Cerebral Palsy

Management in Cerebral Palsy

Cerebral Palsy is the most common physical disability in children. According to Damiano, Alter and Chambers (2009), the latest figure in United States with the incidence of Cerebral Palsy (CP) is 3.6 per 1000 children. There is no certain cure of Cerebral Palsy; however, physical therapy interventions have shown improvement in the motor development of the children suffering from CP. CP produces a hallmark on the motor development leading  to spasticity and decrease in the range of motion. The severity of the CP ranges from motor impairment, contractures, disability and high to moderate assistance in the activities of daily living. It has been noted that the management of CP lacks a strong and linear approach leading to decrease in the life-span and increased in the disability. Damiano et al. (2009), states that walking is the most common

primarily goal of improvement in CP. Damiano et al.(2009), also states that the major goal of physical therapy should include independent mobility including the ability to ambulate among the other forms of mobility. This means improving the generalized body strength and range of motion of a person to be able to ambulate with the wheelchair aid or the walker. The goals for the physical therapy should also focus on developing the upper extremity strength to aid and pull the ambulatory aides. The physical therapist  are required to improve the patient’s loading time, ability to stand in the stance phase with assistance, and ability to make a heel strike against gravity. Damiano et al. (2009), states that stretching can produce efficient result along with other interventions such as orthotic shoes, Botulinum toxin and strength and endurance training.





The main aspect involved in training the person with CP is to enhance the core-muscle strength of the individual. The core-muscle strength  is produced by the muscles of the abdominals along with the lower lumbers. Training the required muscles helps the body to stand in an upright position against gravity. Energy consumption should also be kept in mind by the physical therapists. Low level exercises that include frequent rest intervals (avoid the formation of lactic acid) can produce effective results in CP.  Specific task training exercises such as jumping, walking on treadmill, step up and down and sit to stand exercises should be performed by keeping the interval phase in between the sessions. The delivery of physical therapy should include realistic goals and improvement in the functional measure. Gross motor training exercises and exercises for improving the proprioception should be included.



Physical therapists should also focus on  the impairment of tone in CP. CP involves the negative and positive feature of the upper motor neuron lesion at the level of the body structure (Damiano et al.,2009).



Thus the abnormal tone results in either decrease in tone (hypertonia) or hyperkinesis.  The Physical therapy goals should be patient-oriented and should include realistic achievements depending upon the type of CP and surgical rhizomoty if performed.



Last but not the least in the patient-client management includes evaluating the home-environment, patient’s lifestyle and inspection of the ambulatory aids.  Ambulatory aides should be inspected and points such as weight distribution in the wheelchair, distribution of pressure on seat and any sitting adaptations should be noted.



Spasticity is different from tightness; tightness is more localized without the involvement of upper motor neuron lesion as seen in spasticity.  Severe spasticity if not handled properly might result in dislocations and avulsion fractures.  All this factors are the negative hallmarks that might prevent the person from ambulating and becoming functionally independent.



Thank You,

Sweta Christian,PT.