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Spastic Cerebral Palsy Surgical and Rehabilitation Treatment | Journee’s Story

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Mild: A child can move without assistance; his/her daily activities not limited

Moderate: A child will need braces, medications, and adaptive technology to accomplish daily activities

Severe: A child will require a wheelchair and will have significant challenges in accomplishing daily activities

No CP: A child has CP signs but the impairment was acquired after completion of brain development and is classified under the incident that caused the CP such as traumatic brain injury or encephalopathy

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Classification based on Severity Level

Classification based on Topographical Distribution

Classification based on Motor Function

Classification based on Gross Motor Function Classification System (GMFS)

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Early Detection of Cerebral Palsy for High Risk Infants

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Motor control 
Therapeutic strategies and procedures should address timing, speed, magnitude of force production, and biomechanical efficiency.
Several authors advocate that children with CP should be encouraged to learn motor control strategies to enable adaptive function and maximize energy efficiency, thereby minimizing the impact of neuromuscular and musculoskeletal impairments.

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Anticipatory postural control is an area of research with important implications for physical and occupational therapy.
Practicing postural adjustments as part of goal-directed movement, learning strategies for weight-shifting, and varying task requirements and environmental conditions are strategies that may be effective in improving anticipatory postural adjustment
Two common goals of physical and occupational therapy interventions for children with CP are improving muscle strength and optimizing muscle length.

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Classification levels:

GMFCS Level 1: walks without limitations

GMFCS Level 2: walks with limitations such as walking long distances and balancing; may require use of mobility devices when first learning to walk (prior age 4); may rely on mobility equipment when outside of home for traveling long-distances.

GMFCS Level 3: walks with adaptive equipment assistance; requires hand-held mobility assistance to walk indoors, while utilizing wheeled mobility outdoors, in the community, and at school; can sit on own or with limited external support; has some independence in standing transfers.

GMFCS Level 4: self-mobility with use of powered mobility assistance; usually supported when sitting; self-mobility is limited and likely to be transported in a manual wheelchair or powered mobility.

GMFCS Level 5: severe head trunk and control limitations; requires use of assisted technology and physical assistance; and transported in a manual wheelchair, unless self-mobility can be achieved by learning to operate a powered wheelchair.

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Occupational therapists work to help provide stability and enable weight shifts that are necessary for movements. Occupational therapists also work towards learning to grasp objects as well stabilize sensory motor issues.

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How Does Occupational Therapy Help?

Occupational therapy helps people develop or recover the skills needed to lead independent, satisfying lives. The "occupation" in occupational therapy does not refer to one's profession. Rather, it refers to the everyday activities that give life meaning.

For a child, these meaningful activities include playing and learning. Pediatric occupational therapy focuses on improving the child's ability to play and learn, which are important for development and becoming independent.

For children with cerebral palsy, occupational therapy can help with muscle and joint coordination issues - issues that can make everyday tasks difficult. Some of these tasks include eating, brushing teeth and bathing. Occupational therapy can help to improve physical, cognitive and social abilities, as well as fine motor skills and posture. This therapy can also help address difficulties with processing sensory information.

Benefits of Occupational Therapy

Occupational therapy is beneficial for children with cerebral palsy in many ways.

By optimizing upper body function and improving the coordination of small muscles, occupational therapy can help children with CP master the basic activities of daily living.
Occupational therapy can help children by:

Increasing their chance for independence

Improving their ability to play and learn

Boosting their self-esteem and confidence

Helping them develop a workable routine

Giving them a sense of accomplishment

Improving their quality of life

Parents and caregivers spend a lot of time helping children with cerebral palsy perform basic day-to-day activities. As the child begins to see the benefits of occupational therapy, the parents and caregivers do, too.
For parents and caregivers, occupational therapy helps by:

Reducing the demand on them

Reducing stress

Providing a sense of security

Improving their quality of life

Allowing them to watch their child improve and become independent

Each type of cerebral palsy presents different symptoms that may hinder a child's ability to live independently and complete daily activities.
Occupational therapy can help with the following issues related to each type of CP:

Spastic - Muscle stiffness in the upper and/or lower limbs and jerky movements characterize spastic cerebral palsy. Among other things, this can lead to difficulty getting dressed, bathing, using the bathroom, eating, drinking, writing and holding objects.

