Cerebral Palsy Treatment: A Multipronged Approach.

Cerebral Palsy Treatment: A Multipronged Approach

​More than 17 million people worldwide suffer from some form of cerebral palsy.  In the United States, more than 760,000 people are affected.  This is equivalent to one child with cerebral palsy for every 323 children born (Centers for Disease Control and Prevention).  As such, it is the most common disorder to affect young children (Krigger).  The term cerebral palsy does not only refer to one disorder, but rather a group of disorders that can affect the ability of a person to move their bodies normally.  It is generally the result of abnormal development and/or brain damage, but in most patients, the cause remains uncertain.  Symptoms of cerebral palsy include the following: poor coordination of muscles, uncontrollable movements, disproportionate reflexes, difficulty walking, spastic paralysis, poor posture, difficulty speaking, difficulty hearing, impaired vision, incontinence, and intellectual disabilities.  These are some of the most common symptoms; however, these symptoms do not represent the full spectrum of the experience of cerebral palsy.  Because cerebral palsy can affect so many individuals and poses a specifically difficult risk to children, individual cases should be addressed using the most up-to-date evidence-based treatment options that exist today.  Treatment of cerebral palsy should take a multifaceted approach and include the appropriate combination of physical therapy, occupational therapy, speech therapy, medication therapy, vitamin supplementation, and more informal social and emotional supports.

​Physical therapy is an important treatment path for individuals living with cerebral palsy.  Because cerebral palsy is primarily a movement disorder, physical therapy can provide some of the most noticeable benefits to the patient.  Physical therapy can help cerebral palsy patients to develop muscle strength, flexibility, and improved control over their movements. It can also improve coordination, balance, posture, and gait—all challenges for cerebral palsy patients (Damiano).

Physical therapy techniques include specialized exercises, stretching, joint mobilization, soft tissue mobilization, and endurance exercises.  Physical therapy equipment for cerebral palsy patients includes the following: bands, rollers, weights, balance balls, exercise machines, hot and cold packs, and ultrasounds.  In addition, effective physical therapy activities can be custom-tailored to meet the needs of children who benefit from playing and recreation just as much as other forms of physical therapy.  This approach includes the following kinds of activities: dancing, swimming, and throwing and catching balls.  These activities can be greatly beneficial when it comes to improving children with cerebral palsy’s coordination, strength, balance, and range of motion (Damiano).

A complement to physical therapy is occupational therapy.  In contrast to physical therapy which focuses solely on the movements and abilities of the body itself, occupational therapyis broader and also encompasses a wide range of other techniques and approaches that help a patient to accomplish everyday tasks and activities.  These kinds of tasks include feeding oneself, getting dressed, brushing teeth and other grooming responsibilities, using writing utensils, using devices like phones and computers, completing household chores, and so much more. Occupational therapy is extremely useful to patients with cerebral palsy because, by helping cerebral palsy patients to maximize their levels of daily functioning, it can help to empower them into becoming more independent and self-sufficient (Steultjens, Dekker, Bouter, Van De Nes, Lambregts, & Van Den Ende).

Occupational therapy is particularly effective for improving the quality of life of cerebral palsy patients because it takes into consideration the home environment of each individual patient.  Manipulating the environment to facilitate the accomplishment of everyday tasks and activities can be monumentally successful.  In addition, occupational therapy can also be applied to the school environment.  This is especially important because it can be difficult for cerebral palsy patients to accomplish certain activities in the classroom environment.  Occupational therapy can help the patient complete tasks at school such as the following: opening doors and lockers, using the bathroom, traveling on the school bus, sitting at a desk, navigating facilities, and interacting with other students and workers at the school (Steultjens, Dekker, Bouter, Van De Nes, Lambregts, &Van Den Ende).

Speech therapy is another important part of treatment for cerebral palsy.  In children with cerebral palsy, speech and communication can be impaired for a number of reasons, including motor impairments, intellectual disabilities, and sensory impairments.  Common speech therapy approaches to use with patients that have cerebral palsy include augmentative and alternative communication systems to provide assistance to patients as they try to express their needs and ideas.  Augmentative and alternative communication systems can include tools such as charts that rely on symbols or electronic devices that provide voice output, but they also include intuitive techniques that countless people use on a regular basis, such as gesturing and pointing (Pennington, Goldbart, & Marshall, 2004).

