Cerebral Palsy - Treatment Overview

SYMPTOMS & TREATMENTS

Cerebral palsy (CP) cannot be cured. But a variety of treatments can help people with CP to maximize their abilities and physical strength, prevent complications, and improve their quality of life. The brain injury or problem that causes CP does not get worse over time. But new symptoms can appear or become worse over time because of how a child grows and develops.

Specific treatment varies by individual and changes as needed if new issues develop. In general, treatment focuses on measures that maintain or improve a person's quality of life and overall health.

Initial treatment

Physical therapy is an important treatment that begins soon after a child is diagnosed and often continues throughout his or her life. This therapy also may begin before a definite diagnosis is made, depending on the child's symptoms.

Medicines can help control some of the symptoms of CP and prevent complications. This treatment may include injectable antispasmodics to help relax tight muscles and improve range of motion. Other medicines may be used for common problems related to cerebral palsy, such as anticonvulsant medicines for seizures.

In some cases, orthopedic surgery (for muscles, tendons, and joints) or selective dorsal rhizotomy (cutting nerves of affected limbs) for contracture or other mobility problems is performed soon after diagnosis on a baby or very young child with severe problems.

Often the biggest problem for parents is fear of the unknown. Learning about CP can help you to understand the condition and be familiar with some of the challenges and joys of raising a child with cerebral palsy. Being informed can help give you a sense of control about how best to help your child. For more information, talk to your doctor or see the Other Places to Get Help section of this topic.

Ongoing treatment

Ongoing treatment for cerebral palsy (CP) focuses on continuing and adjusting existing treatments and adding new treatments as necessary. Although the brain injury that causes CP does not get worse over time, some of its effects can appear for the first time, change, or become more severe as a child gets older.

Regular visits with your child's doctor and specialists are important for monitoring your child's condition. These visits may include tests, such as questionnaires to evaluate whether new developmental milestones are being achieved as expected, or periodic blood tests to find out about the effects of medicine your child may be taking. Your child should also have regular eye, hearing, and speech evaluations.

Other tests may be done to find out whether common problems related to cerebral palsy have developed. These problems can then be treated as they appear.

Ongoing treatment for cerebral palsy may include:

Physical therapy. This is usually animportant part of ongoing treatment for CP and can help your child become asmobile as possible. It may also help prevent the need for surgery. If a childhas surgery, intense physical therapy may be needed for 6 months or more.
Monitoring of any medicines being taken, to help control symptomsand prevent complications. Medicines may includeantispasmodics orinjectable antispasmodics to help relax muscles andreduce spasms,anticonvulsants to help treat seizures, oranticholinergics to help manage uncontrollable bodymovements (dystonic cerebral palsy) or frequent drooling.
Orthopedic surgery (for muscles, tendons, and joints)orselective dorsal rhizotomy (cutting nerves of affectedlimbs) to try to prevent problems with bones and related muscles, ligaments,and tendons.
Special devices and equipment, such as braces, casts,and splints. The specific types used depend on a child's needs. For example, achild may get a cast after surgery or as a means to restrict movement in onearea to strengthen muscles and tendons in another part of the body.

Ongoing treatment for CP may also include:

Biofeedback. This therapy may be useful as part ofphysical therapy or on its own. During biofeedback sessions, people with CPlearn ways to control their affected muscles. Some people find this techniquehelpful in reducing muscle tension. Biofeedback does not help everyone withCP.
Massage therapy andhatha yoga. These therapies are designed to help relaxtense muscles, strengthen muscles, and keep joints flexible. Hatha yogabreathing exercises are sometimes used to try to prevent lung infections. Moreresearch is needed to determine the health benefits of these therapies forpeople with CP.
Therapies to stimulate learning and sensorydevelopment. Babies and young children may benefit from stimulation orneurodevelopmental therapies. Some of these therapies also help people of otherages. These therapies cannot repair damaged parts of the brain. But they may beable to stimulate undamaged parts of the brain.

You may hear about a wide range of controversial treatments. Some of these may cause harm. Do not be afraid to talk to your doctor about any type of treatment you are considering for your child.

