All people are unique. Cerebral palsy does not make the affected people different; it’s the people’s perception of them that makes the difference. Their struggle to reach whatever they have achieved is incomparable. Though their condition can’t be reversed, the treatments for cerebral palsy will definitely bestow them with the ability to deal with life in a better way.
This blog is not to scare the parents of children with cerebral palsy but to enlighten them on what cerebral palsy is and the causes, symptoms, and diagnosis. Then it probes into the best ever treatments for cerebral palsy that makes the affected people overcome their disability to the maximum extent.
Table of Contents
What’s Cerebral Palsy?
Cerebral palsy was a term used to describe brain weakness. It is a group of disorders in the brain that affects the movement and balance of children. An abnormality in early brain development or brain damage during the early stages of development will cause children to be unable to move their limbs as they desire. The symptoms would differ depending on the severity of the perinatal brain abnormality. Some people may require special equipment to move around or communicate. Some may have intellectual disabilities, problems with vision, hearing, speech, etc.
According to the Centers for Disease Control and Prevention, 1 to 4 children worldwide are affected by Cerebral palsy. Reaching for the Stars, one of the largest parent-led global non-profit cerebral palsy foundations, was instrumental in designating March 25th as Cerebral Palsy Awareness Day and selecting a green ribbon as the symbol of CP awareness.
Cerebral Palsy Types
Depending on the area of damage in the brain, and the difficulty in movements, the cerebral palsy would be classified into the following types:
Spastic Cerebral Palsy
The people affected with spastic cerebral palsy will have stiff and jerky movements due to their increased muscle tone. Their stiff muscles make their movements difficult.
The people affected will have gait abnormality, crossed knees, muscle and joint contractures, and limited mobility. Around 75 to 85 percent of children with cerebral palsy would have spastic palsy. More than half of them could walk on their own, while a smaller number would need canes or walkers.
Spastic cerebral palsy develops when the motor cortex and the brain’s pyramidal tracts that link up the motor cortex to the spinal cord are damaged. It is classified into the following categories based on the affected limbs.
- Spastic Diplegia most commonly affects the legs. Children who have cerebral palsy with spastic diplegia may also have minor upper-body movement issues. Preterm birth is a common cause of spastic diplegia.
- Spastic Hemiplegia is a condition that affects only one side of the body. Mostly the arm is more affected than the leg, as evidenced by a stringently flexed wrist or elbow.
- Hemiplegia can result from prenatal brain bleeding. The involvement of all four limbs characterizes Spastic Quadriplegia. Legs are generally more impacted than arms. Quadriplegia can result in limited control of facial muscles.
Dyskinetic Cerebral Palsy
The damage to the brain’s basal ganglia causes dyskinetic cerebral palsy. Symptoms of dyskinetic CP range from stiff, rigid movements to floppy movements. It will be challenging for them to control how their muscles move. Variations in the level of control can occur from day to day. Children with dyskinetic cerebral palsy would struggle with walking, balance, coordination, tremors, and object grasping. They would also have trouble controlling their arms, feet, and legs. Only 5 to 6 percent of the children affected with CP were reported to be having dyskinetic cerebral palsy.
It has three characteristics like athetosis, chorea, and dystonia. Slow and writing movements are referred to as athetosis. Chorea is associated with acute and uneven movements. Dystonia is marked by painful twisting movements.
Ataxic Cerebral Palsy
Balance and coordination would be challenges for children with ataxic cerebral palsy, as the cerebellum is affected. They may walk with their legs wider apart than other children and struggle with activities such as writing. Some people would also struggle with depth perception, which is the ability to accurately judge how close or far something is. Other issues they may face include poor motor skills, difficulties walking, balance, shaking, tremors, and difficulties with depth perception.
Mixed Cerebral Palsy
Mixed-type cerebral palsy is caused by damage to the motor control centers in various parts of the brain. Children with mixed cerebral palsy will exhibit symptoms from at least two types of CP. Mixed CP accounts for approximately 10% of all people with the disorder.
The children with mixed CP may also have swallowing difficulties, putting them at risk of malnutrition. They may also have a chance of developing mild to severe intellectual disabilities. For example, a child with both spastic and ataxic CP is at risk of developing brain malformations and difficulties grasping.
What Causes Cerebral Palsy?