There are several medications that can be used in patients that have cerebral palsy.  Medications can be used for symptom reduction, as well as to prevent complications from arising.  The medications that a cerebral palsy patient’s physician will recommend will vary depending on the patient’s unique experience and symptoms of cerebral palsy.  For example, patients with seizures as one of their cerebral palsy symptoms should take medications that can help to control their involuntary movements.  These drugs are called anticholinergics, anticonvulsants, antispastics, and antidepressants.  Patients with digestive problems might take other gastrointestinal medications or stool softeners.  In addition, anti-inflammatory drugs can be used to help control patients’ pain, which may be due to a variety of cerebral palsy symptoms and/or surgery (Krigger).

In addition to these kinds of medications, the effect of vitamin supplementation has been studied in children with cerebral palsy and indicated positive patient outcomes.  For example, Kilpinen-Loisa, Nenonen, Pihko, and Maktie have shown in their research that high dosages of vitamin D supplementation can help support normal skeletal development and mineralization in children patients with cerebral palsy.  This is especially important given that other research has indicated that children with cerebral palsy are often severely lacking in intake of the following nutrients: iron, folate, niacin, calcium, vitamin E, and vitamin D (Hillesund, Skranes, Trygg, and Bohmer).  Since a proactive approach of nutritional nourishment and and vitamin supplementation can only help and has no negative side effects, it should be one of the first priorities, especially for children who may not be eligible for certain strong medications that are used to treat cerebral palsy.

One final component of a multifaceted approach to treating patients with cerebral palsy is an approach that prioritizes social and emotional support.  According to research by Majnemer, Shevell, Rosenbaum, Law, and Poulin, the quality of life on a social and emotional level among children patients with cerebral palsy is variable in the same way that it is among children as a whole, with or without such a diagnosis.  In addition, physical limitations were not shown to correspond with low-quality of social and emotional life.  Taken together, these research findings suggest that, just like all children, the quality of life of children with cerebral palsy depends heavily on their relationships with their family members and social networks.  The implications of this place responsibility on family members of children with cerebral palsy, other caregivers, and the healthcare system, which has a responsibility to support parents in caring for cerebral palsy patients so that they can be more emotionally present for their children.  It also suggests that opportunities for cerebral palsy patients to interact with people in everyday public contexts would be beneficial to their emotional development and happiness.

Taking a multifaceted treatment approach that also includes social and emotional supports for patients with cerebral palsy requires a holistic health care perspective.  However, critics may argue that specialization is more effective than an approach that takes into consideration a little bit of everything.  While this may be true in some instances, a holistic paradigm does not preclude the use of specialized medicine.  Rather, it holds that specialized medicine must be complemented by other angles due to the multilayered nature of the patient and cerebral palsy. Furthermore, the holistic paradigm in healthcare is growing in popularity among patients, and it has been shown to be effective at treating cerebral palsy (Pelchat & Lefebvre).  Therefore, it should not be viewed as a threat to traditional perspectives in medicine, but rather an expansive improvement.

Overall, cerebral palsy has such a profound affect on patients’ lives, many of whom are young children, that it is critical that everything possible is done in order to alleviate their symptoms and improve their quality of life.  Research shows that there are many successful methods of treating cerebral palsy, and a holistic healthcare paradigm helps to unite these different approaches into a patient-centered model of care that combines physical therapy, occupational therapy, speech therapy, medication therapy, vitamin supplementation, and social and emotional support.  A multipronged treatment protocol will be the most beneficial to both patients and their caregivers.

Works Cited

Centers for Disease Control and Prevention. Cerebral Palsy. Data and Statistics, 2019, https://www.cdc.gov/ncbddd/cp/data.html.

Damiano, Diane L. "Activity, activity, activity: rethinking our physical therapy approach to cerebral palsy." Physical therapy 86.11 (2006): 1534-1540.

Hillesund, Elisabet, et al. "Micronutrient status in children with cerebral palsy." Acta Paediatrica 96.8 (2007): 1195-1198.

Kilpinen-Loisa, P., et al. "High-dose vitamin D supplementation in children with cerebral palsy or neuromuscular disorder." Neuropediatrics 38.04 (2007): 167-172.

Krigger, Karen W. "Cerebral palsy: an overview." American family physician 73.1 (2006).

Majnemer, Annette, et al. "Determinants of life quality in school-age children with cerebral palsy." The Journal of pediatrics 151.5 (2007): 470-475.

Pelchat, Diane, and Helene Lefebvre. "A holistic intervention programme for families with a child with a disability." Journal of Advanced Nursing 48.2 (2004): 124-131.

Pennington, Lindsay, Juliet Goldbart, and Julie Marshall. "Speech and language therapy to improve the communication skills of children with cerebral palsy." Cochrane Database of Systematic Reviews 2 (2004).

Steultjens, Esther MJ, et al. "Occupational therapy for children with cerebral palsy: a systematic review." Clinical rehabilitation 18.1 (2004): 1-14.

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