What are the management options for cerebral palsy?

Management Options for Cerebral Palsy

Early diagnosis and prompt referral to cerebral palsy-specific interventions are essential to optimize motor and cognitive outcomes, prevent secondary complications, and enhance caregiver well-being in patients with cerebral palsy. 1

Early Interventions to Optimize Motor, Cognition, and Communication Skills

• Physical and occupational therapy interventions should use child-initiated movement, task-specific practice, and environmental adaptations that stimulate independent task performance 1
• Specific evidence-based interventions include:
  • Learning Games Curriculum for children with diplegia 1
  • Constraint-induced movement therapy (CIMT) or bimanual therapy for children with hemiplegia 1
  • Goals-Activity-Motor Enrichment (GAME) for all subtypes of cerebral palsy 1
• Speech language pathology interventions should foster parent-infant transactions and provide compensation when speech is not possible or inadequate 1
  • Examples include the Hanen It Takes Two to Talk and More Than Words programs 1
  • Alternative and augmentative communication should be implemented when needed 1

Prevention and Management of Secondary Impairments

Pain Management

• Procedural pain should be avoided where possible as untreated pain elevates risk for long-term neuropathic pain 1
• Use pharmacological therapy and environmental interventions for ongoing pain 1
• Implement preemptive analgesia for procedural pain 1

Orthopedic Management

• Conduct anteroposterior pelvic radiographs every 6-12 months starting at age 12 months to monitor for hip displacement 1
• Regular surveillance and intervention can lower rates of hip displacement, contracture, and scoliosis 1

Neurological Management

• Implement standard antiepileptic pharmacological management for seizures, which affect approximately 35% of patients 1, 2

Urinary Tract Management

• Conduct medical investigations for bladder issues as abnormal anatomical findings are common 1
• Provide standard toilet training over a longer duration as control may take longer 1

Sleep Management

• Conduct specialist assessments and early treatment before secondary academic and behavioral problems emerge 1
• Interventions include sleep hygiene, parental education, spasticity management, melatonin (2.5-10 mg), and gabapentin (5 mg/kg) 1

Oral Care

• For sialorrhea (affects 1 in 5 patients), consider botulinum toxin A, benztropine mesylate, or glycopyrrolate 1, 2

Vision and Hearing

• Assess vision in the first 48 hours of life using early assessment tools 1
• Provide vision intervention for infants with abnormal vision at term-equivalent age and reassess at 3 months 1
• Implement standard early hearing accommodations for hearing impairment 1

Feeding and Nutrition

• Comprehensively assess swallowing safety if concerns or clinical history of pneumonia exists 1
• Consider tube feeding if indicated, as aspiration pneumonia is the leading cause of death in individuals with cerebral palsy 1
• Monitor weight regularly as severe physical disability elevates risk for malnutrition 1

Multidisciplinary Team Approach

• Management requires coordination between physicians, rehabilitation therapists, educators, nurses, and social care providers 3, 4
• Rehabilitation should focus on neurological rehabilitation that capitalizes on neuroplasticity 4
• Regular monitoring for comorbidities is essential as 75% have chronic pain, 49% have intellectual disability, and 26% have behavioral disorders 2

Functional Outcomes and Prognosis

• In high-income countries, approximately 2 in 3 individuals with cerebral palsy will walk 1, 2
• About 3 in 4 will develop speech 1, 2
• Approximately 1 in 2 will have normal intelligence 1, 2
• Mortality risk increases incrementally with increasing number of impairments 5

Transition to Adult Care

• As life expectancy approaches that of the general population, therapies must address the needs of adults aging with disability 4
• Return to work may be facilitated by cognitive or vocational rehabilitation 1
• Driving ability is often linked to cognitive function, particularly attention and executive function 1

By implementing these evidence-based interventions early and consistently, clinicians can significantly improve outcomes for patients with cerebral palsy across their lifespan.