Each person with CP has unique strengths and areas of difficulty. But most people with CP need ongoing help with:

Feeding and eating. Cerebral palsy canaffect jaw control and interfere with the ability to chew, suck, and swallow.Special utensils, such as plates that stick to a surface; properly positioningyour child at meals; and serving soft or semi-solid foods, such as oatmeal, maybe helpful.
Using the toilet. Some people withcerebral palsy have stiff hip joints or similar problems that make using atoilet difficult. Others do not have dependable bladder control. Training froman occupational therapist and special undergarments are common ways to helptreat this condition.
Bowel elimination. People with CP oftenbecome constipated, making stool difficult to pass. Stool softeners and mildlaxatives are frequently used for this problem. For more information, see thetopicsConstipation, Age 11 and Younger orConstipation, Age 12 and Older.
Bathing and grooming. People with cerebral palsy who do not have control oftheir hands or arms usually are unable to groom themselves. Others can betaught some level of self-grooming through regular practice.
Dressing. Provide clothing and shoes that are easy to put on andtake off, such as those that zip or button in the front (not the back) or thathave large buttons, ties, or Velcro fasteners.
Dental care. Cerebral palsy can affect the jaw muscles, make teeth improperlypositioned and prone to decay, and cause sensitivity in the mouth and tongue.Also, many people with CP find it difficult to use a toothbrush. You can helpyour child by providing special equipment, such as a mechanized teeth-cleaningwater spray or electric toothbrush; buying toothpaste for sensitive gums; andmaking sure he or she has regular dental cleanings.
Skin care.Drooling is common in people with CP, and it can cause skin irritation aroundthe chin, mouth, and chest. You can help protect skin by blotting rather thanwiping drool, using absorbent cloths to cover the chest, and applying lotionsor cornstarch to areas that are prone to irritation.
Speaking. Some people with CP have problems with themuscles in their jaws and mouth as well as hearing loss. These problems, aloneor in combination, can make it difficult for them to form words. Try to speakslowly, look directly at your child, and use pictures or objects as you talk.Also, read with your child a lot and use picture books to help your childexpress himself or herself.
Keeping active. Your child needs tomove his or her limbs to help keep muscles strong and joints flexible. Have himor her move and play as much as possible. Involve other family members too. Askthe doctor, physical therapist, or other parents for ideas.
Safety. People with CP are prone to falls and otheraccidents, especially if they are affected byseizures. You can take general safety measures athome-such as having heavy, sturdy furniture or not polishing floors-to helpyour child avoid accidents. Also, use common sense and care around sharpobjects, and never leave a person with CP alone while he or she isbathing.

Behavioral therapy, in which a counselor helps a child learn better ways to communicate, may be a part of ongoing treatment. It is most often used to help school-age children with CP learn better ways to interact with others, especially their peers.

Working with others involved with your child's care, understanding your child's needs and rights, and taking care of yourself and other family members are all important parts of ongoing treatment for people with cerebral palsy. These strategies include:

Researching and understanding your child'seducational rights. In the United States, disabledchildren are eligible for free early treatment programs and equal access topublic education. You also have the right to be fully informed abouteducational decisions concerning your child. Contact your state and localeducation departments for detailed information about these accommodations. Inaddition,vocational training may benefit some teens and youngadults.
Working with your child's teachers, school administrators,special learning consultants, and school boards to develop the best educationalplan for your child. A cooperative team approach helps your child realize hisor her potential.
Supporting your child emotionally. Your child'sneeds will change over time. As children grow and become more aware of theirphysical limitations, they need to be able to talk about their feelings and howthey are treated. It is sometimes easier for them to talk with someone who isnot a family member. Ask your doctor about whether emotionalcounseling might benefit your child. Also, involveyour child as much as possible when making decisions about his or her healthcare.
Getting proper rest, eating well, exercising, and learningways to cope with the challenges of raising a child with CP. You will bebetter equipped to help your child when you have physical energy and emotionalstrength.
Working together as a family. The entire family isaffected when one member has CP.Helping family members cope with this situation isimportant, especially for siblings. You can help prevent other children fromhaving unrealistic fears and concerns, feeling left out, or becomingoverwhelmed.

Most children with cerebral palsy live to adulthood and have a somewhat shorter than normal life span. But a lot depends on the type of CP and how it affects your child's health.