Athetoid - Children with athetoid cerebral palsy are unable to regulate muscle tone, which makes it difficult to control their movements. Trouble with grasping objects, posture, drooling, swallowing, and speaking are common among children with athetoid CP.

Ataxic - Problems with balance and coordination are common among children with ataxic cerebral palsy. These children often struggle with precise movements and have tremors or shakiness. This makes it difficult to perform tasks like writing or eating that require precise finger movements, or repetitive movements like clapping.

What to Expect in Occupational Therapy

As with physical therapy and speech therapy, occupational therapy is different for every child with cerebral palsy. Each child's occupational therapy treatment plan is highly individualized and tailored to their individual physical, intellectual and social-emotional abilities.

During your child's first therapy session, the occupational therapist will perform a complete evaluation. This includes testing the child's fine motor, perceptual and oral-motor development, and observing how the child responds to touch and movement. The occupational therapist will also interview the parent to find out about the child's strengths and weaknesses when performing daily activities, as well as pinpoint the specific goals for the child to work toward.

Most children with cerebral palsy need to be reevaluated every six to nine months. After these evaluations, the occupational therapist will tweak the treatment plan accordingly based on progress and change.

Exercises Used in Occupational Therapy

Occupational therapy involves using functional activities to progressively improve functional performance.
Occupational therapy exercises focus on the following skill areas:

Fine Motor Control - Improves hand dexterity by working on hand muscle strength, finger isolations, in-hand manipulations, arching the palm of the hand, thumb opposition and pincer grasp. Activities include squeezing a clothespin, playing with water squirt toys and pushing coins into the slot of a piggy bank.

Bilateral Coordination - Play/movements teach the child to control both sides of the body at the same time, like drumming, pushing a rolling pin and pulling apart construction toys (Legos).

Upper Body Strength and Stability - Play focuses on strengthening and stabilizing the trunk (core), shoulder and wrist muscles through exercises, such as crawling, lying on the tummy while reading, playing catch in a kneeling position and pouring water from a pitcher into a cup.

Crossing the Midline - These activities, like making figure eights with streamers and throwing balls at a target to the right or left of center, teach the child to reach across the middle of their body with their arms and legs to the opposite side.

Visual Motor Skills - Improves hand-eye coordination through activities, like drawing, stringing beads or macaroni and catching and throwing a ball.

Visual Perception - These activities improve the ability to understand, evaluate and interpret what's being seen. Activities include alphabet puzzles, playing with different shapes and matching games.

Self-Care - Improves the ability to perform activities of daily living and prepare the child to be more independent at home, at school and in the community. Exercises can be as simple as practicing these ADLs, like brushing their teeth, getting dressed and self-feeding.

Occupational therapists use specific techniques to help children reach their goals, including:

Pediatric Constraint Induced Movement Therapy (CIMT) - Improves the ability to move weaker parts of the body by restraining its stronger counterpart. For a child who has difficulty moving one of their arms, the stronger arm will be completely restrained for a period of time while the weaker arm is strengthened and trained.

Sensory Integration Therapy - Improves the ability to receive, register, interpret and act on information that comes to the brain through sensory receptors. These activities provide the child with different sensory experiences and can include playing with balls, play dough, silly putty, sand and water, walking on different carpet textures and finger painting.

Equipment Used in Occupational Therapy

Many different tools and assistive devices are used in occupational therapy. Equipment can range from common household items to high-tech assistive technologies.

Tools

Everyday household items (straws, clothes pins, tweezers, sponges, etc.)

Books

Adaptive scissors (with spring closures or grips for easier use)

Writing utensils

Splints

Adaptations to clothing (zipper pulls, button hooks, reachers)

Toys to help with the development of motor skills

Games and toys that help with motor and cognitive development

Assistive Devices

Pencil grips

Specialized feeding utensils

Seating and positioning equipment

Computer software and accessibility

Household aids and equipment

School chairs and tables

Toilet and bathing aids

Tablets

Occupational Therapy by Age

Occupational therapy helps people of all ages. For children with cerebral palsy, treatment will be based on the child's physical, intellectual, social and language abilities, as well as their age.

Toddlers - Treatment for toddlers revolves around play and learning. Games and toys are used to improve the child's cognitive and physical development.

Young Children - Therapy for young children works on improving cognitive and physical development, as well as the child's ability to perform daily living activities. Occupational therapy can also improve the child's performance in school and their socialization skills.

