What are the treatments and therapies for spastic cerebral palsy?

There are numerous treatments and therapies for spastic cerebral palsy, ranging from therapeutic and supportive treatments to surgical and medical interventions to decrease functional impairments and muscle-stress symptoms. These therapies are usually combined for maximal effect as part of a comprehensive treatment plan.



What Forms of Spastic Cerebral Palsy Do Treatments Address?

Spastic cerebral palsy is the most common type of cerebral palsy (CP), affecting approximately 77% of children who have CP. Children with spastic cerebral palsy have very stiff and tight muscle groups. Spastic muscles are always contracting, and there is weakness of the muscles opposing the spastic ones.  This causes abnormal positions of the joints on which the muscles act.  The joints can become deformed, which may cause them to become fixed in place (a fixed contracture) over time.

What is spastic cerebral palsy? Cerebral Palsy Infographic

The  most common type of spastic cerebral palsy is spastic diplegia, which is characterized by involvement of the lower extremities. Most children with spastic diplegia have at least some capacity to walk, but the muscles are very tight and the children have a scissor gait.  A scissor gait is when the child appears to be crouching because tightness in the hips, legs, and pelvis keep these areas flexed to various degrees.  In addition, muscles called adductors cause the knees and thighs to hit each other or cross in a scissor-like movement.  The child is often forced to walk on tiptoe.

Clonus and muscle spasms are not uncommon.  Clonus is a series of involuntary rhythmic muscular contractions and relaxations.  These are caused by the pain and/or stress of muscle tightness, indicating especially hard-working and/or exhausted muscles.  The spasticity itself can and usually does also lead to very early onset of muscle-stress symptoms such as arthritis and tendonitis.


Who Provides Therapeutic Care to Children with Cerebral Palsy?

Treatment for spastic cerebral palsy occurs on a multitude of fronts.  The child’s physician should work closely with physical, speech, and occupational therapists to improve the child’s ability to move, speak, and perform everyday activities such as going to school.  An orthotics and prosthetics team can provide braces and other orthotic devices to help with balance, walking, and movement.  Medicines can help relax muscle spasms and control pain and seizures.  Sometimes surgery is performed to lessen spasticity.

Cerebral palsy lawyers discuss the importance of having a licensed physical therapist involved in the care of a child with spastic cerebral palsy.It is important to have trained professionals involved in every aspect of treatment for spastic cerebral palsy.  Most experts agree that having the family provide care is not a good idea regardless of how hard the family members try.  It is important that the family is involved, but the consensus among experts is that family-provided care diminishes the family relationship into a caregiver-patient relationship.  In addition, a family member may be reluctant to put the child through the painful therapy that often is necessary to reap full therapeutic benefits. Some children with spastic cerebral palsy have difficulty communicating, which is why trained professionals must be involved –  professionals can notice problems that could become serious or life-threatening that parents may not spot.


Types of Therapy for Spastic Cerebral Palsy

Physical Therapy for Spastic Cerebral Palsy

Physical therapy is aimed at promoting motor and developmental skills. The parent or caregiver should be taught the exercises or activities that are necessary to help the child reach their full potential and improve function.

Daily range-of-motion (ROM) exercises are important to (1) prevent or delay contractures caused by spasticity and (2) to maintain the mobility of joints and soft tissues. Stretching exercises increase range of motion. Progressive resistance exercises increase strength. Age-appropriate play and adaptive toys and games based on desired exercises make therapy fun and get the child’s full cooperation. Strengthening knee extensor muscles helps to improve crouching and stride length. Postural and motor control training is important and should follow the developmental sequence of normal children; head and neck control should be achieved, if possible, before advancing to lower body (trunk) control.

Children and their parents often enjoy hippotherapy (therapeutic horseback-riding; this is a type of complementary/alternative therapy). Hippotherapy can help improve the child’s muscle tone, ROM, strength, coordination, and balance.  It offers many social, cognitive, physical, and emotional benefits.

The use of Kinesio taping (elastic therapeutic tape) can help reeducate muscles for stretching and strengthening, and aquatic therapy and electrical stimulation can also be beneficial for strengthening weakened muscles and maintaining muscle size.  In a child with weak dorsiflexors (muscles in the lower leg that act on the foot) that are causing foot drop or tripping, for example, electrical stimulation to the anterior tibialis (shin muscle) could be beneficial. Electrical stimulation of weakened muscles is usually well-tolerated in older children.

Vibration and short-term use of heat and cold over the child’s tendons may decrease spasticity.  These treatments, however, only decrease spasticity briefly and should be used in conjunction with ROM and stretching exercises.

Physical therapy is crucial when a child has had surgery to help correct spasticity; it helps the child obtain maximum benefit from surgery.

