Different Types of Therapy for Spastic Cerebral Palsy

There is no cure for cerebral palsy because brain cells cannot be replaced. The aim of treatment is to make life as healthy as possible and provide maximum independence for people whose mental capacities allow it.

As school-age approaches, treatment focuses on improving communication and reducing socially problematic symptoms such as drooling. No effort is spared to place children of normal intelligence in public schools. Parents do much of the therapy once they learn the techniques.

Therapy: This happens to be the most crucial part of the cerebral palsy treatment in India. There are two types of therapies for such issues, occupational therapy, and physiotherapy.

occupational therapy is used for training in everyday activities so this therapy is essential.

Occupational Therapy: How is it done?

This therapy is a way of evaluating both the motor disorders of the child and the disorders of non-verbal functions classified by the domain (visual exploration, gnosis, constructive praxis, spatialization, visual perception, and graphics) according to his age (concerning calibration ages).

The implementation of an adapted rehabilitation

Rehabilitation will mainly go through play, sport, and specific therapy program, allowing progressive and active learning for the child and making him an actor of his own development.

Postural control, coordination of movements, eye tracking, and graphics can be worked on individually and globally.

Each child has disorders and a different environment, which is why the initial assessment is essential to set up an appropriate rehabilitation.

A reassessment of the child's difficulties and progress will be necessary throughout the care.

Involving parents throughout the rehabilitation is essential; the occupational therapist transmits to them the activities they can perform daily and the most suitable facilities for their child.

Physiotherapy

Physiotherapy happens to be a sanitary discipline which usually involves aspects of movement disorder. The role of physiotherapy in spastic Cerebral Palsy is essential and is adjusted to the new technological advances. In centers for best cerebral palsy treatment in India, you can find their services.

From the field of Physiotherapy, the primary objective is not to lose functionality in the motor and musculoskeletal aspect through different techniques that work to improve motor control, balance, strength, joint stability. Among them, the experts promote the strengthening and empowerment of the spastic muscle, the reduction of muscle contractures, the correction of gait, the emancipation of the proprioceptive system, the increase in both selective motor control and postural control and the improvement of balance with different techniques, all supported them by scientific evidence. It is always done through play, to create greater adherence to treatment for the child.

Risk Of Cerebral Palsy During Birth

The most common reason for brain damage which ultimately leads to Cerebral Palsy (CP) is oxygen deprivation for the newborn or the fetus. This condition is also known as birth asphyxia. For certain children, difficult labor results in complications that could cause brain damage, and eventually CP.

Brain damage that leads to CP may take place before birth, during birth, within one month of giving birth or in the first few years of a child’s life while the brain undergoes development. It is important that the presence of such a disorder is detected early, in order to commence cp treatment in India.

Here is the list of risk factors that can increase the chances of congenital cerebral palsy:

1) Infections during the pregnancy period- Herpes, rubella (German measles), toxoplasmosis and cytomegalovirus can infect the placenta and womb, which may result in cerebral palsy.

2) Multiple gestations- Twins, triplets and more births together could lead to CP. The risk is also high for an infant whose twin or triplet dies shortly after birth.

3) Exposure to harmful chemicals- If a mother happens to be exposed to toxic substances such as high doses of methyl mercury during pregnancy, the risk of CP is high.

4) Low weight at birth or premature birth- Infants who were born before term (in less than 37 weeks of pregnancy) as well as those weighing less than 5.5 pounds at birth are at risk.

5) Medical conditions of the mother- Risk can be high if the mother is facing difficult health conditions such as :

a) Seizures

b) Abnormal thyroid activity

c) Excess protein in the urine

d) Developmental disabilities   

Almost 3.8% of the population suffers from cerebral palsy India. 15-20% of physically disabled children are affected by this disease. The topographic classification of CP has monoplegia, diplegia, hemiplegia, and quadriplegia. Early diagnosis is very important for proper treatment, but then it cannot be detected in an infant less than 6 months old unless severity is very high. Repeated examinations and subsequent observation are necessary over time for mild cases before an exact diagnosis.

Different Types Of Treatments For Children With Cerebral Palsy

The treatment administered to individuals affected with Cerebral Palsy (CP) need multidisciplinary approach including helps of orthopedic surgeon, occupational therapist, physical therapist, speech therapist etc. Treatment planning is depends upon many factor like diagnosis, complication, associated medical issues and grade of disability and movement disorder etc. Early treatment of cerebral palsy in children has the likelihood of bringing about the most positive change. Since every diagnosis differs from another, the type of treatment also varies.

Factors determining the type of treatment

Based on the following factors, courses of treatments are decided by doctors:

· Degree of disability

· Type of movement disorder

· Co-existing conditions

· Type of cerebral palsy

Treatment is inclusive of long and short term approaches to the specific condition of a child. The course for a child may involve physical therapy, surgery, medications and more.

Treatment options for cerebral palsy in children

1) Use of physical therapy- If CP has been detected at a very young age, therapy can be started at the same time. The method is personalized as per every case, and is focused on the most impacted areas of the body. Recommendations of physical therapy include strength training, stretching, muscle relaxation exercises and developmental program. The therapy also undergoes change as the child ages.

2) Occupational therapy- The idea behind occupational therapy is to increase independence amongst CP patients. For teens and adults, therapies may revolve around enhancing the patient’s ability to work. However, occupational therapy is meant to improve quality of life for people across a wide variety of age groups. Benefits of application include carrying out household tasks smoothly, mobility and independence in personal care.

