From the Guidelines
When teaching about cerebral palsy (CP) patients on rounds, emphasize the importance of early, accurate diagnosis and early intervention to maximize neuroplasticity and minimize deleterious modifications to muscle and bone growth and development, as supported by the highest quality evidence from 2017 1. The key teaching points for patients with cerebral palsy during rounds should include:
- The importance of a multidisciplinary approach to management, involving clinicians, therapists, and family members to address the complex needs of CP patients 1
- Early intervention using task-specific, motor training-based therapies, such as Goals-Activity-Motor Enrichment (GAME) and constraint-induced movement therapy (CIMT), to induce neuroplasticity and produce functional gains 1
- Spasticity management using medications like baclofen, diazepam, or dantrolene, as well as botulinum toxin injections and intrathecal baclofen pumps for severe cases 1
- Pain management, which is often undertreated in CP patients, and regular physical and occupational therapy to maintain function and prevent contractures 1
- Screening for common comorbidities, including seizures, intellectual disability, vision and hearing impairments, gastrointestinal issues, and nutritional challenges 1
- Growth monitoring and addressing feeding difficulties, which may require specialized feeding techniques or gastrostomy tubes in severe cases 1
- The importance of individualized care plans, focusing on maximizing function and quality of life rather than "curing" the condition, and promoting parent or caregiver coping and mental health 1 Some key points to emphasize include:
- The aim of early intervention should be to optimize motor, cognition, and communication outcomes, prevent secondary impairments, and promote parent or caregiver coping and mental health 1
- CP presents on a spectrum, and individualized care plans are essential to address the unique needs of each patient 1
- Regular surveillance and intervention can help prevent complications, such as hip displacement, contracture, and scoliosis, and improve long-term outcomes 1
From the Research
Key Teaching Points for Patients with Cerebral Palsy
- A multidisciplinary approach to care is essential for patients with cerebral palsy, addressing both physical and emotional needs 2, 3, 4
- Treatment options may include:
- Physiotherapy
- Occupational therapy
- Oral spasmolytic and antidystonic drugs
- Botulinum toxin injections
- Orthopedic procedures
- Continuous infusion of intrathecal baclofen (ITB)
- Selective dorsal rhizotomy (SDR)
- Selective peripheral neurotomy 3
- Palliative care plays a critical role in addressing the emotional, psychological, and social aspects of the patient's condition and providing family support, counseling, and guidance on managing the care burden 2
- Transitional care for patients with cerebral palsy is crucial as they navigate adulthood, and various models have been described, including transitional care clinics with multidisciplinary teams and facilitator-led transitional care 5
- Healthcare services for children with cerebral palsy and their families should be delivered using approaches such as family-centred care, the World Health Organisation's International Classification of Functioning, Disability and Health, and collaborative community-based primary care 6
- A comprehensive treatment plan should be implemented, including physical therapy, speech therapy, and pharmacological treatment, as well as non-pharmacological treatments such as neurodevelopmental therapy, biofeedback, and orthotic support 2