upon two principles. One of them is neuronal plasticity which means that the brain is capable of altering its own structure and functioning to meet the demands of any particular environment. The second principle is that learning can lead to development. This was proven by a psychologist named Lev Vygotsky in the 1900s.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)