What're the treatments for conditions associated with cerebral palsy?
Posture and mobility: Spasticity, muscle coordination, ataxia, and scoliosis are all significant impairments that affect the posture and mobility of a person with cerebral palsy. The physical therapist works with the family to maximize the child's ability to move affected limbs, to develop normal motor patterns, and to maintain posture. Adaptive equipment may be
needed, including wheelchairs, walkers, shoe inserts, crutches, or braces. The need for adaptive equipment may change as the person develops, or as new treatments are introduced. The parents or other caregivers are taught safe transfer techniques to aid the person who cannot move independently from wheelchair to bed, for example.
Spasticity: Mild spasticity may be treated by regular stretching of the affected muscles through their full range of motion. This usually is done at least daily. Moderate spasticity may require bracing to keep the limb out of the abnormal position, or serial casting to return it to its normal position. Ankle-foot braces (orthoses) made of lightweight plastic are often used to increase a child's stability and to promote proper joint alignment. Before fixed contracture develops, botulinum toxin (a highly active neurotoxin; Botox) injections can help loosen the affected muscles. Alcohol or phenol injection into the nerve controlling the muscle is also done; these injections are less costly than botulinum toxin, but they may cause more serious side effects, including pain, loss of sensation, and excess weakness. Fixed contractures are usually treated with either serial casting or tenotomy surgery. In this surgery, the tendons of the affected muscle are cut. The limb is then cast in a more normal position while the tendon regrows. Tenotomy is commonly done to prevent hip dislocation and to correct equinus. Another type of surgery available is dorsal rhizotomy. In this procedure, selected nerve roots in the spinal cord are cut to prevent them from stimulating the spastic muscles. Spasticity may also be treated with muscle relaxing drugs, including diazepam (Valium), dantrolene (Dantrium), and baclofen (Lioresal). A baclofen pump can also be implanted to deliver the drug directly to the spinal cord, its site of action, allowing more effective spasticity reduction with fewer side effects.
Ataxia and coordination: Ataxia, or lack of balance control, is another factor affecting mobility. Physical therapy is an important tool to help the child with CP maximize balance. Coordination can be worsened if one member of a muscle pair is overly strong; bracing or surgical transfer of the muscle to a less overpowering position may help.
Scoliosis: Scoliosis, or spine curvature, can develop when the muscles that hold the spine in place become either weak or spastic. In either case, an imbalance of forces pulls the vertebrae (bones making up the spinal column) out of alignment. This can cause pain, as well as interfere with normal posture and internal organ function. Scoliosis may be treated with a trunk brace. If this proves unsuccessful, spinal fusion surgery may be needed to join the vertebrae together, which keeps the spine straight.
Seizures: Seizures occur in 30-50% of children with CP. Seizures may be restricted to one limb (focal) or generalized. Grand mal seizures are the most common type of generalized seizure for people with CP. Seizures may be treated with drugs, most commonly carbamazepine (Tegretol) or ethosuximide (Zarontin). A combination of a ketogenic diet and fasting may also be used to control seizures. Although the need for antiseizure medication is temporary in some children, it may be required throughout life for others.
Strabismus: Strabismus occurs in nearly half of all people with spastic CP. Strabismus may be treated with patching and corrective lenses. When these do not work, it may be treated with either surgery on the eye muscles causing the problem or by injection of botulinum toxin.
Nutrition: The person with CP may not be able to feed easily, because of poor coordination of the tongue and mouth muscles, or inability to hold and move utensils independently. The person may not take in adequate nutrition for full growth and development, worsening the results of the disorder. Careful attention to nutritional needs can prevent these problems. Nutritional supplements may be needed. Poor swallowing coordination may lead to aspiration, or inhaling of food or saliva. A speech-language therapist may be able to teach the person more effective movement patterns to avoid aspiration. In severe cases, a gastrostomy tube may be required to provide adequate nutrition directly into the digestive system while preventing aspiration. Nutrition may need to be monitored throughout childhood and adolescence, since meeting the increased food demands of a growing body may become difficult.
Feeding and digestive problems: Individuals with cerebral palsy often have gastroesophageal reflux or GERD (severe heartburn and related symptoms caused by regurgitation of acid from the stomach) as well as swallowing and feeding problems. A team consisting of a doctor who specializes in digestive diseases (gastroenterologist), a nutritionist, and a feeding and swallowing therapist can assess nutritional status and treat problems. Swallowing therapy helps the child eat and drink independently and helps prevent aspiration. The child’s diet must be customized to accommodate limitations in swallowing. Children with severe swallowing problems require feeding through a tube.
Other common medical problems: Drooling, dental caries (cavities), and gum disease are more common in people with CP than in the general population, partly because of lowered coordination and increased muscle tightness in the mouth and jaw. Each of these can be prevented to some degree, either through behavioral changes alone or in combination with drug therapy. Constipation is more common as well, and may be treated through dietary changes, or with enemas or suppositories when necessary.