Finding an Occupational Therapist

Occupational therapists are licensed healthcare professionals. Finding an occupational therapist who has experience working with cerebral palsy patients is very important to ensure your child gets the best treatment possible.

If you need help finding an occupational therapists, ask your child's pediatrician if they have any recommendations. Occupational, physical and speech therapists often work together to create comprehensive treatment plans. If your child is seeing a physical or speech therapist, they may be able to connect you with an occupational therapist.

To learn more about how to locate an occupational therapist, try downloading our free Cerebral Palsy Guide, which includes over 60 pages of in-depth information for children and parents of a child with CP.

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Occupational Therapy for Cerebral Palsy - Improve Daily Skills

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Occupational therapy helps people develop or recover the skills needed to lead independent, satisfying lives. The "occupation" in occupational therapy does not refer to one's profession. Rather, it refers to the everyday activities that give life meaning. For a child, these meaningful activities include playing and learning.

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PT assist people with CP in improving physical functions such as: walking, going up/down the stairs, wheelchair use, etc. PT's also help CP patients in gaining strength and movement so that they can function to their best abilities throughout their lives.

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Physical Therapy Guide to Cerebral Palsy

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Cerebral palsy is a term that describes a group of disorders affecting the normal development of movement and posture. CP is caused by injury to the brain that occurs before, during, or up to two year

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Cerebral palsy cannot be cured it is a lifelong disorder for those born with it. However, there are some forms of medication that can alleviate some symptoms to improve quality of life.

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A wide assortment of medications is utilized to treat Cerebral Palsy. Some reduce symptoms, while others address complications. Drug therapy is used to control body movements, prevent seizures, treat depression, relax muscles, assist digestion, and manage pain. Medication is often adjusted for tolerance and effectiveness.

What medications are used to treat Cerebral Palsy?

A wide assortment of medications for Cerebral Palsy is used to reduce symptoms and address complications. Children who experience seizures, spasticity, and unwanted or uncontrolled movements, such as athetosis and chorea, for example, are often prescribed drugs to minimize the movements. Some medications are used to relax muscles, increase comfort and facilitate better posture.

Medication is often prescribed to improve associated conditions, as well. Many drugs will aid digestive problems, breathing difficulties, skin conditions, and behavioral or learning issues.

When choosing prescriptions, doctors and parents consider the benefits as well as the short- and long-term side effects. Many drugs used to treat Cerebral Palsy are very powerful, and some are not recommended for children. Some doctors may avoid prescribing certain medications to children because of the potential impact on the child’s growth and development.

Drug manufacturers change, new medications are developed, industry regulations fluctuate and insurance coverage is modified annually.

Despite extensive knowledge of the medical field and pharmaceutical industry, it is often a process of trial and error for a doctor to determine which drug will work best – and in what dosage – for any given child. Even when success is achieved, some medications must be regularly monitored and adjusted.

Certain medications are designed to target specific conditions, such as seizures, but that medication may be available in several different forms. Since every person has his or her own unique chemistry, a medication that works well for one child may have adverse effects on another. Some children may acquire tolerance of some medications and require an adjustment in dosage.

All changes in conditions, symptoms or treatment should be shared with the primary care physician to ensure drug therapy is properly prescribed.

The most common medications used to treat Cerebral Palsy include medications within these categories:

Anticholinergics (uncontrolled body movements)

Anticonvulsants (seizure medications)

Antidepressants (depression medications)

Antispastic (muscle relaxers)

Anti-inflammatories (pain management)

Stool softeners

These categories are detailed below.

Anticholinergics (uncontrolled body movements)

Anticholinergic medications are used to treat uncontrolled body movements such as muscle stiffness, tremors and spasms, as well as drooling associated with non-spastic Cerebral Palsy. The result of the medication is temporary. In large doses, some anticholinergics can stimulate the nervous system; in small doses the drug can act as a depressant.

Common uses include treating spastic conditions in the digestive tract, reducing saliva, and decreasing bronchial secretions. Some forms of Cerebral Palsy where anticholinergics may also be prescribed include:

Athetosis – slow, writhing movements that are often repetitive and involuntary

Chorea – jerky, involuntary, irregular and uncontrollable movements

Choreoathetoid – a combination of chorea and athetosis, where movements are jerky, twitching, slow and writhing

Dystonia – prolonged, involuntary contractions that result in twisting motions, tremors and abnormal posture

These drugs work by blocking the neurotransmitter that causes muscles to move. Excessive movement is often caused by excessive flexing of muscles. Nerve impulses cause acetylcholine to be produced and travel across the gaps between nerves. When it binds to the second nerve, it fires, eventually stimulating the prospective muscle. Anticholinergics prevent the acetylcholine from binding to the second nerve, thus limiting muscle stimulation.