Cerebral palsy is different from Erb’s palsy, which is also a type of birth injury like the CP. When Erb’s palsy is caused by damage to the nerves, cerebral palsy results from perinatal brain damage or a lack of development. CP can happen before, after, or during birth. Because the brain controls body movement, any damage to the brain’s parts would reflect the injury based on the area of damage. Around 85 to 90 percent of Cerebral Palsy cases are congenital, and the rest are acquired due to infections or diseases. The following are some of the causes of cerebral palsy:
- Infections like German measles (rubella) and herpes simplex acquired in the womb
- Medical issues during a woman’s pregnancy
- Having a stroke in the womb or after birth
- Genetic disorders
- Lack of oxygen during birth or asphyxia neonatorum
- Jaundice left untreated
- Brain infections like meningitis or encephalitis
- Being rattled as a child (shaken baby syndrome)
- Intracranial hemorrhage or brain bleeding
- Traumatic brain injury as a child from a fall, car accident, or abuse
- Premature birth
- Low-birthweight babies
- Being one from multiple births like twins, triplets, or quadruplets
- Mother’s exposure to drugs or toxic substances that damage the fetus
- Rh incompatibility where the mother’s and the baby’s Rh blood type differ from the other
Cerebral Palsy Symptoms
Even if the causes of cerebral palsy could be prenatal, the symptoms may not be apparent until the child is 2 to 3 years of age. If you see the following symptoms in your kid, never delay making a physician consult.
- Week limbs
- Stiff muscles or overly flexible muscles
- Slow in achieving the developmental milestones
- Uncontrollable movements
- Muscle spasms
- Wobbly hands
- Tiptoe walking
- Contracted joints
- Difficulty falling asleep
- Dislocated hips
- Disability in speech, hearing, or eyesight
- Difficulty in swallowing food
- Disability in learning
- gastro-esophageal reflux disease (GORD)
- Unable to control the bowel movements
- Gait abnormality
Cerebral palsy in adults is just the aggravation of symptoms from childhood. They are more likely to develop chronic health issues, which can lead to a loss of strength and functional reserve, decreased physical activity, an increased risk of musculoskeletal complications, and gradual alterations in swallowing capacity.
How Cerebral Palsy is Diagnosed
Parents could identify the abnormality by monitoring their children’s developmental milestone achievement. In some cases, physicians can identify cerebral palsy early signs during wellness visits by asking parents about their child’s activities and performing a physical examination. In the ninth month, most children will have accomplished important milestones such as flipping, crawling, and attempts to sit and stand. The inability to achieve these would point to an abnormality.
Some mild weaknesses would not be apparent until 4 or 5 years. If you have any doubts about your kid’s milestone achievement, you can consult the pediatric physician for a developmental screening or evaluation. He can distinguish the first signs of cerebral palsy by checking the child’s posture, vision, speech and hearing, coordination and balance, movement control, muscle tone, growth, and development.
If any signs are detected, the physician will then use the following diagnostic methods to detect the area of brain damage and decide on the best treatments for cerebral palsy.
- Cranial Ultrasound: The safest method to get the pictures of the brain of an infant would be through an ultrasound. One can get to know the preliminary assessment of the damages to the brain to an extent in this.
- CT scan: Computed Tomography can also be efficient in getting finer images of the brain to identify the damages.
- MRI scans: MRIs give more detailed images pointing out the exact location and type of damage in the brain.
- Electroencephalogram (EEG): An EEG can be useful to rule out other disorders like epilepsy and confirm cerebral palsy. The electrodes fixed on the head will note down the electrical activities in the brain.
Treatments for Cerebral Palsy
Based on the need of the child, the type of the cerebral palsy, level of impairment, and location of movement issues, the following specialists can be consulted:
- Physical therapists
- Behavioral therapists or Applied Behavior Analysis Therapists
- Developmental pediatricians
- Speech and language therapists
- Occupational therapists
- Otolaryngologists (ear, nose, and throat specialists)
Though the CDC estimated a million dollars to cater to the needs of a child with cerebral palsy for his lifetime, you have various financial assistance to proceed with the treatments for cerebral palsy. Let’s know more about the various treatment options and their efficiency in making the lives of children with cerebral palsy better.
