How is it treated and managed?

Cerebral Palsy (CP) cannot be cured but management aims to use appropriate combinations of interventions to promote function, to prevent secondary impairments and attempt to increase a child’s developmental capabilities.

Its management is multidisciplinary with physical, occupational and nutritional therapy to maximise rehabilitative efforts.

Medical treatment

Oral medications such as baclofen and diazepam are used to reduce spasticity and other medications such as trihexyphenidyl can be used to treat dystonia. Tizanidine (zanaflex) as well as dantrolene (dantrium) are sometimes used to help spasticity, however they are less commonly used due to their side effects.

More recently, botulinum toxin injections such as Botox have been used to reduce the stiffness in specific muscles.

Seizure disorders are managed with anticonvulsant medications. See Epilepsy guidance.

Surgical Treatment

Surgical management may be helpful to treat contractures, deformities or joint dislocations e.g. tendon lengthening, tendon transfer, bone surgery, hip and spinal surgery.

Selective Dorsal (or Posterior) Rhizotomy is a surgical procedure used to treat spasticity in the lower limbs. It involves cutting some of the nerves in the spine to release the spasticity. Other recent advances with proven benefits are intrathecal baclofen (for spasticity) and deep brain stimulation (for dystonia). Stem cell treatment trials have been conducted but the benefits are uncertain at present.

Diet

Problems with the muscle tone of the tongue and throat may cause limitations in the texture of food and liquid. Some children can only manage pureed food and thickened fluids. Bite size food may cause choking and thin fluids may be aspirated. In severely affected children, feeding may be possible only by a tube directly into the stomach (gastrostomy) or into the small intestine (jejunostomy). Those children with quadriplegia and those who are tube fed are at increased risk of aspiration. A change in solid and liquid diet consistency, teaching techniques to protect the airway, and proper positioning during and after meals decrease the occurrence of aspiration to the lungs.

Walking & self care activities

Regular physiotherapy and occupational therapy are crucial. Physiotherapy helps to develop stronger muscles and work on skills such as walking, sitting, and maintaining balance. Occupational therapy can help a child develop fine motor skills such as dressing, feeding, writing, and other daily living tasks.

Various mobility aids may be helpful to assist with walking. Braces may be used to hold the foot in place when the child stands or walks. Some children do require wheelchairs or other special chairs for ambulation. Some chairs also support the entire body in remaining upright. The independent use of these aids by a child is largely dependent on their level of upper limb as well as cognitive function.

Casting and splinting can improve the range of motion of a joint and decrease tone. This can be done on a contracted joint to provide a slow, progressive stretch.

Speech and language Problems

Speaking may be difficult due to problems with the muscle tone of the tongue and throat. Speech therapy can help improve swallowing and communication. Some children also learn to use signing to communicate.

Assistive technology (to manage communication problems) includes -:

• Communication boards have pictures, symbols, letters, or words attached. The child communicates by pointing to or gazing at the pictures or symbols.
• Devices such as voice synthesizers enable the child to "talk" with others.
• Computer technology such as electronic toys with special switches, computer programs operated by simple switch pads or keyboard adaptations.