Cerebral Palsy with PT management

📚Cerebral palsy📚

📚What is cerebral palsy📚...?
( General Introduction )

👉Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture.

👉 CP is the most common motor disability in childhood.

👉 Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles.

👉CP is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control his or her muscles.

👉The symptoms of CP vary from person to person.

👉A person with severe CP might need to use special equipment to be able to walk, or might not be able to walk at all and might need lifelong care.

👉A person with mild CP, on the other hand, might walk a little awkwardly, but might not need any special help. CP does not get worse over time, though the exact symptoms can change over a person’s lifetime.

👉All people with CP have problems with movement and posture.

👉Many also have related conditions such as intellectual disability; seizures; problems with vision, hearing, or speech; changes in the spine (such as scoliosis); or joint problems (such as contractures).

📚Types of Cerebral Palsy📚:-

👉 Doctors classify CP according to the main type of movement disorder involved. Depending on which areas of the brain are affected, one or more of the following movement disorders can occur:

👉Stiff muscles (spasticity).
👉Uncontrollable movements (dyskinesia).
👉Poor balance and coordination (ataxia).

➡️There are four main types of CP:

📖Spastic Cerebral Palsy📖

👉The most common type of CP is spastic CP. Spastic CP affects about 80% of people with CP.

👉People with spastic CP have increased muscle tone. This means their muscles are stiff and, as a result, their movements can be awkward. Spastic CP usually is described by what parts of the body are affected:

👉Spastic diplegia/diparesis―In this type of CP, muscle stiffness is mainly in the legs, with the arms less affected or not affected at all. People with spastic diplegia might have difficulty walking because tight hip and leg muscles cause their legs to pull together, turn inward, and cross at the knees (also known as scissoring).

👉Spastic hemiplegia/hemiparesis―This type of CP affects only one side of a person’s body; usually the arm is more affected than the leg.

📖Spastic quadriplegia📖... 

quadriparesis―Spastic quadriplegia is the most severe form of spastic CP and affects all four limbs, the trunk, and the face. People with spastic quadriparesis usually cannot walk and often have other developmental disabilities such as intellectual disability; seizures; or problems with vision, hearing, or speech.

📖Dyskinetic Cerebral Palsy📖 (also includes athetoid, choreoathetoid, and dystonic cerebral palsies)

👉People with dyskinetic CP have problems controlling the movement of their hands, arms, feet, and legs, making it difficult to sit and walk.

👉The movements are uncontrollable and can be slow and writhing or rapid and jerky. Sometimes the face and tongue are affected and the person has a hard time sucking, swallowing, and talking. A person with dyskinetic CP has muscle tone that can change (varying from too tight to too loose) not only from day to day, but even during a single day.

📖Ataxic Cerebral Palsy📖

👉People with ataxic CP have problems with balance and coordination. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something.

📖Mixed Cerebral Palsy📖

👉Some people have symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP.

📖CAUSE📖

👉Brain damage is the cause of CP, but there are many different things that can trigger damage.  For this reason, the exact cause of cerebral palsy can’t always be determined. Possibilities include:

👉Poor brain development in the womb
Maternal infections or medical conditions

👉Disruption of blood flow to the developing brain

👉Genetic conditions

👉Ingestion of toxins or drugs during pregnancy

👉Damage to the head or skull during delivery

👉Complications related to premature delivery

📖Sign and symptoms📖

📖Early Signs:-

👉The signs of CP vary greatly because there are many different types and levels of disability.

👉The main sign that a child might have CP is a delay reaching motor or movement milestones (such as rolling over, sitting, standing, or walking). Following are some other signs of possible CP.

👉It is important to note that some children without CP also might have some of these signs.👈

📖In a Baby Younger Than 6 Months of Age📖

👉His head lags when you pick him up.

👉while he’s lying on his back.

👉He feels stiff.

👉He feels floppy.

Symptoms

👉When held cradled in your arms, he seems to overextend his back and neck, constantly acting as if he is pushing away from you.

👉When you pick him up, his legs get stiff and they cross or scissor.

📖In a Baby Older Than 6 Months of Age📖

👉She doesn’t roll over in either direction

👉She cannot bring her hands together

👉She has difficulty bringing her hands to her mouth.

👉She reaches out with only one hand while keeping the other fisted.

📖In a Baby Older Than 10 Months of Age📖

👉He crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg
He scoots around on his buttocks or hops on his knees, but does not crawl on all fours.

📚Screening and Diagnosis📚

👉Diagnosing CP at an early age is important to the well-being of children and their families. Diagnosing CP can take several steps:

📖Developmental Monitoring📖

👉Developmental monitoring (also called surveillance) means tracking a child’s growth and development over time. If any concerns about the child’s development are raised during monitoring, then a developmental screening test should be given as soon as possible.

