Cerebral Palsy - Treatment Overview

Treatment Overview

Cerebral palsy (CP) cannot be cured. But a variety of treatments can help people with CP to maximize their abilities and physical strength, prevent complications, and improve their quality of life. The brain injury or problem that causes CP does not get worse over time. New symptoms can appear or become worse over time, however, because of how a child grows and develops.

Specific treatment varies by individual and changes as needed if new issues develop. In general, treatment focuses on measures that maintain or improve a person's quality of life and overall health.

Initial treatment

Physical therapy is an important treatment that begins soon after a child is diagnosed and often continues throughout his or her life. This therapy also may begin before a definite diagnosis is made, depending on the child's symptoms.

Medications can help control some of the symptoms of CP and prevent complications. This treatment may include injectable antispasmodics to help relax tight muscles and improve range of motion. Other medications may be used for common problems related to cerebral palsy, such as anticonvulsant medications for seizures.

In some cases, orthopedic surgery (for muscles, tendons, and joints) or selective posterior rhizotomy (cutting nerves of affected limbs) for contracture or other mobility problems is performed soon after diagnosis on a baby or very young child with severe problems.

Often the biggest problem for parents is fear of the unknown. Learning about CP can help you to understand the condition and be familiar with some of the challenges and joys of raising a child with cerebral palsy. Being informed can help give you a sense of control about how best to help your child. For more information, talk to your health professional or see the Other Places to Get Help section of this topic.

Ongoing treatment

Ongoing treatment for cerebral palsy (CP) focuses on continuing and adjusting existing treatments and adding new treatments as necessary. Although the brain injury that causes CP does not get worse over time, some of its effects can appear for the first time, change, or become more severe as a child gets older.

Regular visits with your child's health professional and specialists are important for monitoring your child's condition. These visits may include tests, such as questionnaires to evaluate whether new developmental milestones are being achieved as expected, or periodic blood tests to find out about the effects of medication your child may be taking. Your child should also have regular eye, hearing, and speech evaluations.

Other tests may be done to determine whether common problems related to cerebral palsy have developed. These problems can then be treated as they appear.

Ongoing treatment for cerebral palsy may include:

• Physical therapy. This is usually an important part of ongoing treatment for CP and can help your child become as mobile as possible. It may also help prevent the need for surgery. If a child has surgery, intense physical therapy may be needed for 6 months or more.
• Monitoring of any medications being taken to help control symptoms and prevent complications. Medications may include antispasmodics or injectable antispasmodics to help relax muscles and reduce spasms, anticonvulsants to help treat seizures, or anticholinergics to help manage uncontrollable body movements (dystonic cerebral palsy) or frequent drooling.
• Orthopedic surgery (for muscles, tendons, and joints) or selective posterior rhizotomy (cutting nerves of affected limbs) to try and prevent problems with bones and related muscles, ligaments, and tendons.
• Special devices and equipment, such as braces, casts, and splints. The specific types used depend on a child's needs. For example, a child may get a cast after surgery or as a means to restrict movement in one area to strengthen muscles and tendons in another part of the body.

Ongoing treatment for CP may also include:

• Biofeedback. This therapy may be useful as part of physical therapy or on its own. During biofeedback sessions, people with CP learn ways to control their affected muscles. Some people find this technique helpful in reducing muscle tension. Biofeedback does not help everyone with CP.
• Massage therapy and hatha yoga. These therapies are designed to help relax tense muscles, strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises are sometimes used to try to prevent lung infections. More research is needed to determine the health benefits of these therapies for people with CP.
• Therapies to stimulate learning and sensory development. Babies and young children may benefit from these stimulation or neurodevelopmental therapies. Some of these therapies also help people of other ages. These therapies cannot repair damaged parts of the brain. However, they may be able to stimulate undamaged parts of the brain.

You may hear about a wide range of controversial treatments. Some of these may cause harm. Do not be afraid to talk to your health professional about any type of treatment you are considering for your child.

