Cerebral Palsy

What Specific Treatments are Available?

Physical, Behavioral and Other 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 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. 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.

A third goal of some physical therapy programs is to improve the child's motor development. A widespread program of physical therapy that works toward this goal is the Bobath technique. A therapist using the Bobath technique tries to counteract these reflexes by positioning the child in an opposing movement.

As the child with cerebral palsy approaches school age, the emphasis of therapy shifts away from early motor development. Efforts now focus on preparing the child for the classroom, helping the child master activities of daily living and maximizing the child's ability to communicate.
Physical therapy can now help the child with cerebral palsy by improving his or her ability to sit, move independently or in a wheelchair, and perform precise tasks such as writing. In occupational therapy, the therapist works with the child to develop such skills as feeding, dressing or using the bathroom. For many children who have difficulty communicating, speech therapy works to identify specific difficulties and overcome them through a program of exercises. Speech therapy can also work to help the child learn to use special communication devices such as a computer with voice synthesizers.

Behavioral therapy provides yet another avenue to improve a child's abilities. This therapy, which uses psychological theory and techniques, can complement physical, speech or occupational therapy.

As a child 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 leisure programs, 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.

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. 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. 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 on the developing nervous system are largely unknown.

Patients with athetoid cerebral palsy may sometimes be given drugs that help reduce abnormal movements. Most often, the prescribed drug belongs to a group of chemicals called anticholinergics that work by reducing the activity of acetylcholine. Acetylcholine is a chemical messenger that helps some brain cells communicate and that triggers muscle contraction. Anticholinergic drugs include trihexyphenidyl, benztropine and procyclidine hydrochloride.

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.

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 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 overactivated nerves controlling leg muscles.

Other surgical techniques include chronic cerebellar stimulation and stereotaxic thalamotomy. In chronic cerebellar stimulation, electrodes are implanted on the surface of the cerebellum and are used to stimulate certain cerebellar nerves. Stereotaxic thalamotomy involves precise cutting of parts of the thalamus, which serves as the brain's relay station for messages from the muscles and sensory organs.

 

What is Cerebral Palsy?
What Other Medical Disorders can be associated with
space Cerebral Palsy?

What Other Major Problems are Associated with Cerebral Palsy?
What are the Risk Factors?
What are the Early Signs?
How is Cerebral Palsy Diagnosed?
How is Cerebral Palsy Managed?
What Specific Treatments are Available?
Glossary Of Terms

 

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