Brain & Nervous System - Cerebral Palsy

What is Cerebral Palsy?

Cerebral palsy (CP) is a disorder of the brain’s ability to control movements and postures. It is caused by damage to the developing brain, before or at the time of birth. A diagnosis of "Cerebral Palsy" covers a wide range of disability with no two people having the same difficulties. The movement problems vary from barely noticeable to severe.

What are the types of Cerebral palsy?

Cerebral Palsy can be classified in several ways.

Muscle Tone

• Children with spastic cerebral palsy have increased muscle tone causing ‘stiff’ muscles. Children with spastic CP need physiotherapy to help stop their joints and muscles becoming stiff or ‘contracted’ and to maximise their physical abilities.
• Children with athetoid, dyskinetic or dystonic cerebral palsy have difficulty controlling their muscles and posture. Physiotherapy aims to help improve their balance, stability, symmetry and control of movement.
• Children with ataxic cerebral palsy usually have problems with balance and the control and selectivity of movements. Physiotherapy can help children with ataxic CP improve the quality of their movements.

Most children do not fit perfectly into one category of muscle tone and demonstrate ‘mixed’ tonal patterns.

Distribution

• A child with quadriplegia has movement difficulties with their whole body.
• Children with hemiplegia have problems with the movement of one side of their bodies.
• Children with diplegia have difficulties with the movements in their legs. Often they also have difficulty with fine, dextrous movements of their hands.
• Children with monoplegia have problems with just one limb.

A specialist Paediatric Physiotherapist will assess and treat a child as a whole and not just focus on the affected area, as secondary difficulties may arise with the unaffected parts of the body.

Function

The Gross Motor Function Classification System looks at abilities at different ages and classifies on a scale of 1 to 5. This system provides an insight into the abilities a child will have as they get older. Briefly, in relation to mobility:

• GMFCS Level I: walks without limitations.
• GMFCS Level II: walks with limitations, such as distances and difficult terrain.
• GMFCS Level III: walks with adaptive equipment assistance, (eg walking frame) indoors, but may need a wheelchair for use outside.
• GMFCS Level IV: may be able to walk with assistance and self-propel a wheelchair short distances.
• GMFCS Level V: May be able to learn to operate a powered wheelchair, but will predominantly be transported in a manual wheelchair.

How can KidsPhysio help?

It has been shown that specialised Paediatric Physiotherapy can help babies and children with cerebral palsy to learn how to move, maximising their abilities and preventing stiffness and tightness in their joints and muscles.

Your Physiotherapist will fully assess your child and use an eclectic approach to their physiotherapy management. Depending on their difficulties and desired outcomes may:

• Practice skills and activities to help improve gross motor skills and functional independence
• Use exercises and games to improve muscle strength and ranges of movement
• Work specifically on balance and walking, and recommend aids such as walking aids or orthotics
• Help your child with processing their sensory environment
• Help you with holding and carrying your child
• Monitor orthopaedic issues, especially hip and back and liaise with consultants as indicated

Kids Physio can provide a flexible approach to your child’s physiotherapy management to suit you and your child’s needs. We will aim to integrate your child’s physiotherapy programme into your day.

Many Health Authorities have waiting lists for Paediatric Physiotherapy and babies have to wait a long time for treatment. KidsPhysio can offer early intervention. It may be that you would like a couple of physiotherapy sessions to help you learn some activities to assist your child until they are seen by the NHS Physiotherapists, or you may prefer your child to have regular physiotherapy treatment sessions. Many families have extra private physiotherapy to supplement the treatment offered by their NHS Physiotherapist.

Many children with CP need additional physiotherapy when they reach adolescence, for muscle tightening and joint contractures. A combination of growth spurts, school commitments making NHS appointment attendance difficult and teenage rebellion make this is a high risk time. KidsPhysio can provide after school appointments at your convenience to help manage joint and muscle contractures and maintain your child’s function.