Occupational Therapy for Spastic Cerebral Palsy

Occupational therapy for children with spastic cerebral palsy should focus on daily life activities, such as feeding, dressing, toileting, grooming, and transfers. Occupational therapy also focuses on the upper body. The goal should be for the child to function as independently as possible with or without the use of adaptive equipment.

Children who can follow directions and have spasticity of  certain muscles in the wrist, forearm, or muscles that control the thumb may benefit from intensive therapy. Activity-based interventions such as modified constraint-induced movement therapy (mCIMT) and bimanual intensive rehabilitation training (IRP) can improve the child’s ability to use the impaired upper limb(s) and improve performance in personal care.  One study found that more benefits were seen from intensive treatment than in standard treatment; in mCIMT, grasp improved, and, in IRP, spontaneous use in bimanual play and activities of daily living in younger children increased.

Speech Therapy for Spastic Cerebral Palsy

Some children with spastic cerebral palsy have involvement of the face and upper airway, causing drooling and difficulty swallowing and speaking. Speech therapy can be used to help improve swallowing and communication. Some children benefit from assistive communication devices if they have some motor control and adequate cognitive skills.

Recreational Therapy for Spastic Cerebral Palsy

Incorporation of play into a child’s therapy program is very important. The child should view physical and occupational therapy as fun, not work. Caregivers should seek fun and creative ways to stimulate children, especially those who have a decreased ability to explore their own environment.

Recreational activities that can help fitness include hippotherapy, adaptive sports, cycling, water therapy, and special camps created for special needs children.

Medications for Spastic Cerebral Palsy

If the child with spastic cerebral palsy has seizures, treatment is based on the type and frequency of the seizures. Complete seizure control can often be achieved using a single medication, but some children with cerebral palsy have particularly difficult-to-control seizures. Medication can have side effects ranging from sedation to hyperactivity. These drugs can also affect liver function and white and red blood cell counts, and it is not uncommon to have bone problems. Side effects are usually not harmful and resolve when the offending medication is discontinued. The goal of the physician should be for the child to become seizure-free with few or no side effects. It is of no benefit to the child to be seizure-free but significantly impaired by medication side effects. Medications are sometimes paired with surgery to maximize results.

Among the most common medications are dantrolene sodium (Dantrium) and diazepam (Valium). Diazepam is both a muscle relaxant and a sedative. Baclofen (Lioresal) can be taken by mouth or infused continuously with an implanted pump directly in the cerebrospinal fluid (the liquid that bathes the spinal cord and the brain). This treatment might be especifically useful for children with spasticity in the lower legs. The most common complications with these medications are drowsiness, sleepiness, and some degree of weakness. The sedative side effects of such medications often limit their usefulness. In the case of the baclofen pump, the most common complication is infection at the catheter site. Additionally, a muscle relaxing agent called botulinum toxin (Botox) can be injected into tight muscles to relax them. When used prudently, this procedure may prevent surgical intervention.

Selective Dorsal Rhizotomy Surgery for Spastic Cerebral Palsy

Spasticity is caused by a problem with communication between the brain and the spinal cord, which may be due to an earlier brain injury.  The message loop between the brain, the spinal cord, the nerves, and the muscles doesn’t function correctly, causing muscle tightness.  During selective dorsal rhizotomy (SDR), physicians carefully identify and test the sensory nerves in the lower spinal cord to see exactly which ones are misfiring and causing spasticity. Only nerves that are working abnormally are cut, interrupting the message loop that caused the spasticity. This provides long-term improvement in muscle tone because the nerves do not grow back together. When followed by months of rehabilitation, SDR can improve the child’s ability to move and control muscle movement and may reduce the need for future orthopedic surgeries.

Baclofen Pump Insertion for Spastic Cerebral Palsy

In this procedure, physicians place a pump about the size of a hockey puck in the child’s abdomen. The pump continuously delivers baclofen into the fluid surrounding the child’s spine. Baclofen is a muscle relaxant that reduces spasticity throughout the child’s body. Since the medicine goes directly into the nervous system, the dose of baclofen the child gets through the pump can be much lower than doses delivered through the mouth. This helps avoid the side effects of higher doses, which include sleepiness and sedation.

During surgery, the pump is placed under the skin of the child’s abdomen. Once the pump is in place, the physician attaches a catheter to it. Then the physician threads the catheter under the skin at waist level to the child’s spine. The catheter is inserted into the spinal canal.

Next, the physician fills the pump with baclofen and sets it to deliver the exact amount of medicine the child needs. The pump begins slowly releasing the medicine through the tube and into the spinal canal. The baclofen pump must be filled with medicine every one to six months, depending on the child’s dose. The pump lasts about five years. Afterward, it must be removed and replaced during another surgery.