3) Massage therapy- This form of therapy should not be used lightly. Vigorous oil massage can increase the spasticity & tightness in body. Light powder massage is necessary for relaxation of muscle and helps a lot in rehabilitation. Massage therapy is not just good for flexibility, but also for complete rejuvenation of soft body tissues. Therapists improve muscle functionality by targeting muscles, tendons, ligaments, joints and skin.

4) Use of speech therapy- Speech therapists helps in managing speech disorders in CP. Children can speak more clearly with the help of this therapy. Language and speech therapy focus both on the language and receptive parts of speech.

5) Necessary medications- Medications are very rarely required to manage abnormal movement pattern and spasticity. Medicine area also required for management of epilepsy. Medicine should not be given to these children without doctor recommendation.

Effective Diet For Children With Cerebral Palsy

Cerebral palsy (CP) is a neuromuscular disorder that affects muscular coordination, movement and muscle tone. Amongst children, it can be difficult to deal if not handled correctly.

These children are frequently affected with malnutrition because of various reasons.  The reasons can be as follows..

• Undernourishment or over nutrition,  hormonal problems

• Frequent infections

• loss of appetite because of constipation or gastro esophageal reflex

• Dependency on others for feeding

• problems in feeding, eating, drinking etc.

• Weight of the child 

However, with the administration of the right feeding and diet techniques, mealtime experiences can be enjoyed despite cerebral palsy in children.

• Estimate energy needs according to: age, activity level, growth rate and muscle tone More spasticity CP require more energy expenditure, Ambulatory spastic CP have medium energy expenditure while Wheel chair bound/non ambulatory have lower energy expenditure. Reduced physical activity leads to weight gain and Wt gain itself detrimental to person’s physical activity and it becomes vicious cycle. 

• The solution is good balanced diet having all the kind of nutrients including vegetables and fruits. 

• These children are more vulnerable to vitamin D deficiency because they are confined indoors. To prevent this regular exposure to sunlight is necessary. 

• Assessment and treatment of any hormone related problem should be done promptly.

• Standing, walking, outdoor activity, regular physical therapy must be done. The key is to be mobile as much as possible. 

Type of nutritional problems for CP children     

Reasons of Nutrition related problems in cerebral palsy in children

1) Feeding, Eating, Drinking and Swallowing Difficulties (FEDS),

2) Oro-motor Difficulties

3) Sensory  Difficultés 

4) Self-Feeding 

5) Gastro-esophageal Reflux

6) Constipation 

7) Tooth Decay

FEDS (Feeding eating, drinking and swallowing) for this it is necessary to maintain posture of child and the body must be in one direction. You can use CP chair or corner chair if needed. The feeder must sit facing towards the child and try to develop coordination by supporting jaw and upper lip closure. The child must first learn to have liquids properly then semisolids and then solids. You must always give small bites and give second bite only after mouth is cleared of the first. Let the child take her own time.  Encourage child to eat himself, use various assistive devices for this. 

GOR: This can be potentially hazardous. If the child regurgitates the food and aspirates it into the lungs it can even be fatal. To prevent this always feed the child in propped up position and always give small but frequent meals.  Avoid giving acidic food and prevent or treat constipation. 

Digestive problems such as constipation and gastro esophageal reflux often make eating uncomfortable. These children are frequently constipated because of less mobility and faulty diet. Give them plenty of fibrous diet like green vegetables, fruits, whole grains etc.   These children are also very much vulnerable for tooth decay which further hampers their nutrition. To prevent this regular cleaning with soft toothbrush is necessary especially at night before sleeping.

Important Facts About Cerebral Palsy

A common childhood disease, Cerebral Palsy (CP) describes individuals with abnormalities in body posture, balance, speech, and movement, all of which are due to problems in the neurological process. This condition is not caused due to hereditary factors but from brain damage. Individuals affected by CP have the same kind of desires and goals as us, so we must not discriminate against them anywhere.

Symptoms of Cerebral Palsy

Have you noticed people around carefully as of late? People affected by CP may be exhibiting some of more of these symptoms. However, these are not the only Cerebral Palsy symptoms and these may vary from case to case.

•    Problem in coordination

•    Decreased or increased muscle tone

•    Tremors

•    Delays in attaining milestones

•    Difficulties in eating

Globally 17 million people are affected by CP. 15-20% of all physically disabled children face Cerebral Palsy, while 3/1000 of live births get this abnormality in India. It is certainly the most common motor disability for childhood across the world. Due to the developing nature of rural and semi-urban areas as well as less technology being used in these areas, cases of CP are high in India.

What can Cerebral Palsy affect?   

The abnormality may affect any of the following limbs:

•    Lower limb (Paraplegia)

•    Affects one side of body (Hemiplegia)

•    Affecting all four limbs but lower limb more severe than upper limb (Diplegia)

•    Affecting all four limbs (Quadriplegia). Sometimes face may be contorted as well

Prevention: cerebral palsy can’t be prevented fully but its incidence can be decrease by strict follow-up and good care given to mother and new born. Regular antenatal checkup under experienced gynecologist, regular ultrasound of foetus, regular intake of folic acid, iron, treatment of hypothyroidism, treatment of TORCH infection, delivery in hospital with good care to new born under pediatrician can decrease the incidence.  However, once CP has kicked in, there is no sure-shot cure as of now.

Medications, surgery and speech therapy, along with physiotherapy, have helped many people in leading a contented life. Exercises and muscle training help the body gradually regain control. Your regular doctor, upon confirmation of CP, is likely to recommend you to a specialist who can train children on the brain and various nervous conditions.  A series of tests will also be run by your neurologist and will also look to eliminate all other causes.