Management of cerebral palsy
Over time, the approach to cerebral palsy management has shifted away from narrow attempts to fix individual physical problems – such as spasticity in a particular limb – to making such treatments part of a larger goal of maximizing the person's independence and community engagement.
[1] Physical activity is recommended for people with cerebral palsy, particularly in terms of cardiorespiratory endurance, muscle strengthening and reduction of sedentary behaviour.
[8] It has been argued that people with cerebral palsy need to maintain a higher level of fitness than the general population to offset loss of functionality as they age.
[12] Aerobic capacity is not routinely assessed in people with cerebral palsy in a rehabilitation context, but Wingate tests have been advocated for use.
[13] Behavioural change methods have been used to promote physical activity among young people with cerebral palsy, but there is no significant evidence for these working.
[17][non-primary source needed] Function gait training in children and young adults with cerebral palsy improves their ability to walk.
[23] The need for lifelong physiotherapy for muscle tone, bone structure and preventing joint dislocation has been debated in terms of the costs and benefits of such therapy.
[24] Physiotherapy exercises are designed to improve balance, postural control, gait, and assist with mobility and transferring the person with CP, for example from a wheelchair to a bed.
[27] Second-generation mirror therapy, which includes the use of robotics or virtual reality, has been developed since the 2000s, however the evidence supporting this is of low quality.
[44] Orthotic devices such as ankle-foot orthoses (AFOs) are often prescribed to achieve the following objectives: correct and/or prevent deformity, provide a base of support, facilitate training in skills, and improve the efficiency of gait.
[58] However, a 2018 Cochrane review (one study met inclusion criteria) on the use of trihexyphenidyl for dystonia found insufficient evidence of its effectiveness.
[73][74] Orthopaedic surgery is widely used to correct fixed deformities and improve the functional capacity and gait pattern of children with CP.
[75][76][77] It is of paramount importance to delay the age at which orthopaedic surgical intervention becomes necessary as surgery early in life carries a greater risk of deformity recurrence especially in cases of ankle equines.
Those who have serious difficulties with eating may undergo a procedure called a gastrostomy: a hole is cut through the belly skin and into the stomach to allow for a feeding tube.
[5] Whole-body vibration might improve speed, gross motor function and femur bone density in children with cerebral palsy.
[86] Potential benefits of aquatic therapy is that children might find it more interesting than exercising on land, and they can try different kinds of movement such as jumping or skipping with less impact on their joints.
While aquatic exercise is feasible and has low risk of adverse effects, the dose required to make a difference to gross motor skills is unclear.
[91] While there is great interest in using video game rehabilitation with children with cerebral palsy, it is difficult to compare outcomes between studies, and therefore to reach evidence-based conclusions on its effectiveness.
The method is promoted by The Institutes for the Achievement of Human Potential (IAHP), a Philadelphia nonprofit organisation, but has been criticised by the American Academy of Pediatrics.
It is a unified system of rehabilitation for people with neurological disorders including cerebral palsy, Parkinson's disease and multiple sclerosis, amongst other conditions.
[33][page needed] Occupational therapists may address issues relating to sensory, cognitive, or motor impairments resulting from CP that affect the child's participation in self-care, productivity, or leisure.
[54][105][page needed] The occupational therapist typically assesses the child to identify abilities and difficulties, and environmental conditions, such as physical and cultural influences, that affect participation in daily activities.
The occupational therapist can educate the child, family, and caregivers about how to prevent pressure sores by monitoring the skin for areas of irritation, changing positions frequently, or using a tilt-in-space wheelchair.
[52] The effect of motor impairments is significant for children with CP because it affects the ability to walk, propel a wheelchair, maintain hygiene, access the community and interact with other people.
Occupational therapists address motor impairments in a variety of ways and makes use of various techniques, depending on the child's needs and goals.
[116][117] Also, occupational therapists often help people apply for government and non-profit funding to provide assistive devices, such as special computer programs or wheelchairs, to children with CP.
[118] Availability of transportation services can be limited for children with CP because of many factors, such as difficulties fitting wheelchairs into vehicles and dependency on public transit schedules.
[115] One way occupational therapists can address this barrier is to teach the child to educate others on CP – thus reducing stigma and enhancing participation.
[118] Finally, occupational therapists take children's preferences into consideration in terms of cosmetic appearance when prescribing or fabricating adaptive equipment and splints.
[121]As of 2016[update] it is thought that research in genetics and genomics, teratology, and developmental neuroscience is going to yield greater understanding of cerebral palsy.
