Managing Cerebral Palsy

Strategies, treatments, and therapies that can help your loved one with cerebral palsy.

Cerebral palsy cannot be cured, but treatment can often improve a person’s capabilities. In fact, many patients can enjoy near-normal lives if their neurological problems are properly managed. There is no standard therapy that works for all patients. Instead, the doctor must work with a team of health care professionals to identify your loved one’s unique needs and create an individual treatment plan to address them.

Approaches that can be incorporated in this plan include:

  • Drugs to control seizures and muscle spasms
  • Special braces to compensate for muscle imbalance
  • Surgery
  • Mechanical aids to help overcome impairments
  • Counseling for emotional and psychological needs
  • Physical, occupational, speech, and/or behavioral therapy.

In general, the earlier treatment begins, the better chance a person has of overcoming developmental disabilities or learning new ways to accomplish difficult tasks.

The Treatment Team

The members of your loved one’s treatment team should be knowledgeable professionals with a wide range of specialties. A typical treatment team might include:

  • A physician trained to help developmentally disabled persons. This physician, often the leader of the treatment team, works to synthesize the professional advice of all team members into a comprehensive treatment plan.
  • An orthopedist, a surgeon who specializes in treating bones, muscles, tendons, and other parts of the body’s skeletal system. An orthopedist might be called on to predict, diagnose, or treat muscle problems associated with cerebral palsy.
  • A physical therapist who designs and implements special exercise programs to improve movement and strength.
  • An occupational therapist, who can help your loved one learn skills for day-to-day living, school, or work.
  • A speech and language pathologist, who specializes in diagnosing and treating communication problems.
  • A social worker, who can help you and your loved one locate community assistance and education programs.
  • A psychologist, who can help you both cope with the special stresses and demands of cerebral palsy. In some cases, psychologists may also oversee therapy to modify unhelpful or destructive behaviors or habits.
  • An educator, who may play an especially important role when mental impairment or learning disabilities present a challenge.

Your loved one, as well as you and other family members are also key members of the treatment team, and should be intimately involved in all steps of planning, making decisions, and applying treatments. Studies have shown that family support and personal determination are two of the most important predictors of which individuals who have cerebral palsy will achieve long-term goals.

Therapies

Therapy—whether for movement, speech, or practical tasks—is a cornerstone of cerebral palsy treatment. The skills a 2-year-old needs to explore the world are very different from those that a child needs in the classroom or a young adult needs to become independent. Cerebral palsy therapy should be tailored to reflect these changing demands.

Physical Therapy

Physical therapy usually begins in the first few years of life, soon after the diagnosis is made. Physical therapy programs use specific sets of exercises to work toward two important goals: preventing the weakening or deterioration of muscles that can follow lack of use (called disuse atrophy) and avoiding contracture, in which muscles become fixed in a rigid, abnormal position.

Contracture is one of the most common and serious complications of cerebral palsy. Normally, a child whose bones are growing stretches the body’s muscles and tendons through running and walking and other daily activities. This ensures that muscles will grow at the same rate. But in children with cerebral palsy, spasticity prevents this stretching and, as a result, muscles do not grow fast enough to keep up with lengthening bones. The resulting contracture can disrupt balance and trigger loss of previous abilities. Physical therapy alone, or in combination with special braces (sometimes called orthotic devices), works to prevent this complication by stretching spastic muscles.
 
Complimentary Therapies

  • In occupational therapy, the therapist works with the patient to develop such skills as feeding, dressing, or using the bathroom. This can help reduce demands on caregivers and boost self-reliance and self-esteem.
  • If your loved one has difficulty communicating, speech therapy works to identify specific difficulties and overcome them through a program of exercises.
  • Behavioral therapy provides yet another avenue to increase a person’s abilities. This therapy, which uses psychological theory and techniques, can complement physical, speech, or occupational therapy.

As a person with cerebral palsy grows older, the need for and types of therapy and other support services will continue to change.

