Children and adults with cerebral palsy require long-term care with a medical care team. This team may include:
- Pediatrician or physiatrist. A pediatrician oversees the treatment plan and medical care.
- Pediatric neurologist. A doctor trained to diagnose and treat children with brain and nervous system (neurological) disorders may be involved in your child's care.
- Orthopedic surgeon. A doctor trained to treat muscle and bone disorders may be involved to diagnose and treat muscle conditions.
- Physical therapist. A physical therapist may help your child improve strength and walking skills, and stretch muscles.
- Occupational therapist. An occupational therapist can provide therapy to your child to develop daily skills and to learn to use adaptive products that help with daily activities.
- Speech-language pathologist. A doctor trained to diagnose and treat speech and language disorders may work with your child if your child suffers from speech, swallowing or language difficulties.
- Developmental therapist. A developmental therapist may provide therapy to help your child develop age-appropriate behaviors, social skills and interpersonal skills.
- Mental health specialist. A mental health specialist, such as a psychologist or psychiatrist, may be involved in your child's care. He or she may help you and your child learn to cope with your child's disability.
- Recreation therapist. Participation in art and cultural programs, sports, and other events that help children expand physical and cognitive skills and abilities. Parents of children often note improvements in a child's speech, self-esteem and emotional well-being.
- Social worker. A social worker may assist your family to find services and plan for care transitions.
- Special education teacher. A special education teacher addresses learning disabilities, determines educational needs and identifies appropriate educational resources.
Medications that can lessen the tightness of muscles may be used to improve functional abilities, treat pain and manage complications related to spasticity or other cerebral palsy symptoms.
It's important to talk about drug treatment risks with your doctor and discuss whether medical treatment is appropriate for your child's needs. Medication selection depends on whether the problem affects only certain muscles (isolated) or the whole body (generalized). Drug treatments may include the following:
Isolated spasticity. When spasticity is isolated to one muscle group, your doctor may recommend onabotulinumtoxinA (Botox) injections directly into the muscle, nerve or both. Botox injections may help to improve drooling. Your child will need injections about every three months.
Side effects may include pain, mild flu-like symptoms, bruising or severe weakness. Other more-serious side effects include difficulty breathing and swallowing.
Generalized spasticity. If the whole body is affected, oral muscle relaxants may relax stiff, contracted muscles. These drugs include diazepam (Valium), dantrolene (Dantrium) and baclofen (Gablofen).
Diazepam carries some dependency risk, so it's not recommended for long-term use. Its side effects include drowsiness, weakness and drooling.
Dantrolene side effects include sleepiness, weakness, nausea and diarrhea.
Baclofen side effects include sleepiness, confusion and nausea. Note that baclofen may also be pumped directly into the spinal cord with a tube. The pump is surgically implanted under the skin of the abdomen.
Your child also may be prescribed medications to reduce drooling. Medications such as trihexyphenidyl, scopolamine or glycopyrrolate (Robinul, Robinul Forte) may be helpful, as can Botox injection into the salivary glands.
A variety of nondrug therapies can help a person with cerebral palsy enhance functional abilities:
Physical therapy. Muscle training and exercises may help your child's strength, flexibility, balance, motor development and mobility. You'll also learn how to safely care for your child's everyday needs at home, such as bathing and feeding your child.
For the first 1 to 2 years after birth, both physical and occupational therapists provide support with issues such as head and trunk control, rolling, and grasping. Later, both types of therapists are involved in wheelchair assessments.
Braces or splints may be recommended for your child. Some of these supports help with function, such as improved walking. Others may stretch stiff muscles to help prevent rigid muscles (contractures).
Occupational therapy. Using alternative strategies and adaptive equipment, occupational therapists work to promote your child's independent participation in daily activities and routines in the home, the school and the community.
Adaptive equipment may include walkers, quadrupedal canes, seating systems or electric wheelchairs.
Speech and language therapy. Speech-language pathologists can help improve your child's ability to speak clearly or to communicate using sign language.
Speech-language pathologists can also teach your child to use communication devices, such as a computer and voice synthesizer, if communication is difficult.
Another communication device may be a board covered with pictures of items and activities your child may see in daily life. Sentences can be constructed by pointing to the pictures.
Speech therapists may also address difficulties with muscles used in eating and swallowing.
- Recreational therapy. Some children may benefit from recreational therapies, such as therapeutic horseback riding. This type of therapy can help improve your child's motor skills, speech and emotional well-being.
Surgical or other procedures
Surgery may be needed to lessen muscle tightness or correct bone abnormalities caused by spasticity. These treatments include:
Orthopedic surgery. Children with severe contractures or deformities may need surgery on bones or joints to place their arms, hips or legs in their correct positions.
Surgical procedures can also lengthen muscles and tendons that are proportionally too short because of severe contractures. These corrections can lessen pain and improve mobility. The procedures may also make it easier to use a walker, braces or crutches.
- Severing nerves. In some severe cases, when other treatments haven't helped, surgeons may cut the nerves serving the spastic muscles in a procedure called selective dorsal rhizotomy. This relaxes the muscle and reduces pain, but can also cause numbness.
Some children and adolescents with cerebral palsy use some form of complementary or alternative medicine.
For example, hyperbaric oxygen therapy is widely promoted for cerebral palsy treatment despite limited evidence of efficacy. This and other unproven therapies for cerebral palsy should be viewed with skepticism. Controlled clinical trials involving therapies such as hyperbaric oxygen therapy, resistance exercise training using special clothing, assisted motion completion for children and certain forms of electrical stimulation have been inconclusive or showed no benefit to date, and the therapies are not accepted mainstream clinical practice.
Stem cell therapy is being explored as a treatment approach for cerebral palsy, but research is still assessing whether such approaches are safe and effective. Studies in the U.S. and elsewhere are examining the safety and tolerability of umbilical cord blood stem cell infusion in children with cerebral palsy.
Aug. 25, 2016
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