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Cerebral palsy refers to a family of interrelated neuromuscular disorders, all of which affect in some way a person’s movements, balance and coordination. At this time, there is no cure for cerebral palsy. All forms of the disorder will lead to lifelong disabilities, though the severity of impairment can differ widely between patients.
While cerebral palsy is currently incurable, medical professionals have developed a wide array of treatments, or “interventions,” designed to improve the lives of people with CP.
Cerebral Palsy Interventions: The Team Approach
Some cerebral palsy interventions were created to help patients develop their existing abilities further, increasing physical strength and improving functional skills. Other treatments attempt to tackle common medical complications that people with cerebral palsy often develop. No matter the specific goal of any one intervention, each therapy has at its core the objective of improving a patient’s overall health and quality-of-life.
Most children with cerebral palsy will benefit from the services of multiple health care providers and specialists, taking a collaborative team-based approach. Needless to say, the specific mix of therapies that will benefit individual patients are as unique as the patients themselves. Cerebral palsy treatment is far from a one-size-fits-all proposition.
As children age, their symptoms and functional impairments can change. While these symptomatic changes do not reflect a change in the underlying brain damage that causes cerebral palsy, they can dramatically shift a patient’s health care needs. At the same time, many patients with cerebral palsy will begin to take more control over their own care as they grow up.
The Basics Of CP Treatment
Cerebral palsy therapies can be divided into four basic categories:
- physical and occupational therapy
- devices and assistive equipment
- pharmaceutical medications
- surgical interventions
In practice, these various treatment modalities will be blended together, allowing their mutual benefits to enhance each other. For example, most pharmaceutical interventions have greater benefits when paired with occupational and physio-therapies. Likewise, surgical treatments are almost always followed by extensive courses of physical therapy.
Physical & Occupational Therapy
Physical therapy is usually the first intervention in any cerebral palsy treatment plan. Most children will begin to visit a physical therapist soon after their diagnosis. Some patients, depending on their symptoms, will start even before a definitive diagnosis has been made.
Designing a unique program of exercises and stretches, physical therapists help children improve big picture aspects of movement and balance, things like strength, flexibility and posture. Physical therapists can also be a great resource for understanding the specific movement challenges a child faces.
Physical therapy generally has two interrelated goals:
- preventing disuse atrophy – strengthening muscles that don’t get used so much to reduce the risk of deterioration
- preventing contracture – loosening muscles that could become fixed in a specific position
Occupational therapy, on the other hand, focuses on functional abilities and fine motor skills. How can a patient more effectively perform specific tasks in the world? Finding workable answers to questions like that help people with cerebral palsy become more independent.
Speech & Language Therapy
For children who have difficulty communicating, speech-language pathologists employ a number of therapeutic techniques that can help patients speak more clearly or communicate in new ways. Sign language is one option. Computers that use voice synthesizers are another.
Speech-language pathologists often focus their attention on the oral muscles that make speech, eating and swallowing difficult.
Devices & Assistive Equipment
Physical therapists often encourage the use of specialized equipment, both to guide the development of body structures and improve functional abilities in the here-and-now:
- Crutches (for patients who can ambulate, or walk)
- Standers – provide support and stability for short- or long-term standing
Orthotics, devices that “train” the growth of major muscle groups and improve mobility, can also be helpful. Some equipment is designed to prevent further impairments that could change the way a child walks. Casts and splints, for example, can be used to hold joints in a functional position or guide the proper development of a body structure.
Devices can also prove helpful in treating joint contracture, a common complication in which a child’s joint becomes “locked” between shortened muscles. Specially-designed casts can encourage these taut muscles to lengthen, ultimately loosening the joint and allowing for increased control and a wider range of motion.
In some cases, occupational therapy and assistive technologies are used together to improve fine motor function. A method known as Constraint-Induced Movement Therapy (or “shaping”) involves artificially disabling one limb, then encouraging the child to engage in fun activities or puzzles using their less-functional appendage.
Unfortunately, cerebral palsy treatments don’t always receive the research attention they deserve. The link between using restraints to immobilize a child’s more-functional limb and actual improvements remains unclear, according to experts at Columbia University. In fact, there’s some evidence that intensive practice in limb use provides the real benefit, regardless of whether or not a child’s other limb is restrained.