Anticholinergic side effects are typically mild, and can include dry mouth, blurred vision, and constipation. To avoid amplification of side effects, this drug is not usually prescribed along with antihistamines commonly used to treat allergies.

Common anticholinergic medications are:

Benztropine mesylate

Carbidopa-levodopa (Sinemet)

Glycopyrrolate (Robinul)

Procyclidine hydrochloride (Kemadrin)

Trihexyphenidyl hydrochloride

Anticonvulsants (seizure medications)

Anticonvulsants are prescribed in hopes of reducing or preventing seizure activity. They also stabilize mood. Anticonvulsants reduce, or depress, excessive stimulation to the brain without affecting respiration or causing drowsiness. Different drugs control different types of seizures. To prescribe properly, the medical provider selects a type and dosage appropriate to the specific type of seizure the child is experiencing. The child is then monitored closely for any adverse reactions, which may result in a prescription or dosage change.

Prescriptions should be followed as prescribed so medications can be properly monitored and adjusted. Parents are urged to keep a journal of episodes and reactions for practitioner review.

Prescribed medicines may be changed or dosages altered based on the child’s reactions, or over time as the child’s body will likely build tolerance to the medication. A child’s dosage may be higher than what is required for an adult, as children process the drug faster. Individuals are known to respond to anticonvulsants differently.

Anticonvulsant dosage can be increased, but at a certain point it becomes advisable to switch medications – an event known as a changeover – altogether. If a changeover does occur, the child is weened from the previous medication to minimize or alleviate withdrawals. Withdrawals can cause anxiety, cramping, delirium, hallucinations, temper tantrums, trembling, and even death.

In some instances, practitioners will prescribe multiple drug therapy by combining more than one anticonvulsant. This increases the risk of adverse side effects, drug interactions, and complicates the ability to analyze the reaction to the prescriptions.

Side effects from anticonvulsants can vary depending on the drug prescribed, but may include constipation, convulsions, dizziness, drowsiness, fatigue, hair loss, headaches, incontinence, and nausea. Anticonvulsants may also cause a change in appetite, mood, weight, and vision.

Common anticonvulsants include:

Gabapentin (Neurontin)

Lamotrigine (Lamictal)

Oxcarbazepine (Trileptal)

Topiramate (Topamax)

Zonisamide (Zonegran)

Antidepressants (depression medications)

Antidepressants are psychiatric medications with mood altering and analgesic qualities used to treat depression, anxiety, and in some cases seizures. One-third of those with a chronic illness, such as Cerebral Palsy, may be depressed. Depression is a persistent sense of sadness, helplessness, and hopelessness.

The following factors inherent in impairment may contribute to an individual’s depression:

Perceived limitations

Chronic pain levels

Perceived stigmas of those with disability

Lack of control and coordination

Dependence upon others

Feelings of powerlessness

Peer pressure

Social isolation

Quality of life

In addition, depression can worsen the medical condition by:

Aggravating the Cerebral Palsy

Decreasing confidence

Increasing fatigue

Intensifying pain

Worsening ability to cope

Not only are the individuals with chronic medical conditions at risk, but those who are caring for them are also susceptible to depression due to:

the stress of caring for an individual with a chronic medical condition

the challenges of day-to-day living with added responsibilities

feelings of helplessness and hopelessness in not being able to cure the individual

the emotional toll of a child’s diagnosis and the life-long realities of the condition

the financial burden of disability

sense of being overwhelmed

With depression comes loss of appetite, concentration, energy, interest, sleep, and pleasure. Other signs of depression may involve:

Fatigue

Indecisiveness

Irritability

Isolation

Lethargy

Moodiness

Personality change

Pessimism

Testiness

Suicidal tendencies or thoughts

Whining

Surprisingly, research indicates a person is more prone to depression from lack of coping skills and perspective, rather than the actual severity of a medical condition. Some have reported the stigma associated with depression keeps individuals from seeking help. However, depression is highly treatable.