📖Developmental Screening📖

👉During developmental screening a short test is given to see if the child has specific developmental delays, such as motor or movement delays. If the results of the screening test are cause for concern, then the doctor will make referrals for developmental and medical evaluations.

📖TREATMENT📖

BASIC INTRODUCTION :

👉There is no cure for CP, but treatment can improve the lives of those who have the condition. It is important to begin a treatment program as early as possible.

👉After a CP diagnosis is made, a team of health professionals works with the child and family to develop a plan to help the child reach his or her full potential. Common treatments include medicines; surgery; braces; and physical, occupational, and speech therapy. No single treatment is the best one for all children with CP. Before deciding on a treatment plan, it is important to talk with the child’s doctor to understand all the risks and benefits.

How Is Cerebral Palsy Treated?

👉A variety of treatment options can improve symptoms and quality of life for babies and children. Many interventions can be started immediately after a diagnosis is given.

📖Medications📖

👉 Various medications help control spastic movements, seizures, relieve pain, and manage other symptoms and related conditions:

👉Baclofen or other muscle relaxants
👉Diazepam
👉Anticonvulsants
👉Anticholinergics
👉Antacids
👉Stool softeners/laxatives
👉Sleep aids
👉Surgery

👉Surgery is a critical part of treatment for many children with CP. Surgical procedures may improve mobility or manage pain. Common procedures include tendon or muscle release, the repair of hip dislocations, and scoliosis surgery.

📖Therapies📖

👉Several different types of therapies are used for children and babies with cerebral palsy.

👉They can improve physical, mental, social, and learning deficits. If started early, therapies for cerebral palsy can reduce impairment and lessen the risk of developing other associated conditions.

👉Common types of therapy used to help children with cerebral palsy are:

👉Physical
👉Occupational
👉Feeding
👉Aqua
👉Horse and animal
👉Music
👉Play
👉Behavioral
👉Speech/Language
👉Bowel program

What is the Life Expectancy for Cerebral Palsy?

👉Many children diagnosed with cerebral palsy have the same life expectancy as any other. This wasn’t always true, but earlier diagnosis and better therapies have improved many health conditions for these children.

👉While CP does not usually shorten life expectancy, it does require early intervention and good medical care for the best outcomes. This is especially true for those with severe disabilities.

👉Some of the conditions associated with cerebral palsy can be life-threatening if not treated. These include breathing and swallowing difficulties (which can cause pneumonia or malnutrition), seizures, chronic nutritional deficiencies, or life-threatening pressure infections.

📚Physiotherapy management 📚

Physiotherapy treatment Goal:-

👉Overcoming physical limitations

👉Expanding range of joint motion

👉Building and maintaining muscle tone

👉Increasing recreational capabilities

👉Identifying alternate ways to perform everyday tasks

👉Fostering independence

👉Decreasing the likelihood of contractures, bone deformity

👉Educating children and parents about adaptive equipment

👉Providing sensory stimulation

👉Increasing fitness

👉Increasing flexibility

👉Improving posture

👉Improving gait

👉Minimizing pain and discomfort

📖PHYSIOTHERAPIST ALSO FOCUS IN...

👉Gait

👉Range of joint motion

👉Physical strength

👉Flexibility

👉Balance

👉Endurance

👉Joint integrity

👉Posture

👉Neuromoter development

👉Sensory integration

👉Cognitive functioning

👉Reflexes

👉Breathing, respiration

📖Physiotherapy for Cerebral Palsy in children📖

👉For children, treatment for Cerebral Palsy primarily aims to increase mobility and promote physical development such as sitting, crawling and walking.

👉 Treatment should be started early and should aim to continue on a regular basis. Every child with Cerebral Palsy presents differently and has different needs.

👉At Hobbs Rehabilitation, our specialist paediatric physiotherapists will tailor a treatment program specific to each child’s needs. Some of the physiotherapy treatments we offer aim to:
👇👇👇

👉Increase muscle strength and activation.

👉Decrease muscles tightness and spasms through stretching programs and splinting Techniques.

👉Encourage physical development through play and everyday activities

👉Improve mobility with the use of different aids.

📖Physiotherapy for Cerebral Palsy in adults📖

👉For adults, treatment is aimed at improving muscle activation and control and improving functional abilities.

👉 Specialist services for adults with Cerebral Palsy are often less widely available than those for children.  Every individual with Cerebral Palsy presents with different symptoms, needs and priorities depending on their age and the extent of the damage to the brain. Each individual will be assessed by their therapist and have treatment tailored to their needs and goals.

👉 Some of the physiotherapy treatments we offer can help to:

👉Increase muscle strength through strengthening and mobilisation exercises.

