Cerebral Palsy is a progressive, developmental condition found in children starting between the age group of 3-5 years . It is a congenital disability that affects the body and posture. Cerebral Palsy is the most frequent cause of physical disability in children after polio. About 1 in every 300 babies worldwide is born with or develops cerebral palsy.
Causes can be –
- Prenatal (Inherited, infection to mother, blood type, etc).
- Perinatal (Birth asphyxia, birth injuries, premature delivery).
- Postnatal (brain tumour, head injuries, brain infection, etc).
Types of cerebral Palsy –
- Spastic CP– The spastic child is rigid or stiff. Movements are slow.
- Athetoid CP– Athetosis is a slow, sudden uncontrolled quick movement of the child’s feet, arm or face muscles.The arms, legs seems to be jumpy and move too fast and too far. Regular shakes and spasm are present.
- Ataxic CP – The child has poor balance, has difficulty initiating a work. There is often fall and clumsiness in movements.
This is a problematic situation that many parents face but cannot avoid it. So rather treating the conditions, it is necessary to handle the sentiment of the child . The normal development, communication, self care and the importance of relationship should be taught to the child .
The condition cannot be cured completely but can be maintained through many treatment protocols , such as Physiotherapy which plays a pivotal role in the form of conservative rehabilitation for these children and the management of it should be as described below –
- Maintaining daily functional activities-
It becomes quite difficult for such children to do their day to day activities . So , the physiotherapist should observe the activities which can be best done by the child and should work upon them.
A physiotherapy session should be started as quickly as possible to diagnose, evaluate and examine the child for a better prognosis.
- Activities like toileting, hair combing, dressing, eating should be focused on and if the child is able to understand and do it, then parents should teach him/her to do it himself/herself and assist them to do so. But , the parents should be advised to make the child use the arm and leg that are most affected, in order to develop normal synergy pattern of the body part.
- Posture correction-
In case of spastic or flaccid cases, the posture is abnormally positioned and should be corrected at the earliest to avoid permanent deformity. Posture analysis is done by the therapist and management of posture correction is initiated. Whatever the child is doing (crawling, sitting, lying,), each activity should be done with correct posture and also specific designed CP chairs, logs, bolsters, walkers, can also be used. Parents should be encouraged to play with the child , give her interesting things to play with maintaining correct position.
In case of lying and sleeping, anti-spastic position should be maintained. Like bending forward, lying in a hammock or over a barrel, etc.
Trunk rotation is necessary to walk with help of rolling. Twisting and rolling for catching a toy can help .
Corrected sitting and playing is encouraged. Sitting in “W” position can correct the lower leg deformity.
Corrected standing with support of forward hand hold, rollator, standing frame, etc.
3. Prevention of contractures-
Prevention of contracture is of much importance for the normal development of the child and to prevent further deformity.
- Range of motion exercises should be started by the physiotherapist and exercises in ways that do not increase spasticity and helps relaxation of spastic muscles.
- Moist heat(hydrotherapy), slow stretch can be included.
- Massage intermittently when done, will also aid in reducing muscle spasm, tightness and cramping. But it should be done very gently and twice a week.
- Correct handling and carrying of the child is taught to the parents by the therapist.