Treatment of Cerebral Palsy
While Cerebral Palsy as a disorder is not curable, many of the symptoms that most debilitate individuals with Cerebral Palsy can be treated. What is most important is to have a multidisciplinary team of professional and caring physical and mental health experts who know that those living with Cerebral Palsy can have a productive and fruitful life. These professionals should include those with experience in physical therapy, psychotherapy, speech therapy, occupational therapy, surgery, and pain management. In order for treatment to be effective, everybody involved in the child’s life must be included in the decision to apply a particular treatment, its side effects, the expectations of the treatment etc.
Physical Therapy
Physical therapy consists of a routine of daily range of motion exercises designed to prevent muscles from growing weak and to avoid contracture, which is the process by which muscles become rigid and fixed into abnormal and uncomfortable positions. Physical therapy is the cornerstone of any Cerebral Palsy treatment and should begin soon after diagnosis is made.
In order to understand why physical therapy is so important, one must comprehend the nature of the contractions that plague many individuals with Cerebral Palsy. A contracture is a chronic shortening of a muscle due to weakness and abnormal tone. In individuals without Cerebral Palsy, muscles and tendons grow at the same rate as bone. Cerebral Palsy individuals, however, have slower muscle and tendon growth and muscle growth may not keep up with bone growth. In essence, the muscles and tendons become fixed instead of stretching (spasticity), resulting in loss of balance and motor skills.
Physical therapy in conjunction with assistive orthotics such as braces works to stretch the muscles and reduce spasticity in individuals with Cerebral Palsy. It can make major improvements in the life of a child, making it easier to sit, move independently with a walker or wheelchair, and perform fine motor coordination tasks such as writing and holding utensils.
Speech Therapy
The uncontrolled movements experienced by children with Athetoid Cerebral Palsy (see section on types of Cerebral Palsy) may cause them to have trouble pronouncing words and swallowing. These difficulties may hinder a child’s social development and prevent adequate nutrition.
A qualified speech therapist will regularly work with a child to pronounce troublesome sounds, and if the child cannot speak at all, to use other means of communicating. For example, many children have been taught to use computers with voice synthesizers.
Surgery
Individuals with Cerebral Palsy may experience slower than normal muscle and tendon growth which can lead to a condition known as muscle spasticity. Muscle spasticity causes muscles to grow rigid, leading to contractions which limit movement, balance, and coordination. While drug and other therapies might help with the contractions, almost all individuals with Cerebral Palsy symptoms that limit movement will be recommended to have surgery at some point in their lives. While there are many different techniques used by the surgeon that depend on the individual, the basic process is the same – to lengthen muscles and tendons that are proportionately too short.
Surgery for Cerebral Palsy is an extremely intensive process that probably will involve months of recovery. For that reason, surgeons will almost always try to take care of every problematic muscle at one time, or if impossible, to have a series of surgeries within a short period of time.
Occupational Therapy
An occupational therapist seeks to assist individuals with Cerebral Palsy in carrying out the every day functions necessary to carry out work, school, and other aspects of life. They do this partly by working to improve the small muscles of the Cerebral Palsy person’s body, focusing on the hands, feet, fingers, and toes. Once motor skills have been improved, occupational therapists will show the child how to draw, eat, cut, dress, and properly work wheelchairs and other assistive devices. A good occupational therapist will also show the child what various pieces of equipment are available to make life a little easier.
Medication
Most of the medications used in the treatment of Cerebral Palsy are used to control and reduce the muscle spasms, abnormal movements, and seizures experienced by many individuals. Drugs are considered especially useful by doctors to treat a patient following surgery. It should be noted that each individual responds differently to drugs and different combinations may be needed to control the patients symptoms. In addition, almost all of the below drugs have significant side effects that will vary from individual to individual. Common drugs include:
Muscle spasm medications:
- Diazepam (valium): A general relaxant of the brain and body
- Baclofen: Blocks signals sent from the spinal cord to contract the muscles
- Dantrolene: Disrupts the muscle contraction process
- Botulinum Toxin (Botox): Blocks acetylcholine to reduce muscle spasm
- Phenol (Alcohol): Injected into a muscle to reduce spasticity. Often used to prevent the need for surgery by weakening the muscle so that physical therapists can work to lengthen it.
Abnormal movement medications(anticholinergics) for Athetoid Cerebral Palsy:
- TrihexyPhenidyl (Artane) – Inhibits the effects of acetylcholine – a chemical in brain cells that triggers muscle contraction
- Benztropine (Cogentin) – Inhibits the effects of acetylcholine – a chemical in brain cells that triggers muscle contraction
- Procyclodine Hydrochloride (Kemadrine) – Inhibits the effects of acetylcholine – a chemical in brain cells that triggers muscle contraction
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