Management

Cerebral palsy cannot be cured but treatment will often improve a child’s capabilities. Many children go on to enjoy near normal adult lives if their disabilities are properly managed. In general, the earlier specialized care begins, the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them. For each child a specially designed plan is to be developed keeping in view the core disabilities of the individual.


COMPREHENSIVE MANAGEMENT

There is no standard therapy that works for every individual with cerebral palsy. Once the diagnosis is made, and the type of cerebral palsy is determined, a team of health care professionals will work with a child and his or her parents to identify specific impairments and needs, and then develop an appropriate plan to tackle the core disabilities that affect the child’s quality of life. A comprehensive management plan will pull in a combination of health professionals with expertise in the following:

Physical therapy to improve walking and gait, stretch spastic muscles, and prevent deformities;

Occupational therapy to develop compensating tactics for everyday activities such as dressing, going to school, and participating in day-to-day activities.

Speech therapy to address swallowing disorders, speed impediments, and other obstacles to communication;

Counseling and behavioral therapy to address emotional and psychological needs and help children cope emotionally with their disabilities;

Drugs to control seizures, relax muscle spasms, and alleviate pain;

Surgery to correct anatomical abnormalities or release tight muscles;

Braces and other orthotic devices to compensate for muscle imbalance, improve posture and walking, and increase independent mobility;

Mechanical aids such as wheelchairs and rolling walkers for individuals who are not independently mobile and

Communication aids such as computers, voice synthesizers, or symbol boards to allow severely impaired individuals to communicate with others.

Doctors use tests and evaluation scales to determine a child’s level of disability, and then make decisions about the types of treatments and the best timing and strategy for interventions. Early intervention programs typically provide all the required therapies within a single treatment centre. Centres also focus on parents’ needs, often offering support groups, babysitting services, and respite care.

The members of the treatment team for a child with cerebral palsy will most likely include the following:

A physician, such as a pediatrician, pediatric neurologist, or pediatric psychiatrist, who is trained to help developmentally disabled children. This doctor, who often acts as the leader of the treatment team, integrates the professional advice of all team members into a comprehensive treatment plan, makes sure the plan is implemented properly, and follows the child’s progress over a number of years.
An orthopedist, a surgeon who specializes in treating the bones, muscles, tendons, and other parts of the skeletal system. An orthopedist is often brought in to diagnose and treat muscle problems associated with cerebral palsy.
A physical therapist, who designs and puts into practice special exercise programs to improve strength and functional mobility.
An occupational therapist, who teaches the skills necessary for day-do-day living, school, and work.
A speech and language pathologist, who specializes in diagnosing and treating disabilities relating to difficulties with swallowing and communication.
A social worker, who helps individuals and their families cope with the special stresses and demands of cerebral palsy. In some cases psychologists may also oversee therapy to modify unhelpful or destructive behaviors.
An educator, who may play an especially important role when mental retardation or learning disabilities present a challenge to education.
A good program will encourage the open exchange of information, offer respectful and supportive care, encourage partnerships between parents and the health care professionals they work with, and acknowledge that although medical specialists may be the experts, it’s parents who know their children best.


SPECIFIC TREATMENTS

Physical therapy, usually begun in the first few years of life or soon after the diagnosis is made, is a cornerstone of cerebral palsy treatment. Physical therapy programs use specific sets of exercises and activities to work toward two important goals: preventing weakening or deterioration in the muscles that aren’t being used (disuse atrophy), and keeping muscles from becoming fixed in a rigid, abnormal position (contracture).

Resistive exercise programs (also called strength training) and other types of exercise are often used to increase muscle performance, especially in children and adolescents with mild cerebral palsy. Daily bouts of exercise keep muscles that aren’t normally used moving and active and less prone to wasting away. Exercise also reduces the risk of contracture, one of the most common and serious complications of cerebral palsy.

Occupational therapy – This kind of therapy focuses on optimizing upper body function, improving posture, and making the most of a child’s mobility. An occupational therapist helps a child master the basic activities of daily living, such as eating, dressing, and using the bathroom alone.


Recreational therapies – Recreational therapies, such as therapeutic horseback riding (also called hippotherapy), are sometimes used with mildly impaired children to improve gross motor skills. Parents of children who participate in recreational therapies usually notice an improvement in their child’s speech, self-esteem, and emotional well being.


Speech and language therapy – About 20 percent of children with cerebral palsy are unable to produce intelligible speech. They also experience challenges in other areas of communication, such as hand gestures and facial expressions, and they have difficulty participating in the basic give and take of a normal conversation. These challenges will last throughout their lives.

Speech and language therapists observe, diagnose, and treat the communication disorders associated with cerebral palsy. They use a program of exercises to teach children how to overcome specific communication difficulties.


MEDICAL INTERVENTION

Oral medications such as diazepam, baclofen, dantrolene sodium, and tizanidine are usually used as the first line of treatment to relax stiff, contracted, or overactive muscles. These drugs are easy to use, except that dosages high enough to be effective often have side effects, among them drowsiness, upset stomach, high blood pressure, and possible liver damage with long-term use. Oral medications are most appropriate for children who need only mild reduction in muscle tone or who have widespread spasticity.

Botulinum toxin (BT-A), injected locally, has become a standard treatment for overactive muscles in children with spastic movement disorders such as cerebral palsy. BT-A relaxes contracted muscles by keeping nerve cells from over-activating muscle.