Physical therapy is one of the most common and effective treatments for cerebral palsy. It has numerous advantages, from improving mobility to preventing future issues like contractures and joint dislocations by keeping the body strong and flexible. Children with milder cases of CP may only require physical therapy to be treated. It may be used in conjunction with other treatments or medications in more severe cases.
Because cerebral palsy affects different parts of the body, therapists would determine the type of cerebral palsy physical therapy required for the children based on the severity, type, and comorbid conditions. The age of the child with cerebral palsy also plays a key role in determining the type of therapy. The orthotic equipment like braces, casts, splints, and shoe inserts are used to help with walking, posture, and joint mobility. Mainly physical therapy is used to improve the following:
- Increasing muscle tone
- Helping with posture and walking
- Correcting spinal and limb deformities
- Easing the joint movements
Physical therapists who have treated children with CP are familiar with the special demands of these children and can create a treatment plan that is tailored to their specific needs.
Another crucial treatment for cerebral palsy is occupational therapy. The occupational therapists can train the children with CP to be independent in doing the daily needs and routine activities like eating, getting dressed, and using the bathroom. It can also help children with CP improve their posture and fine motor skills, as well as their physical, cognitive, and social capacities. This therapy can also help with sensory information processing issues.
The occupational therapy would help the kids to investigate and interact with their surroundings and help them learn adjustment and problem-solving. The kids would be taught to maintain a routine or activity schedule and perform daily living activities more independently. The therapy would enhance their gross and fine motor skills and modify their sensory and emotional requirements.
Speech therapy is one of the apt treatments for cerebral palsy. Children with cerebral palsy would struggle to move their facial muscles, jaw, and tongue. It would be difficult for them to speak and articulate. Three-quarters of children with cerebral palsy will have speech problems. Speech therapy allows children to more easily express themselves and their needs, improving their relationships with others and giving them more self-esteem, confidence, and independence.
Early intervention with speech therapy will result in greater improvement in the children. If communication is difficult, speech-language pathologists can help improve your child’s ability to speak clearly and would use communication devices such as a computer and voice synthesizer.
The medications would be chosen based on the symptoms that the children are experiencing, such as spasticity, seizures, tremors, incontinence, acid reflex, involuntary movements, and other concomitant conditions associated with cerebral palsy.
The physician may recommend a botulinum toxin-A (Botox) nerve or muscle injections every three months to alleviate spasticity. Drooling can be controlled with Botox injections. Baclofen, tizanidine (Zanaflex), diazepam (Valium), or dantrolene (Dantrium) are muscle relaxants that can help with the flexibility of the muscles for people with cerebral palsy.
Surgical Treatments for Cerebral Palsy
According to the severity of abnormality in the body function, the following surgeries could be beneficial to children with CP.
Children with severe contractures or abnormalities may need orthopedic surgery (bone or joint surgery) to rectify the position of their arms, spine, hips, or legs. These adjustments can help to reduce pain and increase mobility.
- Tendon transfer: A tendon is transferred by cutting and replacing it. It is done to ensure that the body’s muscles are properly aligned. This surgery also helps reduce pain and walking difficulties in children with CP, along with improving wrist extension and flexibility.
- Tendon lengthening: Tightness in the tendon that connects the muscles to the bones, limits limb movement. Operating on stiff tendons to lengthen them, and prevent spasticity, would help improve the child’s ability to sit or walk freely and comfortably.
- Muscle lengthening: Surgically lengthening muscles through minor incisions and relaxing muscles allows patients to stretch more freely and improves their capacity to walk and move independently. Tightness in the fingers, hands, and arms may be relieved by surgical muscle lengthening.
- Tenotomy/myotomy: When children have severe contractures and no other treatment opportunities exist, doctors perform a tenotomy (cutting tendons) or a myotomy (cutting muscles) to alleviate discomfort and tightness. These procedures can also improve muscular function, reduce stiffness, improve upper-limb control, and improve grasping ability.
- Arthrodesis: Arthrodesis is a significant procedure that is used as a last resort in surgical treatments for cerebral palsy. The bone joints will be fused to make it robust enough to facilitate walking in cases with reduced mobility and severe spasticity. This will help to alleviate some of the pain when walking.
- Osteotomy: Osteotomy is the process of reshaping or realigning the damaged bones into appropriate alignment. It will help to maintain mobility in the lower extremities, including the hip, knee, and ankle.
