Cerebral palsy (CP) may be defined as a group of disorders of the development of movement and posture which lead to activity limitation and are attributed to non-progressive disturbances occurred during the development of fetal or infant brain. Often the motor disorders of the cerebral palsy are accompanied by disturbances of sensation, perception, cognition, communication and/or by seizure disorder. The group of disorders is a result of a range of etiologies occurring in prenatal, perinatal or post natal period and range in severity. Although the condition is non progressive but overtime the clinical manifestations may change as the brain develops with co-occurrence of other neurological impairments.
Cerebral Palsy Physical Therapy
Depending upon the body movement and postural problem, Cerebral Palsy may be classified as:
- Spastic (Pyramidal) CP – It the most common type of Cerebral Palsy. A person with spastic cerebral palsy develops such a tightness of muscles in some parts of the body that the muscles are unable to relax and the affected joints become stiff and difficult to move. Some of the common problems faced by spastic CP patient include poor coordination and balance, problem in controlling movements, difficulty in talking and eating.
Spastic CP may further be classified depending upon the number of limbs affected:
- Monoplegia – Only one arm or leg is affected
- Hemiplegia or diplegia – One arm and leg of same side of the body is affected (hemiplegia) or both legs are affected (diplegia or paraplegia).
- Triplegia – Either both arms and one leg or both legs and one arm are affected.
- Quadriplegia – Both arms and both legs are affected. The muscles of trunk, mouth, tongue and windpipe may also be affected.
- Nonspastic (Extrapyramidal) CP – It may be classified as dyskinetic (athetoid and dystonic forms) and ataxic cerebral palsy
- Dyskinetic cerebral palsy – A person with Dyskinetic CP has muscle tone which fluctuates between loose and tight. The movement may sometimes be rapid and jerky or uncontrolled.
- Ataxic cerebral palsy – It is the rarest type of CP in which entire body including trunk, arms, hands and legs is affected with abnormal body movements.
- Mixed CP – Children having symptoms of more than one type of cerebral palsy such as spastic legs (symptoms of spastic diplegic CP) with poor facial muscle control (symptoms of dyskinetic CP) are said to have Mixed CP.
Signs and Symptoms of cerebral palsy can vary widely. Some of the movement and coordination problems associated with CP may involve:
- Stiff muscles with exaggerated reflexes (spasticity)
- Either too stiff or too floppy muscle tone
- Stiff muscles with normal reflexes (rigidity)
- Slow writhing movements (athetosis)
- Lack of coordination of muscles (ataxia)
- Involuntary movements or tremors
- Delayed motor skills milestones such as crawling, pushing up on arms, sitting up
- Difficulty walking, a crouched gait, scissors like gait, walking on toes
- Favoring one side of the body such as dragging a leg while crawling
- Difficulty with swallowing or excessive drooling
- Difficulty with performing precise activities such as picking up a spoon
- Difficulty with sucking or eating
- Delays in speech development or difficulty speaking
Some other neurological problems associated with CP are:
- Intellectual disabilities
- Difficulty with hearing or vision
- Abnormal touch or pain perception
- Oral diseases
- Urinary incontinence
- Psychiatric conditions
Any abnormality or disruption in brain development, usually before the child is born may lead to Cerebral Palsy. In many cases, the exact cause may not be known. However, some factors that may lead to abnormal brain development may include:
- Maternal infections that affect development of fetus
- Random mutations in genes controlling development of brain
- Lack of oxygen to the brain (asphyxia) associated with difficult labor or delivery.
- Fetal stroke
- Traumatic head injury to an infant from a fall or motor vehicle
- Infant infections causing inflammation in or around brain
There are a number of risk factors that are associated with occurrence of Cerebral Palsy, to name a few:
- Maternal Health Factors – Infections or health problems to mother during pregnancy such as infection with German measles, Cytomegalovirus, Chicken pox, Syphilis, Toxoplasmosis, certain toxins and other problems like intellectual disabilities or seizures.
- Infant illness – Bacterial infections, viral encephalitis, untreated jaundice
- Other factors of pregnancy and birth – Low birth weight, Breech birth, Premature birth or Multiple babies sharing the uterus
For children with cerebral palsy, it is difficult to make predictions about prognosis in a child before the age of two. Cerebral palsy is neither a worsening condition nor a degenerative disease but there is no cure for the condition per se. The only helping factor is that the disease is non-progressive and does not worsen. However, as children are continually developing mentally and physically, making an accurate prognosis of the disease is difficult.