The relaxing effect of a BT-A injection lasts approximately 3 months. Undesirable side effects are mild and short-lived, consisting of pain upon injection and occasionally mild flu-like symptoms. BT-A injections are most effective when followed by a stretching program including physical therapy and splinting. BT-A injections work best for children who have some control over their motor movements and have a limited number of muscles to treat, none of which is fixed or rigid.

Intrathecal baclofen therapy uses an implantable pump to deliver baclofen, a muscle relaxant, into the fluid surrounding the spinal cord. Baclofen works by decreasing the excitability of nerve cells in the spinal cord, which then reduces muscle spasticity throughout the body. Because it is delivered directly into the nervous system, the intrathecal dose of baclofen can be as low as one one-hundredth of the oral dose. Studies have shown it reduces spasticity and pain. DAILY CARE

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

Feeding and eating- Cerebral palsy can affect jaw control and interfere with the ability to chew, suck, and swallow. Special utensils, such as plates that stick to a surface; properly positioning your child at meals; and serving soft or semi-solid foods, such as oatmeal, may be helpful.

Using the toilet- Some people with cerebral palsy have stiff hip joints or similar problems that make using a toilet difficult. Others do not have dependable bladder control. Training from an occupational therapist and special undergarments are common ways to help treat this condition.

Bathing and grooming- People with cerebral palsy who do not have control of their hands or arms usually are unable to groom themselves. Others can be taught some level of self-grooming through regular practice.

Dressing- Provide clothing and shoes that are easy to put on and take off, such as those that zip or button in the front (not the back) or that have large buttons, ties, or Velcro fasteners.

Dental Care- Cerebral palsy can affect the jaw muscles, make teeth improperly positioned 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 help your child by providing special equipment, such as a mechanized teeth-cleaning water spray or electric toothbrush, buying toothpaste for sensitive gums; and making sure he or she has regular dental cleanings.

Skin Care- Drooling is common in people with CP, which can cause skin irritation around the chin, mouth, and chest. You can help prevent skin irritations and protect your child’s skin by blotting rather than wiping drool, using absorbent cloths to cover the chest, and applying lotions or corn starch to areas that are prone to irritation.

Speaking- Some people with CP have problems with the muscles in their jaws and mouth as well as hearing loss. These problems, alone or in combination, can make it difficult to form words. You can make better communication possible by speaking slowly, looking directly at your child during conversations, and using pictures or objects as you talk. Reading to your child is also important, and using books with bright pictures may be most effective.

Safety- People with CP are prone to falls and other accidents, especially if they are affected by seizures. You can take general safety measures at home-such as having heavy, sturdy furniture or not polishing floors-to help your child avoid accidents. Also, use common sense and care around sharp objects, and never leave a person with CP alone while he or she is bathing.


ROLE OF CAREGIVER

Since cerebral palsy is actually a set of symptoms associated with a variety of causes, potential treatments will have to be diverse. Many scientists are now focusing on recent discoveries that suggest we will be able to replace lost or damaged brain cells. While such therapies are not yet available, it is likely that real clinical trials will begin in the next 5 to 10 years.

The more we know about the causes of cerebral palsy, the more we can do to prevent it. Avoiding the use of certain drugs during the pregnancy whether legal, such as prescribed medications, alcohol or tobacco, or illegal such as cocaine and crack, will also decrease the chances of cerebral palsy in a child.

It cannot be overemphasized that the most important person in the lives of children with cerebral palsy is their caregiver. The caregiver, whether a parent or other person, must be able to recognize a child’s needs and provide for him or her a loving, positive environment. Because of the difficulty that many children with cerebral palsy have in expressing their needs, they are at great risk for unintentional and intentional neglect as well as overt child abuse. Often, the care of children with cerebral palsy can be quite taxing emotionally and financially on the family. The appropriate care for children with cerebral palsy, therefore, must take into account mental health and financial support for families and caregivers. Many state-run programs provide out-of-home schooling as well as respite care for the caregivers, but these services often fall short of what is truly needed. Healthcare practitioners can very simply improve the lives of their patients by taking some extra time to listen to the concerns and hopes of the caregivers and provide thoughtful answers to their questions.

We must recognize that many, and possibly most, children with cerebral palsy can lead full, meaningful, and happy lives. The team of parents, caregivers, and health practitioners have the responsibility to help the child with cerebral palsy achieve this goal.


HOLISTIC VIEW

Clearly, children with cerebral palsy may have very substantial problems, but almost all have the potential to learn, achieve, succeed, and create a happy life for themselves. This cannot happen without effort, and they need the help of their families. Having a child with cerebral palsy brings many challenges. It is understandable, then, that parents and siblings of a child with cerebral palsy may have significant stress. You may feel guilt, anger, anxiety, and/or hopelessness. You feel alone and uncertain about what you should do.

Before you can help yourself or your child, you need to develop appropriate expectations and get organized. Only then can you learn practical ways to cope with the child’s problems and put these methods into practice. But making changes is not always easy. Sometimes it helps to have someone to talk to.

The family must take a holistic view of the situation and create happy atmosphere in the family and try to lead a normal life. The family must help faith in the Almighty and reconcile with the situation. Some yoga exercises and message therapies as prescribed under ayurvedic system of medicine can be designed to help relax toned up muscles, strengthen muscles and keep body and skin radiant. Pranayama and other breathing exercises are also useful to strengthen lungs. SSOG subscribes to holistic view of treatment for which specialist ayurveda doctor is available for consultation. However efficacy of these therapies differs from each case to case and upon severity of the level of spasticity.