Treatment for depression is multi-faceted. Focus is on gaining emotional support, guidance, counseling, and perspective. Drug therapy can be used exclusively or in combination with any of the following:

Behavioral therapy – to identify and address perception and gain new perspective

Biofeedback and massage therapy – to relax, meditate, calm, peacefully escape, and energize

Healthy diet and exercise – to provide the body with essentials to cope

Sleep – to rest properly and re-energize

Support groups – for emotional support and to relate to others in similar state

Psychotherapy – for professional assistance to optimize mental health

The benefits of treatment for depression can be life-altering. Drug therapy changes the brain chemistry in a way that can be euphoric, provide hope, increase energy levels, supply optimism, enhance therapy participation, and provide the ability to cope with everyday life. A person who forgoes treatment for depression runs the risk of magnifying symptoms, and in some instances, developing suicidal tendencies. A person with depression may not always recognize or acknowledge their condition.

Antidepressants, in combination with other medicines, may result in serious side effects and death. The primary medical provider should be aware of all the prescriptions, treatments and health conditions to thwart drug interactions, harmful side effects, or dangers. Antidepressants can also be harmful during pregnancy. If pregnancy is suspected, a doctor should be consulted immediately.

Side effects from antidepressants may include:

Agitation

Blurred vision

Constipation

Dizziness

Dry mouth

Headache

Insomnia

Nausea

Nervousness

Stomach upset

Weight gain

Some commonly prescribed antidepressants include:

Citalopram – Celexa

Escitalopram – Lexapro

Fluoxetine – Prozac

Paroxetine – Paxil

Sertraline – Zoloff

Antispastic (muscle relaxers)

Antispastics, also known as muscles relaxers, are prescribed to relax contracted, overactive, or stiff muscles. Antispastic medications are often the first treatment choice for reducing tremors or controlling widespread spasticity, as they are easy to use and non-invasive.

Antispastics can be administered orally in tablet form, or by injection directly into affected muscles or via the intrathecal baclofen pump, which is surgically implanted in the abdomen to deliver medication directly to the fluid that surrounds the spinal cord. Oral medications are usually prescribed for overall spasticity, while injections target a specific muscle. The benefits of oral medications and injections are usually short-term, requiring refills or further injections. The pump, on the other hand, provides steady doses of medication on a long-term basis. The pump must be maintained and refilled so as not to run the risk of abrupt withdrawals, or death.

The specific antispastic medication prescribed, as well as dosage, length of treatment, method of administration and the use of other complementary treatments, vary with each individual and his or her circumstance. For example, oral medications, such as valium, are typically administered daily. Alcohol wash injections target specific nerves and can provide relief for a few months to several years. Botox is usually administered in three-month intervals. Other injectable antispasmodics typically remain effective for about three to eight months. The intrathecal baclofen pump is found to be most effective on those with chronic, severe stiffness and those with uncontrolled muscle movements.

Some benefits derived from antispastic medications include:

Control muscle contractions

Delay surgery

Increase range of motion

Improve ability to participate in therapies

Reduce impairment

Reduce tremors and muscle spasms

Relax overactive muscles

Relax tight muscles

Possible side effects to antispastic medications, vary with the type, the individual, and the dosage, but may include:

Confusion

Constipation

Diarrhea

Dizziness

Drowsiness

Flu-like symptoms

General weakness

Headache

High blood pressure

Incontinence

Insomnia

Liver damage

Nausea

Pain upon injection

Slowed heart rate

Slurred speech

Medications vary in the way they relax muscles. Some, like baclofen, relax the muscle directly, while others, like diazepam, act on brain chemistry. Botox(R) causes mild muscle paralysis. Commonly prescribed antispastic medications include:

Baclofen (Botulinum toxin, or Botox(R))

Diazepam (Valium(R))

Dantrolene

Flexeril (Cyclobenzadrine)

Dantrium (Dantrolene)

Intrathecal Baclofen

Tizanidine

Anti-inflammatories (pain control)

Medscape reports 67%-84% of individuals with Cerebral Palsy experience bothersome pain lasting one hour or longer per episode. Anti-inflamatories address pain by reducing or alleviating inflammation.

Many medications and alternative treatments are available to manage pain often associated with Cerebral Palsy. Pain medications can range from over-the-counter (OTC) to prescription drugs, such as non-steroidal, anti-inflammatory drugs (NSAIDs) or anti-inflammatory corticosteroids. Many of these medications play a significant role in reducing pain as they alleviate the primary causes of discomfort. For minor pain, alternative therapies – hot or cold compresses, acupuncture, or massage therapy, for example – may be considered.