- Spine surgery: When cerebral palsy causes scoliosis, surgeons will fuse a few levels of vertebrae or realign the unnaturally curved spine with metal plates and screws or bone grafts. This will keep the spine in proper alignment and prevent nerve impingement.
SDR (selective dorsal rhizotomy) is a long-term effective neurosurgical procedure that improves movement, reduces spasticity, and relieves pain. The surgeons will locate and cut the sensory nerve fibers responsible for spastic muscular movements. This may assist maximize the number of messages transmitted from the muscles to the brain, as well as lessen spasticity by enhancing the patient’s ability to walk, sit, stand, self-care, and participate in daily activities.
Gastroenterology surgery is carried out to improve digestion, sucking, swallowing, chewing, and food processing. There are different types of surgical interventions available for these situations. They include
- Fundoplication: A surgical technique that involves the placement of a valve at the top of the stomach to prevent digestive acids from returning to the food pipe, hence reducing vomiting and lung infections.
- Nasogastric tube: This tube is used to transport food from the nose to the stomach for a brief period of time.
- Gastronomy tube: This tube is inserted into the stomach through the abdominal wall to feed a person who has difficulties swallowing.
- Submandibular duct relocation: Submandibular duct relocation will be performed if medications fail to reduce drooling.
- Bladder augmentation: This is for those with cerebral palsy who have urinary incontinence or UTIs (urinary tract infections). It is accomplished by expanding the bladder and improving bladder control.
Hydrocephalus would develop in approximately 15% of children with CP. It is a medical condition in which cerebrospinal fluid builds up in the brain. It will cause abnormal brain swelling and increase the size of the head. A long flexible tube with valves called a shunt would be used to drain the spinal fluid.
Hearing correction Surgery
People with cerebral palsy may develop hearing impairments or complete hearing loss. Cochlear implants will use a complex set of transmitters, microphones, and processors to help patients perceive and interpret sounds by processing input into meaningful sounds.
Vision Correction Surgery
Cerebral palsy patients may have vision impairments such as cortical blindness, strabismus, and hyperopia or farsightedness. Although most of these conditions can be corrected with glasses or contact lenses, severe cases may necessitate surgery. Photorefractive keratectomy (PRK) and laser-assisted in-situ keratomileusis (LASIK) are effective surgical treatments for cerebral palsy vision issues. The cornea is reshaped in both procedures to allow light to enter the eye effectively for proper vision.
Can stem cell therapy, be a savior for cerebral palsy?
The study of the possibility of using stem cells to cure cerebral palsy is still in its infancy. A systematic literature search was conducted on PubMed and EMBASE to identify randomized controlled clinical trials (RCT) determining the impact of stem cell transplantation in children with cerebral palsy.
Before we get to the research results, let’s know about stem cells. Stem cells are unique human cells that can divide and replicate themselves over long periods of time, as well as differentiate into more specific functional cell types. As a result, they can differentiate into specialized cell types of the body, such as heart, lung, or brain cells, and be used in regenerative therapeutic strategies.
Mainly the cells can be retrieved in two ways. Allogeneic cells are taken from a donor and given to a patient, whereas autologous cells are derived from the patient. The main stem cell sources in CP treatment are bone marrow (BM) or umbilical cord blood (UCB)-derived stem cells.
Research conducted on animals has shown that stem cells can reduce symptoms and reduce brain damage. However, the reason for the outcome remains a mystery. Currently, stem cell therapy for cerebral palsy has a significant positive effect on gross motor function with limited improvement. If it can be fruitful in reversing the symptoms of cerebral palsy, it would be a milestone in the treatment for cerebral palsy.
Researches are ongoing on medications that may induce the rejuvenation of new stem cells in the body. This treatment would allow the child’s own stem cells to be used to repair damaged tissues. This research is currently in the clinical trial phase, which means that the primary goal of the study is to determine its suitability and safety for the patients.
To sum up,
Though no treatment for cerebral palsy may completely reverse the condition, it can significantly reduce symptoms and increase the ability to perform daily activities, as well as make the affected people independent in meeting fundamental human requirements. The ongoing research on stem cell therapy to cure cerebral palsy is giving a ray of hope to the parents of kids affected with CP.