👉Minimise abnormal patterns of movement through re-alignment and activation of muscles.

👉Improve postural alignment through mobilisation and strengthening.

👉Improve balance and mobility through assessment of different seating and mobility aids and postural  re-education.

👉Increase sensation through sensory stimulation.

👉Reduce muscle stiffness, spasms and pain through stretching programmes.

👉Reduce the risk of falls through balance work, gait re-education and training.

👉Help reduce foot drop through functional electrical stimulation (FES) and various orthotics.

👉Increase independence and quality of life through management of positioning in bed and seating.

📖Occupational Therapy for Cerebral Palsy📖

👉Cerebral Palsy affects individuals of all ages, therefore our specialist OT’s aim to improve areas of personal care, work or leisure that are becoming difficult and help each person to achieve their individual goals. This can be achieved through:

👉Functional activities independently or in groups.

👉Assessing function in your own environment and establish any needs for equipment, adaptations, or further rehabilitation.

👉Hand therapy including splinting and exercise programmes.

👉Advice and management of pressure relief through bed positioning and seating adaptations.

👉Management and education to help individuals adapt and manage altered sensation.

👉Knowledge of a wide variety of equipment available to aid transfers and mobility.

Speech and Language Therapy for Cerebral Palsy:

👉 Individuals with Cerebral Palsy often have difficulties with their speech and swallowing. Difficulties in written and non-verbal communication can also be experienced. Our specialist speech and language therapists can assist with:

👉Training for family and carers on how to communicate with someone with dysphagia.

👉Advice and management with various communication aids.

👉Treatment at the centre or in your own home.

👉Assistance with written communication including adaptive equipment.

📖Neuropsychology for Cerebral Palsy📖

👉Cerebral Palsy is a lifelong condition and affects people of all ages. Coming to terms with the symptoms and loss of independence at any age is a challenge. Our clinical neuropsychologists can help to provide:

👉Detailed assessment of a clients’ functioning in particular their cognition, behaviour and emotional state.

👉Providing advice, consultation, teaching and supervision to other professionals as well as family and carers.

👉Management and advice for anxiety and changes in mood.

📖Orthotics for Cerebral Palsy📖

👉Orthotics may be an every-day requirement that often need re-adjusting as the individual grows. Our specialist orthotist can help by designing, fitting and altering orthoses to best complement your treatment and rehabilitation.

These include:

👉Orthotics to prevent foot drop and aid walking.

👉Night and day resting splints to maintain alignment and prevent contractures.

👉Insoles to improve alignment, proprioception and gait.

👉Alteration to shoes to assist with leg length discrepancies, alignment and improve mobility.

📖Static Weight-bearing Exercises📖

👉Stimulation of antigravity muscle strength, prevention of hip dislocation, reduction in spasticity and improvements in bone mineral density, self-confidence and motor function have all been achieved through the use of Static Weight-Bearing exercises such as Tilt-Table and Standing Frame.

📖Muscle Strengthening Exercises📖

👉It aims to increase the power of weak antagonist muscles and of the corresponding spastic agonists and to provide the functional benefits of strengthening in children with CP.

📖Functional Exercises📖

👉Training related to specific functional activities combining aerobic and anaerobic capacity and strength training in ambulatory children, has been shown to significantly improve overall physical fitness, the intensity of activities, and quality of life.

📖Body Weight Supported Treadmill Training📖

👉Stepping movements from Reflex Stepping Reactions are normally present in newborns and infants, before the infant starts to bear weight, stand and walk. Body Weight Supported Treadmill Training, is achieved through supporting the child in a harness on the treadmill in an upright posture limiting overall weight bearing, on a slow moving treadmill, eliciting the stepping movements.

👉 Treadmill training, thus allows the development of stepping movements needed for ambulation. Studies using 3-4 sessions per week lasting for 3-4 months have shown improvement in lower extremity movements and gait patterns in children with cerebral Palsy.

📖Electrical Stimulation📖

The goal of the electrical stimulation is to increase muscle strength and motor function.

👉Electrical stimulation is provided by Transcutaneous Electrical Nerve Stimulation (TENS) Unit which is portable, non-invasive and can be used in the home-setting by parents or the patient.

👉Neuromuscular Electrical Stimulation (NMES) involves application of transcutaneous electrical current that results in muscle contraction. NMES has been postulated to increase muscle strength by increasing the cross-sectional area of the muscle and by increased recruitment of type 2 muscle fibers.

👉 Functional Electrical Stimulation (FES) refers to the application of electrical stimulation during a given task or activity when a specific muscle is expected to be contracting.

🙏REGARD🙏
BY LOSERPHYSIO TEAM