Cerebral palsy is a group of disorders characterized by motor dysfunction, such as poor muscle and coordination skills. Many children with cerebral palsy also have seizures. The symptoms of cerebral palsy range in severity and are caused by injury to the developing brain. Often, this brain damage is caused by the following:
- Oxygen deprivation and resultant hypoxic ischemic encephalopathy (HIE)
- Brain bleeds and hemorrhages
- Infection in the baby’s brain (such as sepsis or meningitis), which can be caused by the mother having herpes simplex virus (HSV), group b strep (GBS), urinary tract infection and bacterial vaginosis
- Improperly treated high bilirubin levels (jaundice) that cause a form of brain damage called kernicterus
Although cerebral palsy complications can be severe, there are many treatments and therapies available that can improve a child’s long term outlook and help the child live a full life. Research shows that in people with cerebral palsy who have severe multiple handicaps, the mortality rate is greatly decreased by the aggressiveness and quality of care received.
Proper care can help a child with cerebral palsy live a long and full life. Management of these children requires collaboration among health care and other professionals to maximize the child’s mobility, ability to swallow, social and emotional development, communication, education, and nutrition when it comes to activities of daily living. If the child has difficulty swallowing or any problems with the upper airway, exercises and devices that decrease the problems should be used, and speech therapists can help with all these issues.
Helping Your Child With Their Cerebral Palsy Through Exercise and Physical Therapy
Research shows that children with cerebral palsy benefit greatly from exercise and physical therapy, and in fact, these activities can improve their life expectancy. Spasticity and hyperreflexia can greatly hinder a child’s ability to perform many physical functions. When children have spasticity, the muscle groups are very stiff and tight due to constantly contracting muscles. In hyperreflexia, children have overactive reflexes that include twitching and spastic tendencies. Decreasing or overcoming these problems is essential so the child can maximize exercise and physical therapy and have a full and long life.
For medical therapy of spasticity, most experts recommend Botox. Furthermore, it is the consensus of the medical community that a surgery called selective dorsal rhizotomy (SDR) is extremely beneficial for children who have spasticity, or spastic cerebral palsy, which is the most common form of cerebral palsy. This surgery can be particularly helpful for children who are not able to move around due to contractures, which is permanent shortening of muscles, tendons and/or ligaments caused by prolonged spasticity in a concentrated muscle area.
Another limitation to being able to exercise and partake in physical therapy occurs when a child has hip disorders–including hip dislocation–and pain. Pain and hip problems are very common in children who have spastic cerebral palsy. Children that are unable to move around or who cannot move around very well are at the greatest risk of having hip disorders. These children should have regular radiographic screening starting at age 18-30 months so that hip disorders can be detected early and treated. Hip dislocation is preventable when early hip problems are noticed and treated.
Electrical stimulation is used in an effort to increase muscle strength. In neuromuscular electrical stimulation (NMES), high intensity impulses of short duration are used to generate muscle contraction. In threshold electrical stimulation (TES), there is lower intensity stimulation, and this is typically performed when the child is sleeping.
Having the ability to regularly receive physical therapy is very important; physical therapy is crucial for children with cerebral palsy, and it is a vital part of cerebral palsy management. The goal of physical therapy is to reduce muscle tone (tightness) and improve muscle and overall body function.
The best physical therapy approaches include the following:
- Bimanual training for hemiplegic cerebral palsy – a child with this type of cerebral palsy has spastic muscles of the arm, leg and trunk on the same side of the body. In other words, the muscles on one side of the body are in a constant state of contraction. Bimanual training uses repetitive tasks to train the child to use two hands together
- Constraint-induced movement therapy (CIMT) – for children with hemiplegic cerebral palsy, CIMT promotes function of the affected limb through encouraging that limb’s movement by restraining the unaffected limb. “Forced use” is when the unaffected limb is restrained, thereby “forcing” the child to perform daily tasks with the spastic limb
- Goal-directed / functional training – in this type of physical therapy, the child sets the goals and activities are based on these goals. A motor-learning approach is used, which consists of repetitive movements that become like reflexes; that is, they become part of the child’s muscle memory
- Context-focused therapy – this therapy promotes successful performance of tasks by changing the task or environment instead of changing the child’s approach. In other words, the therapist makes the task or environment work for the child
- Occupational therapy – this therapy typically is used for upper limb activities following Botox treatment
Research also supports the use of home programs that improve motor activity performance and self care, as well as fitness training programs. Exercise programs are quite beneficial, but are only effective in individuals that have sufficient motor skills to permit participation, and are beneficial only as long as the training continues.
There are many devices that can provide important support for children with cerebral palsy, especially those children that have severe impairments. Motorized wheelchairs, switching devices used to activate communication systems, voice-activated computers, and other systems that help a child control her environment can improve quality of life by enhancing social interactions and functional abilities.
Nutrition and Cerebral Palsy
Problems using the lips, tongue and jaw is common in children with cerebral palsy, and this dysfunction, called oromotor dysfunction, can cause problems with feeding. One study found oromotor dysfunction in 90% of babies and toddlers with cerebral palsy. Sucking and swallowing problems are common, and many babies and young children need help with feeding. Sometimes older children and adults also have difficulty eating. These difficulties require caregivers to spend substantial time with oral feeding. Some children may not receive enough food and nutrients if the time available for feeding is limited.
Difficulty with feeding affects how sick a child gets as well as how long the child will live, and this is especially true for children with severe cerebral palsy. In addition, when a child has oromotor dysfunction, the child is more likely to inhale food and liquids and develop aspiration pneumonia, which can be fatal. Children with cerebral palsy therefore require regular assessments of feeding skills and nutritional status, including weight and stature. In children with growth failure or long term aspiration, alternative feeding methods must be considered. This may include a feeding tube, which delivers food and nutrients to the baby or child through a tube in their stomach, thereby bypassing the child’s mouth.
Children with cerebral palsy should be compared to growth charts. These charts tell parents and physicians what the normal weight is for a given child’s age; if the weight falls below a certain number, there is an increased risk of sickness and death.
The long term outlook for children with cerebral palsy is highly variable and it depends on the severity and type of cerebral palsy as well as the aggressiveness and quality of care the child receives. It is crucial that every effort be made to keep a child healthy and active throughout their life.
Michigan Birth Injury Attorneys Helping Victims with Seizures, HIE, and CP
If your child has seizures, hypoxic ischemic encephalopathy (HIE) and/or cerebral palsy, contact the award winning birth injury lawyers at Reiter & Walsh ABC Law Centers. Reiter & Walsh is a national birth injury law firm that has been helping children for decades. Attorney Jesse Reiter, co-founder of the firm, has been focusing solely on birth injury cases for over 28 years and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy.
Jesse is currently recognized as one of the best medical malpractice attorneys in America by U.S. News and World Report 2014, which also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
The nationally recognized birth injury lawyers at Reiter & Walsh have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and they give personal attention to each child and family they represent. The award winning firm has numerous multi-million dollar verdicts and settlements that attest to its success and no fees are ever paid to the firm until your case is won. Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation. The firm’s award winning lawyers are available 24 / 7 to speak with you.