Each person with CP has unique strengths and areas of difficulty. However, most people with CP need ongoing help with:

• Feeding and eating. Cerebral palsy can affect jaw control and interfere with the ability to chew, suck, and swallow. Special utensils, such as plates that stick to a surface; properly positioning your child at meals; and serving soft or semi-solid foods, such as oatmeal, may be helpful.
• Using the toilet. Some people with cerebral palsy have stiff hip joints or similar problems that make using a toilet difficult. Others do not have dependable bladder control. Training from an occupational therapist and special undergarments are common ways to help treat this condition.
• Bowel elimination. People with CP often become constipated, making stools difficult to pass. Stool softeners and mild laxatives are frequently used for this problem. For more information, see the topics Constipation, Age 11 and Younger or Constipation, Age 12 and Older.
• Bathing and grooming. People with cerebral palsy who do not have control of their hands or arms usually are unable to groom themselves. Others can be taught some level of self-grooming through regular practice.
• Dressing. Provide clothing and shoes that are easy to put on and take off, such as those that zip or button in the front (not the back) or that have large buttons, ties, or Velcro fasteners.
• Dental care. Cerebral palsy can affect the jaw muscles, make teeth improperly positioned and prone to decay, and cause sensitivity in the mouth and tongue. Also, many people with CP find it difficult to use a toothbrush. You can help your child by providing special equipment, such as a mechanized teeth-cleaning water spray or electric toothbrush; buying toothpaste for sensitive gums; and making sure he or she has regular dental cleanings.
• Skin care. Drooling is common in people with CP, and it can cause skin irritation around the chin, mouth, and chest. You can help protect skin by blotting rather than wiping drool, using absorbent cloths to cover the chest, and applying lotions or cornstarch to areas that are prone to irritation.
• Speaking. Some people with CP have problems with the muscles in their jaws and mouth as well as hearing loss. These problems, alone or in combination, can make it difficult for them to form words. You can make better communication possible by speaking slowly, looking directly at your child during conversations, and using pictures or objects as you talk. Reading to your child is also important, and using books with bright pictures may be most effective.
• Safety. People with CP are prone to falls and other accidents, especially if they are affected by seizures. You can take general safety measures at home—such as having heavy, sturdy furniture or not polishing floors—to help your child avoid accidents. Also, use common sense and care around sharp objects and never leave a person with CP alone while he or she is bathing.

Behavioral therapy, in which a counselor helps a child learn better ways to communicate, may be a part of ongoing treatment. It is most often used to help school-age children with CP learn better ways to interact with others, especially their peers.

Working with others involved with your child's care, understanding your child's needs and rights, and taking care of yourself and other family members are all important parts of ongoing treatment for people with cerebral palsy. Specifically, these strategies include:

• Researching and understanding your child's educational rights. In the United States, disabled children are eligible for free early treatment programs and equal access to public education. You also have the right to be fully informed about educational decisions concerning your child. Contact your state and local education departments for detailed information about these accommodations. In addition, vocational training may benefit some teens and young adults.
• Working with your child's teachers, school administrators, special learning consultants, and school boards to develop the best educational plan for your child. A cooperative team approach helps your child realize his or her potential.
• Supporting your child emotionally. Your child's needs will change over time. As children grow and become more aware of their physical limitations, they need to be able to talk about their feelings and how they are treated. It is sometimes easier for them to talk with someone who is not a family member. Ask your health professional about whether emotional counseling might benefit your child. In addition, involve your child as much as possible when making decisions about his or her health care.
• Getting proper rest, eating well, exercising, and learning ways to cope with the challenges of raising a child with CP. You will be better equipped to help your child when you have physical energy and emotional strength.
• Working together as a family. The entire family is affected when one member has CP. Helping family members cope with this situation is important, especially for siblings. You can help prevent other children from developing unrealistic fears and concerns, feeling left out, or becoming overwhelmed.

