Treatment for Cerebral Palsy
Early diagnosis and prompt referral to cerebral palsy-specific early intervention is essential to optimize motor and cognitive plasticity, prevent secondary complications, and enhance quality of life for children with cerebral palsy. 1
Diagnostic Approach
Early diagnosis is crucial for effective treatment and involves:
- Before 5 months' corrected age: Term-age MRI (86-89% sensitivity), Prechtl Qualitative Assessment of General Movements (98% sensitivity), and Hammersmith Infant Neurological Examination (90% sensitivity) 1
- After 5 months' corrected age: MRI, Hammersmith Infant Neurological Examination, and Developmental Assessment of Young Children 1
- In low-resource settings: Hammersmith Infant Neurological Examination is recommended when MRI is unavailable 1
Motor Intervention
Motor therapy should be targeted to the specific type of cerebral palsy:
Spastic cerebral palsy (85-91% of cases):
- Pharmacological: Baclofen to reduce spasticity 2
- Physical therapy with child-initiated movement and task-specific practice 1
- For hemiplegia: Constraint-Induced Movement Therapy (CIMT) or bimanual therapy 1
- For diplegia: Learning Games Curriculum 1
- For all subtypes: Goal-Activity-Motor Enrichment (GAME) 1
Dyskinetic cerebral palsy (4-7% of cases):
- Specialized movement therapy
- Medication management for movement disorders
- Adaptive equipment 1
Ataxic cerebral palsy (4-6% of cases):
- Balance and coordination training
- Adaptive equipment 1
Prevention of Secondary Complications
Orthopedic Management
- Hip surveillance: Anteroposterior pelvic radiographs every 6-12 months starting at age 12 months 1
- Orthotic support for improved gait and prevention of contractures 2
- Regular monitoring for scoliosis and other musculoskeletal issues
Neurological Management
- Standard antiepileptic medications for seizures (affects 35% of patients) 1
- Pain management: Avoid procedural pain where possible, use preemptive analgesia for procedures, and appropriate pharmacological therapy for chronic pain (affects 75% of patients) 1
Gastrointestinal Management
- Comprehensive swallowing assessment if concerns exist (aspiration pneumonia is the leading cause of death) 1
- Regular weight monitoring due to risk of malnutrition with severe physical disability 1
- For sialorrhea (affects 20%): Botulinum toxin A, benztropine mesylate, or glycopyrrolate 1
Other Essential Interventions
- Sleep management: Sleep hygiene, parental education, spasticity management, melatonin (2.5-10 mg), or gabapentin (5 mg/kg) 1
- Bladder management: Medical investigations for anatomical abnormalities, extended toilet training 1
- Vision assessment and intervention (11% have functional blindness) 1
- Hearing accommodations (4% have hearing impairment) 1
Communication Intervention
- Speech language pathology to foster parent-infant communication 1
- For non-verbal children (25% of cases): Alternative and augmentative communication systems 1
- Programs such as Hanen It Takes Two to Talk and More Than Words 1
Psychological and Family Support
- Address emotional and psychological aspects through palliative care approaches 2
- Family support, counseling, and guidance on managing care burden 2
- Behavioral therapy for behavioral disorders (affects 26% of patients) 1
Multidisciplinary Approach
Treatment requires coordination between:
- Neurologists
- Physical and occupational therapists
- Speech-language pathologists
- Orthopedic specialists
- Psychologists
- Social workers
- Nutritionists
- Primary care providers 1, 2
Common Pitfalls to Avoid
- Delayed diagnosis leading to missed critical windows for neuroplasticity 1
- Focusing solely on motor symptoms while neglecting comorbidities
- Inadequate pain management leading to increased risk of neuropathic pain 1
- Failure to regularly monitor for hip displacement and other orthopedic complications 1
- Overlooking swallowing safety assessment, which can lead to aspiration pneumonia 1
- Neglecting the emotional and psychological needs of both the child and family 2
The treatment approach should be continuously updated as the child develops, with regular reassessment of goals and interventions to maximize functional independence and quality of life.