Many adults get jobs if they have good support from their family and community. You can enroll your teen in occupational therapy as part of a gradual preparation for independent living. Helping your child be independent requires patience and resourcefulness on your part. Expect some frustrating setbacks or obstacles. Your child may need extra help and encouragement to prepare for added expectations and responsibilities.

Treatment if the condition gets worse

Although the brain injury that causes cerebral palsy (CP) does not get worse over time, some of its effects can appear for the first time, change, or become more severe as a child's nervous system grows and develops.

Common problems related to cerebral palsy may develop, become more severe, or lead to complications. Treatment varies by the individual and type of problem but generally can include medicine, surgery, specialized therapies, and orthopedic equipment.

Medicines

Medicines can help treat effects thatsome people experience with CP, such as muscle spasms or seizures.

If severe muscle spasms develop,antispasmodic pills may be given. These pills includediazepam (Valium), dantrolene (Dantrium), and baclofen (Lioresal). Or, lesscommonly, intrathecal baclofen (ITB) may be given. For this, a small pump isplaced under the skin of the abdomen. This pump releases baclofen into thefluid around the spinal cord. ITB may be more helpful than the pill atrelieving spasms, but it is harder to do than pills and has some risks (such asinfection where the pump is implanted).

Injectable antispasmodics, such asbotulinum toxin (Botox), are sometimes used. Thismedicine can be given with a needle directly into an affected muscle. Botulinumtoxin may be more useful than antispasmodic pills for the treatment of CP. Butin rare cases, severe side effects can occur.

If seizures become aproblem,anticonvulsants such as carbamazepine (Tegretol) areused. Anticholinergics, such as glycopyrrolate (Robinul)help a minority of people with CP who have uncontrollable body movements(dystonic cerebral palsy) or drool frequently.

Surgery Types of surgery include:

Orthopedic surgery to loosen tightmuscles, tendons, and joints, particularly on the hips, knees, andankles.
Selective dorsal rhizotomy to cut nerves on the limbsthat are most affected by movements and spasms to allow more flexibility andcontrol.

A doctor evaluates symptoms, age, and the person's general state of health when considering whether to recommend surgery. A thorough checkup is needed to help the doctor determine which muscles and nerves are affected and what type of surgery would best treat the condition. A gait analysis may be included, to evaluate the person's walking patterns.

Physical therapyPhysical therapy is often used as part of ongoingtreatment, but its focus may change after surgery or for problems that are newor getting worse. After surgery, specialized physical therapy may be needed for6 months or longer.Biofeedback may be useful as part of physical therapyor on its own. Although biofeedback does not help everyone with CP, some peoplewho use the technique learn how to control their affected muscles or reducemuscle tension.

Special devices and equipment Many people with CP benefit from using something tomaintain or improve joint mobility, help strengthen muscles and relaxoveractive (spastic) muscles, and assist with daily activities. Such devicesand equipment may include orthotics, casts, standers, special seats, walkers,wheelchairs, special shoes, and other individualized methods to help withspecific problems.

Individualized therapies may also be needed depending on the specific need that develops.

Occupational therapy helps adults adaptto their limitations and live as independently as possible.
Speech therapy helps control the mouth muscles. This therapy can be of greatbenefit to children with speech or eating problems. Speech therapy often startsbefore the child begins school and continues throughout the schoolyears.
Nutritional counseling may help when dietary needs arenot met because of problems with eating certain foods.
Bothmassage therapy andhatha yoga are designed to help relax tense muscles,strengthen muscles, and keep joints flexible. Hatha yoga breathing exercisesare sometimes used to try to prevent lung infections. More research is neededto determine the health benefits of these therapies for people withCP.
Therapies to stimulate learning and sensory development maybenefit babies and young children. Some also help people of other ages. Thesetherapies cannot repair damaged parts of the brain. But they may be able tostimulate undamaged parts of the brain.
Behavioral therapy helpssome school-age children with CP learn better ways to communicate with others.

You may hear about a wide range of controversial treatments, some of which may cause harm. Do not be afraid to talk to your doctor about any type of treatment you are considering for your child.

Prevention

Author:	Debby Golonka, MPH	Last Updated: October 14, 2008
Medical Review:	Michael J. Sexton, MD - Pediatrics Louis Pellegrino, MD - Developmental Pediatrics

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