Physiotherapy for Cerebral Palsy - An overview

Understanding Cerebral Palsy

Cerebral Palsy (CP) is an umbrella term that defines a group of disorders that impacts coordination, movement, muscle strength, and gait. It is caused by abnormal brain development or irreparable damage to the immature and developing brain (during pregnancy or shortly after birth).

CP can affect the whole body, be limited to one or two limbs, or one side of the body. CP is not a degenerative disorder. This means its symptoms will not get worse with time. However, timely diagnosis and immediate treatment can better the person’s ability to be as independently mobile as possible.

How does Cerebral Palsy affect mobility?

CP affects that part of the brain that is responsible for muscle movement. It can lead to flaccid muscles, poor motor coordination, impaired reflexes, impaired balance, incorrect posture, involuntary movements, etc. The extent of mobility issues depends on the type of CP.

The Gross Motor Function Classification System (GMFCS)

The Gross Motor Function Classification System (GMFCS) is a system of classifying the severity of CP that further helps in describing the individual’s abilities and challenges when it comes to mobility. The GMFCS has ascertained the five levels of mobility as follows:

Level 1: Walking without limitations

Level 2: Walking with some limitations

Level 3: Walking with the help of assistive devices like cane or a walker

Level 4: Mobility with self-operated wheelchair

Level 5: Mobility with wheelchair operated by another person

In order to evaluate the degree of difficulty in mobility, the above classification can help greatly.

Benefits of physiotherapy for Cerebral Palsy

Physical therapy will help ● Reduce muscle contractures ● Improve strength and flexibility ● Better coordination and sense of balance ● Increase flexibility

Physical therapy introduced early can also avoid many bone and joint deformities, as well as help children become more independent. It will also help them improve their social and communication skills, participate better at home and school, and boost their psychological well-being.

Benefits of physiotherapy for Cerebral Palsy

Physiotherapy can be tailored to suit the individual needs of the child and based on the type of CP they have been diagnosed with. It can benefit different types of CP in different ways, like:

● SPASTIC CEREBRAL PALSY: Reduce muscle tension and jerky movements; relieve stiffness (through stretching)

● ATHETOID CEREBRAL PALSY: Increase muscle tone, gain control over voluntary movements

● ATAXIC CEREBRAL PALSY: Improve gait, balance, and mobility

Physiotherapy has also proved to be beneficial for other symptoms of CP like scoliosis, lumbar lordosis, knee/hand deformities, pelvic inclination, and shortened Achilles tendon.

Types of physiotherapy for Cerebral Palsy

Exercise, stretching, special equipment, and muscle relaxation techniques are all part of physiotherapy for Cerebral Palsy that address specific needs and limitations.

Let’s take a look at some of the most prescribed physiotherapy activities:

Passive stretching: eases soft tissue tightness, relieves spasticity, enables easier walking, enhances range of motion

● Manual stretching: use full body weight to induce a good stretch; can help overcome hypertonia

● Weight-bearing exercises: targets tight muscles in the lower body

● Splints: improves resting posture, reduces spasticity, improves flexibility; enables long-duration, lowforce stretching

Static weight-bearing exercises: uses devices like tilt-tables and standing frames to guide children through load-bearing activities; improves muscle tone and strength

Types of physiotherapy for Cerebral Palsy

Functional exercises: combination of aerobics and strength training to improve functionality and fitness in children who can walk

Apart from being beneficial, these kinds of activities, like static biking, plyometric exercises are thoroughly enjoyed by children.

Bimanual training: improves coordination of the upper body through play and functional activities that employ both arms

Types of physiotherapy for Cerebral Palsy

Body weight supported treadmill training: develops stepping reflex that is essential for regular perambulation

Electric stimulation: improves muscle strength and nerve function through stimulation; these are safe and non-invasive techniques; can be done at home (guided by the therapist)

Massage therapy: relaxes muscles and gives the child a break from physical strain; also helps with pain relief

Things parents and caregivers should keep in mind

1. Choose a physiotherapist who has worked with children who have CP 2. Cover slippery floors and remove sharp objects from to make a safe environment for your child 3. Start slow with new exercises and equipment, gradually increase intensity 4. Use assistive devices like brace, guard rails, anti-slip gloves, etc. wherever necessary 5. Always supervise therapy sessions. 6. Encourage your little one to speak up if they’re uncomfortable. Stop the exercise immediately if there’s any pain or discomfort. 7. Ensure you have a stretching routine before beginning physical therapy. 8. Encourage and motivate small wins. 9. Speak with your doctor about corrective surgeries that could fix bone or joint deformities.

Play is a child’s work

Children learn through play too. You do not have to always follow an exercise program, per se. You can incorporate physical activity into your child’s daily routine through simple play and games.