Tendon Release Procedures

Tendon release surgery may allow improved range of motion. The surgery is usually performed on the muscles of the calf or inner thigh. Tendon release is a procedure to cut through or disconnect a tendon (tenotomy). The surgery normally involves cutting the tendon and allowing it to retract towards the junction of the muscle and tendon. The purpose of tendon release is to identify and surgically remove the area producing symptoms, while protecting the normal surrounding tissues and their attachments.

Tendon release is commonly done to relieve tightened or shortened muscles (contractures), allow relaxation of joints, and decrease irritation caused by friction. Sometimes the tendon is re-routed to maintain muscle function.

Other Surgical Procedures for Spastic Cerebral Palsy

Strabismus is when the eyes are not properly aligned with each other and don’t work together. A sign of the condition is that one eye moves normally, while the other eye points in, out, up, or down. This condition is not uncommon with spastic cerebral palsy.  Ophthalmologists (eye specialists) can help strabismus by operating on the muscles that control the movement of the eye or to correct some other complications such as cataracts.

Surgeons can sometimes treat seizures that cannot be controlled with medication by removing abnormal brain tissue responsible for seizures. They can also treat epilepsy by stimulating the vagus nerve with an implantable device similar to a pacemaker.  It is thought that stimulating this nerve disrupts the abnormal brain activity that occurs during seizures.

Children who are unable to take in enough calories by mouth may require the placement of a feeding gastrostomy tube (PEG tube) directly into the stomach.


Medical Care for Spastic Cerebral Palsy

Medical care of children with spastic cerebral palsy is often seriously hindered by a child’s inability to communicate needs and sensations. Relatively common childhood illnesses such as ear infections, urinary tract infections, and appendicitis, which are easily treatable in most children, may prove to be life-threatening in children with cerebral palsy due to delayed recognition on the part of caregivers and physicians. Each child with cerebral palsy should have a primary care professional that is experienced with the special medical needs of affected children.

While many experts state that the brain injury that causes cerebral palsy cannot be fixed, there are numerous surgeries, medications, treatments, and therapies that can significantly improve the symptoms of cerebral palsy.  Intense physical therapy, sports, special camps, and physical activity have all been shown to provide significant social, emotional, and physical benefits for people with special needs. Social interaction and a sense of community are very important for kids with spastic cerebral palsy, and when these children can work with experts and do fun activities with other special needs children, the benefits are immeasurable.


Trusted Detroit, Michigan Birth Injury Attorneys Helping Children with Spastic Cerebral Palsy

Birth injury lawyer Jesse Reiter, president of ABC Law Centers, 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. Partners Jesse Reiter and Rebecca Walsh are currently recognized as two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation. The cerebral palsy 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).

If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder, or hypoxic-ischemic encephalopathy (HIE), the award winning attorneys at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy, and a secure future, and we give personal attention to each child and family we represent. Our firm has numerous multi-million dollar verdicts and settlements that attest to our success, and no fees are ever paid to our firm until we win your case.

Free Case Review  |  Available 24/7  |  No Fee Until We Win

Call our toll-free phone line at 888-419-2229
Email attorney Emily Thomas at EThomas@abclawcenters.com
Press the Live Chat button on your browser
Complete Our Online Contact Form


Related Resources


Video: Birth Injury Attorney Emily Thomas on the Importance of Therapy

Video: Birth Injury Attorney Jesse Reiter Discusses the Causes of Spastic Cerebral Palsy

spastic cerebral palsy lawyer discusses causes of cp


Sources:

  • Landau WM. Clinical neuromythology II. Parables of palsy pills and PT pedagogy: a spastic dialectic. Neurology 1988; 38:1496.
  • Glenn MB, Whyte J. The Practical Management of Spasticity in Children and Adults, Lea & Fegiber, Philadelphia 1990.
  • Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society, Delgado MR, Hirtz D, et al. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2010; 74:336.
  • Patrick JH, Roberts AP, Cole GF. Therapeutic choices in the locomotor management of the child with cerebral palsy–more luck than judgement? Arch Dis Child 2001; 85:275.
  • Petersen MC, Palmer FB. Advances in prevention and treatment of cerebral palsy. Ment Retard Dev Disabil Res Rev 2001; 7:30.
  • Dursun N, Dursun E, Alican D. The role of botulinum toxin a in the management of lower limb spasticity in patients with cerebral palsy. Int J Clin Pract 2002; 56:564.
  • Tedroff K, Löwing K, Haglund-Akerlind Y, et al. Botulinum toxin A treatment in toddlers with cerebral palsy. Acta Paediatr 2010; 99:1156.
  • Novak I, McIntyre S, Morgan C, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol 2013; 55:885.