Pain can result from the actual health conditions involved with Cerebral Palsy, or can be experienced when exercising, strengthening and expanding range-of-motion during physical therapy. Pain also results from surgery and post-operative healing, or even from medications injected or administered through a pump. Adjusting to and using orthotics can cause painful sores, while adaptive equipment can cause discomfort from pressure and continual use. Treatment of these, and other sources of pain, can increase overall health.

Some common origins of pain in those with Cerebral Palsy, include:

Gastrointestinal pain – abdominal pain related to digestive complications from malnutrition, malabsorption, impaired orofacial functioning, esophageal issues, aspiration, incontinence, constipation and flatulence.

Orthopedic pain – deformity, compensation, subluxation, degeneration, and dislocation found in the face, fingers, hands, arms, shoulders, back, spine, hips, pelvis, legs, ankles, feet or toes. Procedures performed on the bones, ligaments, joints, tendons, muscles, and nerves. Orthotic overuse, underuse, skin irritation, and rubbing can cause pain, as well.

Pharmaceutical interventions – needle injections, including blood draws, pain medication, intravenous therapy, nasogastric tube placement, and anesthesia.

Rehabilitative therapies – pain worsened by therapy sessions involving assisted stretching and range of motion exercises, including occupational, physical, speech and language therapy.

Surgical pain – pain derived from surgical procedure, post-operative healing, and needle injections such as blood draws, pain medication, and intravenous feeds.

Pain medication can be helpful in reducing or alleviating pain. Not all pain medication can be taken by children or women who may be pregnant. All medications should be cleared by the primary care physician who will ensure there are no adverse effects, can monitor the effectiveness, can check for drug interactions, and is knowledgeable in properly prescribing the drug and its assigned dosage. Four main categories of anti-inflammatories include:

Aspirin – suppresses prostaglandins, regulates body temperature, and constricts blood.

Corticosteroids – anti-inflammatory agent with a large number of other functions, such as glucose utilization, fat metabolism, and bone development.

Nonsteroidal anti-inflammatory drugs (NSAIDs) – a non-steroid substance which has analgesic, antipyretic, and platelet-producing capabilities to primarily treat mild to moderate pain, and fever.

Steroids – decrease inflammation and reduce immune system activity.

Stool softeners

Constipation, a dry, hard stool that is difficult and possibly painful to pass, is common in children with Cerebral Palsy. The condition can be caused by medications, lack of activity, inadequate fluid intake, dietary complications, difficulty in accessing bathrooms and labored breathing.

The primary way to treat constipation is with a healthy diet rich in high-fiber foods. Laxatives, which can be very useful, come in several forms. Stool softeners help to maintain water content to prevent stool from becoming hard and painful. Various stimulants induce bowel contractions and move stool along the intestinal tract.

For more information

To learn about pain management and Cerebral Palsy, visit Pain Management.

To verify that medication has been approved by the Food and Drug Administration, visit FDA Approved Medications.

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A wide assortment of medications is utilized to treat Cerebral Palsy. Some reduce symptoms, while others address complications. Drug therapy is used to control body movements, prevent seizures, treat depression, relax muscles, assist digestion, and manage pain. Medication is often adjusted for toler…

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Monoplegia/monoparesis: One limb is affected; believed this may be a form of hemiplegia/hemiparesis where one limb is significantly impaired

Diplegia/diparesis: Legs are affected more than the arms; primarily affects the lower body

Hemiplegia/hemiparesis: Arm and leg on one side of the body are affected

Paraplegia/paraparesis: Lower half of the body (both legs) are affected

Triplegia/triparesis: Three limbs are affected; could be both arms and a leg or both legs and an arm or one upper and one lower extremity and the face

Double hemiplegia/double hemiparesis: All four limbs are involved but one side of the body is more affected than the other

Tetraplegia/tetraparesis: All four limbs are involved but three limbs are more affected than the fourth

Quadriplegia/quadriparesis: All four limbs are involved

Pentaplegia/pentaparesis: All four limbs are involved, with neck and head paralysis often accompanied by eating and breathing complications

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Classification based on motor function: Two main groupings include spastic and non-spastic

Spastic CP: increased muscle tone

Non-Spastic CP: will exhibit deceased/fluctuating muscle tone

Muscle Tone: Effect on muscle tone and how muscles work together.

