From the Guidelines
For cerebral palsy, we typically order a comprehensive evaluation and management plan tailored to the individual's specific needs, including neuroimaging such as MRI to assess brain structure, and standardized motor assessments like the GMs assessment or HINE, as recommended by strong evidence from 1 and 1. This approach is based on the strongest and most recent evidence, which emphasizes the importance of early detection and intervention in cerebral palsy to optimize neuroplasticity, prevent complications, and enhance parent and caregiver well-being, as highlighted in 1. The management plan should include:
- Neuroimaging such as MRI to assess brain structure, as recommended by 1 with strong evidence
- Standardized motor assessments like the GMs assessment or HINE, which have been shown to be more than 95% accurate in diagnosing cerebral palsy in infants with newborn-detectable risks before 5 months’ corrected age, as stated in 1
- Physical, occupational, and speech therapy evaluations to address motor impairments, daily living skills, and communication difficulties
- Medications commonly prescribed include baclofen or diazepam for spasticity, botulinum toxin injections for focal muscle tightness, and sometimes trihexyphenidyl for dystonia, as part of a comprehensive treatment plan
- Orthopedic evaluations to assess for contractures or hip displacement, while adaptive equipment like braces, wheelchairs, or communication devices may be ordered based on functional needs, as supported by the evidence in 1 This multidisciplinary approach addresses the neurological basis of cerebral palsy while providing comprehensive support for motor, cognitive, and social development to maximize function and quality of life, in line with the recommendations from 1, 1, and 1.
From the Research
Medications for Cerebral Palsy
- Benzodiazepines, dantrolene sodium, baclofen, tizanidine, botulinum toxins, phenol, alcohol, and intrathecal baclofen are common medications used to treat spasticity in children with cerebral palsy 2, 3
- Oral medications and intrathecal baclofen are used for treating generalized spasticity, whilst chemodenervation agents (botulinum toxins, phenol, and alcohol) are used to treat localized spasticity 2
- Botulinum toxin A is an effective anti-spasticity treatment in children with cerebral palsy, but more data concerning safety and long-term effects is needed 2
Non-Pharmacologic Interventions
- Physiotherapy, occupational therapy, use of adaptive equipment, various orthopedic surgical procedures, and neurosurgical procedures are non-pharmacologic interventions used to reduce spasticity in children with cerebral palsy 3, 4
- Physical and occupational therapy, oral medications, botulinum toxin and/or phenol injections, intrathecal baclofen, selective dorsal rhizotomy, and orthopedic surgery are treatments that may be included in a comprehensive team evaluation 4
Motor Rehabilitation
- Evidence-based management and motor rehabilitation of children and adolescents with cerebral palsy should include individualized, age and developmentally appropriate activities, and goal-directed interventions 5
- Task-specific active approaches, such as mobility and gait training, cycling, backward gait, and treadmill, may improve gross motor function and gait, based on low-level evidence 5
- Non-invasive brain stimulation, virtual reality, action-observation therapy, hydrotherapy, and hippotherapy might be complementary to task or goal-oriented physical therapy programs 5