Of all children diagnosed with cerebral palsy, 90% live to adulthood (beyond 20 years old).³ Most adults with CP are employed, despite moderate to severe physical disability. As your child with CP approaches this stage of life, consider enrolling him or her in occupational therapy as part of a gradual preparation for independent living. Helping your child be independent requires patience and resourcefulness on your part. Expect some frustrating setbacks or obstacles. Your child may need extra help and encouragement to prepare for additional expectations and responsibilities.

Treatment if the condition gets worse

Although the brain injury that causes cerebral palsy (CP) does not get worse over time, some of its effects can appear for the first time, change, or become more severe as a child's nervous system grows and develops.

Common problems related to cerebral palsy may develop, become more severe, or lead to complications. Treatment varies by the individual and type of problem but generally can include medication, surgery, specialized therapies, and orthopedic equipment.

Medication

Medications can help treat effects that some people experience with CP, such as muscle spasms or seizures.

If severe muscle spasms develop, antispasmodic pills may be given. These pills include diazepam (Valium), dantrolene (Dantrium), and baclofen (Lioresal). Or, less commonly, intrathecal baclofen (ITB) may be given. For this, a small pump is placed under the skin of the abdomen. This pump releases baclofen into the fluid around the spinal cord. ITB may be more helpful than the pill at relieving spasms, but it is harder to do than pills and has some risks (such as infection where the pump is implanted).

Injectable antispasmodics, such as botulinum toxin (Botox), are sometimes used. This medicine can be given with a needle directly into an affected muscle. Botulinum toxin may be more useful than antispasmodic pills for the treatment of CP. But in rare cases, severe side effects can occur.

If seizures become a problem, anticonvulsants such as carbamazepine (Tegretol) are used. Anticholinergics, such as glycopyrrolate (Robinul) help a minority of people with CP who have uncontrollable body movements (dystonic cerebral palsy) or drool frequently.

Surgery Types of surgery include:

• Orthopedic surgery to loosen tight muscles, tendons, and joints, particularly on the hips, knees, and ankles.
• Selective posterior rhizotomy to cut nerves on the limbs that are most affected by movements and spasms to allow more flexibility and control.

A doctor evaluates symptoms, age, and the person's general state of health when considering whether to recommend surgery. A thorough checkup is needed to help the doctor determine which muscles and nerves are affected and what type of surgery would best treat the condition. A gait analysis may be included, which evaluates the person's walking patterns.

Physical therapyPhysical therapy is often used as part of ongoing treatment, but its focus may change after surgery or for problems that are new or getting worse. After surgery, specialized physical therapy may be needed for 6 months or longer. Biofeedback may be useful as part of physical therapy or on its own. Although biofeedback does not help everyone with CP, some people who use the technique learn how to control their affected muscles or reduce muscle tension.

Special devices and equipment Many people with CP benefit from using materials to maintain or improve joint mobility, help strengthen muscles and relax overactive (spastic) muscles, and assist with daily activities. Such devices and equipment may include orthotics, casts, standers, special seats, walkers, wheelchairs, special shoes, and other individualized materials to help with specific problems.

Individualized therapies may also be needed depending on the specific need that develops.

• Occupational therapy helps adults adapt to their limitations and live as independently as possible.
• Speech therapy helps control the mouth muscles. This therapy can be of great benefit to children with speech or eating problems. Speech therapy often starts before the child begins school and continues throughout the school years.
• Nutritional counseling may help when dietary needs are not met because of problems with eating certain foods.
• Both massage therapy and hatha yoga are designed to help relax tense muscles, strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises are sometimes used to try to prevent lung infections. More research is needed to determine the health benefits of these therapies for people with CP.
• Therapies to stimulate learning and sensory development may benefit babies and young children. Some also help people of other ages. These therapies cannot repair damaged parts of the brain. But they may be able to stimulate undamaged parts of the brain.
• Behavioral therapy helps some school-age children with CP learn better ways to communicate with others.

You may hear about a wide range of controversial treatments, some of which may cause harm. Do not be afraid to talk to your health professional about any type of treatment you are considering for your child.