Treatment for cerebral palsy
(Interventions for Cerebral Palsy)
Although cerebral palsy is a lifelong disability, there are many interventions that can help reduce its impact on the body and the individual’s quality of life. An intervention is a service that aims to improve the condition of cerebral palsy and the day-to-day experience of the person living with it.
Children with cerebral palsy may be supported by a team of professionals including health professionals and community-based support services who work together to help the child and family reach their goals.
Through their late teens and early 20s, many young people take increasing responsibility for their own health and wellbeing. Their team may include health professionals and mainstream community providers such as fitness trainers.
Can cerebral palsy be prevented or cured?
At present, there is no way to totally prevent or cure cerebral palsy.
Public health measures such as mandatory seatbelts, pool fencing and rubella vaccinations continue to prevent some CP. Several interventions for high risk infants have been recently introduced to reduce the risk or severity of cerebral palsy. Three examples are:
- Cooling – Newborn babies who have suffered a brain injury due to lack of oxygen around the time of birth (hypoxic ischemic encephalopathy) may be treated with cooling. Cooling or mild hypothermia involves slightly lowering the infant’s body temperature and aims to reduce the impact of the brain injury.
- Antenatal steroids – A single course of steroids given to mothers who are at risk of a preterm birth reduces the risk of their babies having cerebral palsy.
- Magnesium sulphate – When given to pregnant mothers who are at high risk of very preterm birth, magnesium sulphate can help protect babies from the brain injury that leads to cerebral palsy.
- Doyle, L. W., Crowther, C. A., Middleton, P., Marret, S., & Rouse, D. (2009). Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database of Systematic Reviews(1), CD004661. doi: 10.1002/14651858.CD004661.pub3
- Jacobs, S. E., Berg, M., Hunt, R., Tarnow-Mordi, W. O., Inder, T. E., & Davis, P. G. (2013). Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database of Systematic Reviews, 1, CD003311. doi: 10.1002/14651858.CD003311.pub3
- Sotiriadis, A., Tsiami, A., Papatheodorou, S., Baschat, A. A., Sarafidis, K., & Makrydimas, G. (2015). Neurodevelopmental Outcome After a Single Course of Antenatal Steroids in Children Born Preterm: A Systematic Review and Meta-analysis. Obstetrics and Gynecology, 125(6), 1385-1396. doi: 10.1097/AOG.0000000000000748 See abstract
(Update: 18 Nov 2015)
Interventions for movement difficulties
Medical specialists may prescribe medications that assist movement issues. Some medications are taken orally (e.g. diazepam) and others are injected or delivered through surgically implanted pumps (e.g. Baclofen). Many children with cerebral palsy benefit from Botulinum toxin type A injections into muscles affected by spasticity. This intervention is used from about two years of age and is most effective when used in conjunction with therapy.
- Botulinum Toxin-A injections for supporting pain and comfort
- Occupational therapy following botulinum toxin-A injections
Selective Dorsal Rhizotomy (SDR) is a neurosurgical procedure that is used in a small percentage of children with cerebral palsy to permanently reduce spasticity in their legs.
Physiotherapy and occupational therapy
Physiotherapists and occupational therapists focus on encouraging a person’s day-to-day movement skills such as sitting, walking, playing, dressing and toileting. They will use a range of specialist interventions such as movement training and equipment, e.g. walking frames, wheelchairs, supportive seating, footwear and orthotics.
Interventions for muscle, bone and joint difficulties
Orthopaedic surgeons correct joint deformities and lengthen muscles. Surgery usually takes place in a child’s late primary years or early adolescence to improve walking quality and reduce pain. Paediatric rehabilitation specialists support the management of some of the conditions associated with cerebral palsy, such as spasticity, musculoskeletal issues and growth.
Casts, splints and muscle strengthening
Physiotherapists and occupational therapists may also focus on preventing impairments that might affect movement. They use casts, orthotics and muscle strengthening exercises.
Interventions for communication issues
Communication includes understanding what is being said and learning to use words and sentences. Speech pathologists assess and provide intervention to assist communication skills.
