From the Guidelines
Cerebral palsy is a non-progressive neurological disorder that can be complicated by premature aging and abiotrophy, and management should focus on minimizing these effects through regular physical therapy, pain management, and assistive devices, as well as maintaining physical activity, proper nutrition, and preventive healthcare. As people with cerebral palsy age, they often experience accelerated aging processes beginning in their 30s and 40s, including increased pain, fatigue, joint degeneration, and decreased mobility 1. This premature aging occurs because the underlying neurological damage in CP causes abnormal muscle tone and movement patterns that place excessive stress on the musculoskeletal system over time. Abiotrophy in cerebral palsy refers to the gradual deterioration of muscles, joints, and other tissues that weren't initially affected by the brain injury but degenerate due to years of compensatory movements and abnormal biomechanical stresses.
Key Considerations
- Cerebral palsy is a clinical diagnosis defined as “a group of permanent disorders of the development of movement and posture, causing activity limitations that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain” 1
- Alterations in muscle tone, posture, and/or movement are noted in the first years of life as a consequence of altered brain development, following a permanent and nonprogressive clinical course that often coexists with other neurodevelopmental disorders (NDDs) 1
- Comorbidities and functional limitations are common and disabling, including chronic pain, epilepsy, intellectual disability, musculoskeletal problems, behavioral disorders, sleep disorders, functional blindness, and hearing impairment 1
Management and Intervention
- Early intervention with a multidisciplinary approach including physiatrists, physical therapists, and occupational therapists can help preserve function and quality of life as the person with CP ages 1
- Task-specific, motor training-based early intervention (e.g., Goals-Activity-Motor Enrichment (GAME) and constraint-induced movement therapy (CIMT)) are recommended as the new paradigm of care for cerebral palsy because they induce neuroplasticity and produce functional gains 1
- Regular physical therapy (3-5 sessions weekly), pain management with medications like baclofen (10-25mg three times daily) or tizanidine (2-4mg as needed), and assistive devices that should be reassessed annually are essential components of management 1
Quality of Life and Morbidity
- Maintaining physical activity within tolerance levels, proper nutrition, and preventive healthcare are essential to minimize the aging effects and improve quality of life in individuals with cerebral palsy 1
- Early diagnosis and intervention can help reduce the risk of secondary impairments and minimize the influence of complications that worsen function or interfere with learning 1
From the Research
Cerebral Palsy and Abiotrophy
- Cerebral palsy is a group of permanent, but not unchanging, disorders of movement and/or posture and motor function, which are due to a non-progressive interference, lesion, or abnormality of the developing/immature brain 2.
- Although cerebral palsy is, by definition, a 'static encephalopathy' the associated musculoskeletal pathology is progressive 3.
Aging and Cerebral Palsy
- There is limited information available on the effects of aging on cerebral palsy, however, it is known that the associated musculoskeletal pathology is progressive 3.
- As individuals with cerebral palsy age, they may experience a decline in physical function and an increase in secondary health conditions, such as musculoskeletal pain and contractures.
Abiotrophy and Cerebral Palsy
- Abiotrophy refers to the progressive degeneration of tissues or organs, and in the context of cerebral palsy, it may refer to the progressive musculoskeletal pathology associated with the condition 3.
- The management of spasticity in cerebral palsy is crucial to prevent or delay the onset of abiotrophy, and may include pharmacological and non-pharmacological treatments, such as physical therapy, occupational therapy, orthotics, rhizotomy, and orthopedic surgery 4.
Treatment of Spasticity in Cerebral Palsy
- Botulinum toxin type A is a commonly used treatment for spasticity in cerebral palsy, and has been shown to be effective in reducing spasticity and improving functional outcomes 2, 5.
- Intrathecal baclofen infusion is also a effective treatment for spasticity in cerebral palsy, and may be used in combination with botulinum toxin type A 2, 6.
- The choice of treatment for spasticity in cerebral palsy depends on the individual's specific needs and circumstances, and may involve a multidisciplinary approach.