Tests that are done to diagnose and determine the severity of cerebral palsy may include:
- Electroencephalogram (EEG)
- MRI brain
- Imaging tests for diagnosing structural abnormalities, tumors or hydrocephalus
- Intelligence tests for evaluation of mental impairment
Children and adults with CP generally need long-term care with a medical care team of Pediatrician or Physiatrist, Pediatric Neurologist, Physiotherapist, Occupational Therapist, Speech-language pathologist etc. The line of treatment for CP may include – Medications, Surgical procedures, Pain Management and Therapies to enhance functional abilities.
Cerebral palsy rehabilitation involves a multidisciplinary team of healthcare professionals who develop an individualized treatment plan as per the problems and requirements of the patient. The rehabilitative therapy may include physical therapy, occupational therapy, speech and language therapy and recreational therapy.
Physical therapy is one of the mainstay therapies for the treatment of cerebral palsy. It involves physical exercises, stretching and several other activities that help in improving muscle strength, joint range of motion, flexibility, coordination and balance. With the aim of maximizing function and minimizing disabling contractures, physical therapy helps in developing specific skills such as holding head up, unsupported sitting and walking. Splints, braces or casts may also be used to reach these goals. Physiotherapy management for cerebral palsy thus aims to help the patient reach the highest level of functional independence.
The outcomes of physiotherapy and rehabilitation program for each individual is different and the outcomes of rehabilitation are highly dependent upon the severity of condition and the patient’s functional capacity. However, through physical therapy and rehabilitation, a child is physically and emotionally empowered and is prepared for entering adulthood as an independent individual. Moreover, it also allows a parent to see a child interacting with others, building relationships and trying his best to realize his maximum potential for living independently.
OVERSEAS REHABILITATION CARE (ORC) is the most trusted health care provider offering excellent rehabilitation services in India. At ORC, we understand that each case of cerebral palsy is unique. We thus aim to provide individualized rehabilitation program suiting the unique needs of each person with cerebral palsy. Having treated innumerable patients with different neurological conditions at best physiotherapy clinics in India, ORC understands each patient’s requirements well. The team approach of physical therapists, occupational therapists and speech-language therapists at our clinics provide coordinated care for children and adults with cerebral palsy.
OVERSEAS REHABILITATION CARE (ORC) non-medicinal specialized physical therapy and rehabilitation treatment includes heat, massage, exercises and other external means of treatment to help improve movement and motor skills of patients with cerebral palsy. Our team of physical therapists and other rehabilitation experts carefully assesses the degree of physical limitations of each individual and provides the most beneficial treatment plan to patient with cerebral palsy. Physiotherapy helps patients learn various skills such as walking, standing without support, using an adaptive equipment or wheel chair and other movement skills. Splints, Calipers and Casts may also be used as per the requirements of each patient. Our team of rehabilitation experts also addresses musculoskeletal problems through correct physiotherapy techniques thereby preventing muscular weakness and contractures. The technique of specialized physiotherapy plays an integral role in the daily lives of patients with cerebral palsy. It helps patients realize their maximum potential and functional independence.
Physical Therapy goals for Children with Cerebral Palsy
Every child with cerebral palsy has different needs and thus each rehabilitation program is tailored as per his/her unique needs. Some of our goals of physiotherapy treatment for cerebral palsy in children aim to:
- Improve muscle strength
- Decrease muscle tightness through stretching and splinting techniques
- Promote physical development of child through play-way techniques and everyday activities.
- Enhance mobility with the use of different aids.
Physical Therapy goals for Adults with Cerebral Palsy
As every individual with cerebral palsy has different symptoms, needs and different level of functionalities, each rehabilitation program is uniquely made by our physical therapists and rehabilitation experts. Some of our goals of physiotherapy for adults with cerebral palsy aim to:
- Improve muscle strength through strengthening and mobilization exercises
- Improve postural alignment through mobilization and strengthening
- Minimize abnormal patterns of movement
- Increase sensation through sensory stimulation
- Improve balance and mobility
- Reduce muscle stiffness, spasm and pain through stretching programs
- Reduce risk of falls and gait training
- Provide functional electrical stimulation and various orthotics to prevent foot drop
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