  • Continuing physical therapy addresses movement problems and is supplemented by vocational training, recreation, and special education when necessary.
  • Counseling for emotional and psychological challenges may be needed at any age, but is often most critical during adolescence.
  • Depending on their physical and intellectual abilities, adults may need attendant care, living accommodations, transportation, or employment opportunities.

Regardless of your loved one’s age and which forms of therapy are used, treatment does not end when the he or she leaves the office or treatment center. In fact, most of the work is often done at home. The therapist functions as a coach, providing you and your loved one with strategies and drills that can help improve performance at home and in the world.

Drug Therapy

Physicians usually prescribe drugs for those who have seizures associated with cerebral palsy, and these medications are very effective in preventing seizures in many patients. In general, the drugs given to individuals are chosen based on the type of seizures, since no one drug controls all types. However, different people with the same type of seizure may do better on different drugs, and some individuals may need a combination of two or more drugs to achieve good seizure control. Drugs are also sometimes used to control spasticity, particularly following surgery.

The three medications that are used most often are:

  • Diazepam, which acts as a general relaxant of the brain and body;
  • Baclofen, which blocks signals sent from the spinal cord to contract the muscles; and
  • Dantrolene, which interferes with the process of muscle contraction.

Given by mouth, these drugs can reduce spasticity for short periods, but their value for long-term control of spasticity has not been clearly demonstrated. They may also trigger significant side effects, such as drowsiness, and their long-term effects are largely unknown.

Occasionally, physicians may use alcohol “washes”—or injections of alcohol into a muscle—to reduce spasticity for a short period. This technique is most often used when physicians want to correct a developing contracture. Injecting alcohol into a muscle that is too short weakens the muscle for several weeks and gives physicians time to work on lengthening the muscle through bracing, therapy, or casts. In some cases, this technique may avert the need for surgery.

Surgery

Surgery is often recommended when contractures are severe enough to cause movement problems. In the operating room, surgeons can lengthen muscles and tendons that are proportionately too short.

Because lengthening a muscle makes it weaker, surgery for contractures is usually followed by months of recovery. For this reason, doctors try to fix all of the affected muscles at once when it is possible or, if more than one surgical procedure is unavoidable, they may try to schedule operations close together.

A second surgical technique, known as selective dorsal root rhizotomy, aims to reduce spasticity in the legs by reducing the amount of stimulation that reaches leg muscles via nerves. In the procedure, doctors try to locate and selectively sever over-activated nerves controlling leg muscles. Although there is scientific controversy over how selective this technique actually is, recent research suggests it can reduce spasticity in some patients.

Experimental surgical techniques include chronic cerebellar stimulation and stereotaxic thalamotomy. In chronic cerebellar stimulation, electrodes are implanted on the surface of the cerebellum—the part of the brain responsible for coordinating movement—and are used to stimulate certain cerebellar nerves. While it was hoped that this technique would decrease spasticity and improve motor function, results have been mixed.

Mechanical aids

Whether they are as humble as velcro shoes or as advanced as computerized communication devices, special machines and gadgets in the home, school, and workplace can help your loved one overcome limitations associated with cerebral palsy.

The computer is probably the most dramatic example of a new device that can make a difference in the lives of those with cerebral palsy. For example, a person who is unable to speak or write but can make head movements may be able to learn to control a computer using a special light pointer that attaches to a headband. Equipped with a computer and voice synthesizer, this person could communicate with others. In other cases, technology has led to new versions of old devices, such as the traditional wheelchair and its modern offspring that runs on electricity.

As research continues, you can expect new forms of therapy, improved drugs, better mechanical aids, and better information about which forms of therapy are most effective. In order to take advantage of these innovations, it’s important to keep up with the latest developments in cerebral palsy research. Ask your loved one’s doctor to keep you supplied with the most recent information, and conduct your own research.

Also look into local support groups for relatives and caregivers of loved ones with CP. The leaders and members of these groups can provide both information and understanding, which can be crucial to you and your loved one.

© Copyright FamilyCare America, Inc. All Rights Reserved.

Adapted from “Cerebral Palsy—Hope Through Research,” by the National Institute of Neurological Disorders and Stroke, National Institutes of Health.



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