Treatment (intervention) for communication often involves the use of augmentative or alternative communication systems, such as signing, communication boards and speech generating devices.
Interventions for intellectual disability and learning difficulties
Assessments, special education and learning strategies
Psychologists can provide assessment of a child’s learning and development. Special educators work with families to develop a program of interventions to address each child’s learning needs. Occupational therapists can facilitate a child’s active participation in these learning activities.
Psychologists and occupational therapists can provide assessment and recommend learning strategies to compensate for perceptual difficulties.
Interventions for epilepsy
Medical specialists may prescribe antiepileptic medication to minimise the number of seizures. They will also guide families on the management of seizures when they do occur.
Interventions for pain management
Pain may be treated through medication and by addressing the underlying cause of the pain, e.g. by treating muscle contractures or gaestro-oesophageal reflux.
Psychologists may offer cognitive-behavioural therapy for chronic pain. This process works to help a person change the way they think about pain and, in turn, how they feel and behave about pain.
Massage therapy and hydrotherapy
Temporary relief of pain may be assisted through massage or hydrotherapy.
Interventions for sleep disorders
Medical specialists may prescribe medication or treat the associated issues that impact on sleep.
Psychologists may assist with behaviour therapy or help families to establish routines to help resolve children’s sleep issues.
For children with postural issues that make sleep difficult, occupational therapists and physiotherapists may prescribe special sleep systems to help children feel more comfortable in bed.
Interventions for behaviour and emotional issues
Behaviour therapy and counselling
Psychologists can offer assessment and support for emotional and behavioural challenges, which may include behaviour therapy and cognitive behaviour therapy. Social workers support people with cerebral palsy and their families in many ways, including strengths-based counselling and mutual aid groupwork.
Interventions for issues with eating, digestion and nutrition
Medication and surgery
Treatment (intervention) for severe difficulties with digestion, such as gastro-oesophageal reflux (GOR) includes medications or sometimes surgery. Non-oral feeding may be recommended if the individual has severely limited eating skills or experiences an unsafe swallow. This involves a surgically inserted feeding tube to the stomach or the small intestine.
See: Gastrostomy feeding
Medical interventions are performed by medical specialists in hospitals.
Speech pathologists provide assessment and treatment (intervention) for eating, drinking and swallowing difficulties. Examples of these are learning to use the muscles of the mouth better, using specially designed utensils and sitting in an optimal position.
Dietitians provide advice on improved and balanced nutrition.
Interventions for issues with saliva control (dribbling and drooling)
Speech pathologists may suggest various strategies to help people manage saliva loss. These include remembering to wipe their mouth and wearing age-appropriate clothing protection.
They may also recommend special exercises for the face and mouth, which may lead to better ability to control saliva.
Medical specialists may prescribe medication for saliva control. This is not usually considered a long term treatment option, but can be useful to dry up saliva temporarily. Botulinum Toxin Type A, injected into the salivary glands can reduce the secretion of saliva. In severe cases of drooling, surgery may be suggested to permanently manage saliva.
Interventions for hearing and vision impairment
Hearing and vision impairment are managed as they are for the general population by Ophthalmologists, Optometrists, Audiologists, Ear, Nose and Throat Specialists and General practitioners. Interventions include corrective eye wear (glasses), contact lenses, hearing aids and in some cases medication or surgery.
- Novak, I. (2014). Evidence-based diagnosis, health care, and rehabilitation for children with cerebral palsy. Journal of Child Neurology, 29(8), 1141-1156. doi: 10.1177/0883073814535503 See abstract
- Novak, I., McIntyre, S., Morgan, C., Campbell, L., Dark, L., Morton, N., Stumbles, E., Wilson, S & Goldsmith, S. (2013). A systematic review of interventions for children with cerebral palsy: state of the evidence. Developmental Medicine and Child Neurology, 55(10), 885-910. doi: 10.1111/dmcn.12246
(Update: 17 Nov 2015)