Terms used to describe muscle tone:

Hypertonia/Hypertonic: increased muscle tone, resulting in very stiff limbs; associated with spastic CP

Hypotonia/Hypotonic: decreased muscle tone, resulting in loose, floppy limbs; associated with non-spastic CP

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When referring to location of brain injury, spastic and non-spastic CP is referred to in the medical community as pyramidal and extrapyramidal CP

Consists of 2 groups of nerve fibers responsible for voluntary movements. They descend from the cortex into the brain stem.

Indicate that pyramidal tract is damaged or not functioning properly

Spasticity: implies increased muscle tone

Muscles continually contract, making limbs stiff, rigid, & resistant to flexing or relaxing

Reflexes can be exaggerated

Accounts for 70-70% of CP cases

Injury to the brain occurs in the pyramidal tract and is referred to as upper motor neuron damage

Often named in combination with topographical method that describes which limbs are affected, such as spastic diplegia, spastic hemiparesis, and spastic quadriplegia

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Decreased and/or fluctuating muscle tone

Multiple forms are characterized by particular impairments; one being involuntary movement

Movement can be slow/fast

An injury in the brain outside the pyramidal tract causes non-spastic CP

Mental impairment and seizures are less likely

Lowers likelihood of joint and limb deformities

Ability to speak may be impaired as a result of physical impairment

Two groups: ataxic and dyskinetic

Make up 20% of CP cases

Ataxic/ataxia: affects coordinated movements; balance and posture are involved. Walking gait often very wide and irregular. Control of eye movements and depth perception can be impaired. Does not produce involuntary movements but indicates impaired balance and coordination

Dyskinetic: Has two groups: athetoid and dystonic

Athetoid: cases w/ involuntary movement (esp. Arms, legs, and hands)

Dystonic: cases that affect the trunk muscles more than limbs and results in fixed, twisted posture

Classification by specific movement dysfunction:

Athetosis: slow, writing movements that are often repetitive, sinuous, & rhythmic

Chorea: irregular movements that are not repetitive or rhythmic, and tend to be more jerky/shaky

Choreathetoid: combination of chorea and athetosis’ movements are irregular but twisting and curving

Dystonia: involuntary movements accompanied by an abnormal, sustained posture

Mixed: involves some limbs affected by spasticity and others by athetosis

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Anticholinergics (uncontrolled body movements)

Anticonvulsants (seizure medications)

Antidepressants (depression medications)

Antispastic (muscle relaxers)

Anti-inflammatories (pain management)

Stool softeners

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Invention can be another form of treatment that can help to alleviate symptoms. Occupational therapy, physical therapy, and speech therapy all work together in their scopes of practice to address needs of individuals with Cerebral Palsy.

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Speech-language pathologists work to improve overall language abilities and understanding such as expressive and receptive communication depending on motor deficiencies sometimes swallowing and sound production can be targeted.

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What is External Scientific Evidence

External scientific evidence refers to research that has been conducted in a specific area of treatment, assessment, or service delivery. While evidence may be obtained from individual studies, only evidence-based guidelines and systematic reviews are included in this section.

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What is External Scientific Evidence External scientific evidence refers to research that has been conducted in a specific area of treatment, assessment, or service delivery. While evidence may be obtained from individual studies, only evidence-based guidelines and systematic reviews are included in this section.

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Variations in muscle tone, such as being either too stiff or too floppy

Stiff muscles and exaggerated reflexes (spasticity)

Stiff muscles with normal reflexes (rigidity)

Lack of balance and muscle coordination (ataxia)

Tremors or involuntary movements

Slow, writhing movements

Delays in reaching motor skills milestones, such as pushing up on arms, sitting up or crawling

Favoring one side of the body, such as reaching with one hand or dragging a leg while crawling

Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing, a wide gait or an asymmetrical gait

Excessive drooling or problems with swallowing

Difficulty with sucking or eating

Delays in speech development or difficulty speaking

Learning difficulties

Difficulty with fine motor skills, such as buttoning clothes or picking up utensils

Seizures

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Cerebral palsy is caused by abnormalities or disruptions to the brain. However, most of these causes are unknown.

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There are certain factors that can increase the risk of Cerebral Palsy
Maternal health
Infant illness
Other factors of pregnancy and birth

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Learn about this group of conditions that affect movement. It’s caused by damage to the developing brain, usually before birth.