A collection of chronic conditions known as cerebral palsy impede motor development and disrupt daily activities. Cerebral palsy is caused by non-progressive abnormalities that appear in the growing fetus or infant brain. The most frequent reason for childhood impairment is this. Depending on the cause, there are different levels and types of motor impairment and functional capacities.
Epilepsy, musculoskeletal issues, intellectual disabilities, feeding issues, vision abnormalities, hearing abnormalities, and communication challenges are just a few of the comorbidities that may be present in people with cerebral palsy. A multidisciplinary strategy should be used in the treatment of cerebral palsy. This activity addresses cerebral palsy evaluation, treatment, and complications and emphasizes the value of a multidisciplinary team approach to managing it.
Cerebral palsy is brought on by abnormal fetal or neonatal brain development or brain injury. The non-progressive (“static”) brain lesion or insult that results in CP may happen during pregnancy, during labor, or after delivery. In a given patient, the cause is frequently complicated.
- Congenital brain malformations
- Intrauterine infections
- Intrauterine stroke
- Chromosomal abnormalities
- Hypoxic-ischemic insults
- Central nervous system (CNS) infections
- Accidental and non-accidental trauma
- CNS infections
- Anoxic insults
The most frequent cause of childhood impairment is cerebral palsy. In 1.5 to 2.5 out of every 1000 live births, it happens. Infants born preterm have a much higher prevalence than those born at term. As gestational age decreases, the chance of cerebral palsy increases, with babies delivered at fewer than 28 weeks of gestational age having the highest risk. Additionally, the occurrence is higher in low birth weight babies. Infants born at very low birth weights (less than 1500 grams) are most at risk; cerebral palsy affects 5% to 15% of those born at these low birth weights.  About 80% of cerebral palsy cases are caused by prenatal events, while 10% are caused by postnatal events.
TYPES OF CEREBRAL PALSY
A physical examination can help determine the type of cerebral palsy. The type of tone abnormality and distribution of motor abnormalities are typical features of cerebral palsy. There are various forms of cerebral palsy.
Spastic diplegic: The patient’s motor problems and spasticity are more severe in the legs than in the arms.
Spastic hemiplegic: One side of the patient’s body is affected by spasticity and motor challenges; more frequently the arms than the legs are affected.
Spastic quadriplegic: The patient experiences spasticity and motor difficulty in all four of their extremities; frequently, the upper extremities are more affected than the legs.
Dyskinetic/hyperkinetic (choreoathetosis): The patient displays excessive, uncontrollable motions that combine slow writhing movements with fast, dance-like muscle contractions.
Dystonic: The patient has persistent, uncontrollable muscle spasms that cause twisting and repeated motions
Ataxic and hypotonic: A patient who is ataxic is unsteady, uncoordinated, and frequently hypotonic.
Interprofessional teams are used to treat cerebral palsy. Physical, occupational, and speech therapists, behavioral health specialists, social workers/case managers, and educational specialists make up the team of doctors, along with primary care physicians, neurologists, physiatrists, orthopedists, and other specialists as needed based on co-existing conditions.
The goals of interventions should be to improve the quality of life and lessen the burden of impairment. Functional goals should be realistic and frequently reevaluated by the patient, family, and team. Medication used orally or subcutaneously, such as botulinum toxin, can help treat pain, tone irregularities, and concomitant problems like epilepsy, sialorrhea, gastrointestinal disturbances, and behavioral disorders. Benzodiazepines, baclofen, dantrolene, tizanidine, cyclobenzaprine, botulinum toxin, and phenol are some of the drugs used to treat spasticity.
Trihexyphenidyl, gabapentin, carbidopa-levodopa, and benztropine are common medications used by doctors to treat dystonia. Glycopyrrolate, atropine drops, and scopolamine patches are treatments for sialorrhea. Patients with epilepsy are prescribed anti-seizure drugs. Constipation is a common consequence of cerebral palsy that calls for the use of pro-motility medications and stool softeners. Antidepressants treat depression and anxiety, whereas anti-inflammatories treat pain.
WHAT IS THE ROLE OF PHYSIOTHERAPY IN CEREBRAL PALSY?
The initial step in treating cerebral palsy is frequent physical therapy. It can aid in the development of motor skills and stop mobility issues from deteriorating over time. Children with cerebral palsy can gain more independence with physical therapy, which uses strength and flexibility exercises, heat treatment, massages, and specialized equipment.
Physical therapy’s effectiveness varies depending on the type and degree of each cerebral palsy case. The treatment for children with less severe instances of CP might only include a little physical therapy. It could be combined with other treatments or drugs in more serious cases. Children typically have the highest odds of improving when physical therapy is started as soon as feasible.
Every child with cerebral palsy receives a distinct kind of physical treatment. In order to develop a therapy strategy, the therapist must first assess the child’s mobility issues. Then, in order to improve movement, a mix of exercises, muscle-relaxing methods, and specialized equipment is usually used. The severity of the condition determines how much physical therapy can help a child’s unique problems.
Physical Therapy can improve
- Pain management
- Overall health
Physical therapists also customize treatment based on the area where mobility problems are present. Children with cerebral palsy may only have movement problems in one-half of their bodies (hemiplegia), just their legs (diplegia), or both their torso and all four limbs (quadriplegia). For children with hemiplegia, diplegia, or quadriplegia, therapists recommend specific exercises and routines that could eventually enable the kid to regain movement in the damaged limb.
Physical Therapy also treats a wide range of issues faced by children suffering from cerebral palsy.
- Up to 30% of children with cerebral palsy have scoliosis, an abnormal curvature of the spine.
- Thoracic kyphosis is a forward-bending curvature of the upper spine.
- Lower back twisting is known as lumbar lordosis
- A protrusion of the pelvis, either toward the front or the back, is known as pelvic inclination.
- Rotation of the pelvis in a horizontal direction
- Pelvic obliquity is an angle-based pelvic deformation, unnaturally straight or bent knees that may result from pelvic malformations are known as knee deformities.
- Walking and standing problems are brought on by shortened Achilles tendon, wrist, and hand malformations – abnormal wrist and hand flexing that hinders the growth of fine motor abilities.
Numerous mobility aids are used by physical therapists to enhance the efficacy of their treatments. For assistance with walking, posture, and joint mobility, orthotic devices include braces, casts, splints, and shoe inserts.
The following equipment is also frequently used in physical therapy:
- exercise spheres
- bands of resistance
- free weights
- watering holes
- Cold and hot packs
- electrically stimulating muscles
Electric stimulation is occasionally used to enhance gait and upper limb function. Small electrodes are used in this therapy to activate particular muscles.
Physical Therapy by Age
Babies- Toddler therapy frequently emphasizes playtime. Play is a crucial component of early treatment because it allows young children to learn and experience a lot during their early developmental stages. The practice of certain motions that are essential for learning and physical development in toddlers with CP is frequently avoided. Children can get over this resistance with the aid of a therapist.
Young children- Children with cerebral palsy face additional movement problems at school age, which is roughly between ages 5 and 12, in part because their bodies are expanding. Children can grow in a way that is beneficial to their motor function with the assistance of physical therapy. At this age, exercises and orthotics are most frequently employed. Therapy also supports the development of positive attitudes and healthy routines.
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