Some drugs have been found effective in reducing muscle spasticity, essentially loosening the muscles that become too tight in patients with spastic forms of CP. Baclofen and onabotulinumtoxinA (previously known as Botulinum toxin A) are two common examples:
- Baclofen is usually used to treat spastic muscles throughout the body. The drug can be taken as an oral tablet or using a baclofen pump, a device implanted beneath abdominal skin that pumps the medication directly into the spinal cord.
- OnabotulinumtoxinA, sold under the brand name Botox, induces local muscle paralysis. Doctors mainly use the drug to treat spasticity that is isolated to a single muscle group. Botox can be injected directly into the muscle, the Mayo Clinic reports. Its effect lasts for about three months.
Again, these two drugs are generally reserved for patients with spastic forms of cerebral palsy. Seizures can be treated with pharmaceutical drugs, too, as can excessive drooling. The pain that many people with cerebral palsy experience can be treated through medications, along with surgical or therapeutic interventions that attempt to solve the underlying cause of pain.
Invasive procedures are usually suggested as a last-resort, after medications and occupational therapy have proved unsuccessful. Surgical interventions can be used to relax taut muscles, unlock joint contractures or improve common orthopedic complications.
- Orthopedic surgery – in order to increase a child’s range of motion, surgeons can lengthen tendons, sever severely-tightened muscles or replace a taut tendon with a looser one.
- Selective dorsal rhizotomy – for children with severe muscle spasticity, surgeons can sever isolated nerves in the spinal cord to disable those affected muscles. This procedure is considered aggressive and should be considered only after other therapies have failed.
Surgery is relatively common for children with problems in their legs, but rare for those who are affected primarily in their arms. Doctors disagree on when surgery becomes appropriate. While most experts believe procedures should only be considered after other options have been attempted, the medical consensus ends shortly after that.
Some physicians believe that surgery should be attempted early, when major changes to movement patterns are still possible. Other practitioners, however, think waiting is a better idea, allowing more of a patient’s unique challenges to become apparent and taken into account.
We’ve now discussed the four primary forms of traditional cerebral palsy treatments. We’ll finish our discussion by turning to alternative or complementary therapies that are often advertised for patients with cerebral palsy. These techniques should be approached with a fair degree of skepticism, since the evidence to support their use is either poor or non-existent.
Hyperbaric Oxygen Therapy
Some children develop a cerebral palsy disorder after suffering severe brain damage, usually due to oxygen deprivation, during labor or delivery. The medical community is very excited about the prospects of one potential treatment for this form of brain damage: hypothermia therapy. In hypothermia therapy, a child’s body temperature is artificially lowered directly after birth, allowing brain cells extra time to heal.
Hyperbaric oxygen therapy is a different story. Proponents of the technique suggest that a child’s damaged brain cells can be revived by pumping the body with higher levels of oxygen than normal. This is done by placing children or young adults into a hyperbaric chamber, a specialized machine that increases air pressure and allows the lungs to take in more oxygen than usual. Hyperbaric chambers are used in some legitimate treatments, especially for the decompression sickness that can affect scuba divers.
Medical research, however, does not support the use of hyperbaric oxygen therapy for people with cerebral palsy, according to Nationwide Children’s Hospital. Several studies have shown that hyperbaric chambers used to pump oxygen are no better than those that pump normal air. It’s telling that nearly every study purporting to demonstrate a benefit is anecdotal, presenting the case of a single child. Despite this lack of evidence, hyperbaric therapy centers have been popping up across America over the last decade, advertising their services to parents.
Threshold Electrical Stimulation
Threshold electrical stimulation uses electrodes to deliver low level electrical stimulation to muscles affected by cerebral palsy. The technique is usually applied at home, while a child is sleeping. The point isn’t to induce muscle contraction, which would theoretically strengthen the muscles without effort. In fact, electrical stimulation at higher levels has shown proven benefits in treating muscle weakness.
Stimulation at low levels, on the other hand, hasn’t been linked to similar advantages. Many (admittedly small) studies, like this one published in Clinical Orthopaedics and Related Research, have found that, while children who receive threshold electrical stimulation may see some improvement in muscle strength and gait, these benefits don’t outweigh the method’s downsides. Most patients stop using the treatment before their study periods are even over.
Overall, electrical muscle stimulation at any dosage level has not been found to give patients a long-term benefit. Short-term improvements may appear, but don’t seem to last. For that reason, the vast majority of clinicians believe that electrical stimulation is, at best, unnecessary and, at worst, counter-productive if it eats up time that could be devoted to more effective therapies.