Baby lying down
  • CP

Cerebral Palsy

Cerebral Palsy (CP) refers to a group of conditions that results from abnormalities in the development of the fetal or infantile brain. These permanent, central motor dysfunctions affect muscle tone, posture, and movement. In some cases, they may interfere with sensation or perception, intellectual abilities, or communication and behavior. They can also be associated with seizure disorder or musculoskeletal complications.

What causes CP? It seems that prematurity and low birth weight are the biggest risk factors for the disease, but there isn’t a single causal factor. Several other suspected risk factors include:

  • Perinatal hypoxic-ischemic injury: This is where blood flow going to the fetus is decreased, resulting in a lack of oxygen to the brain.
  • Congenital abnormalities of the central nervous system: The cause of this is largely unknown, but developmental abnormalities can result from radiation exposure, toxins, or infections during critical periods of gestation.
  • Genetic susceptibility: Newer genomic technology is showing that there may be a genetic component of cerebral palsy.
  • Multiple birth.
  • Stroke during the perinatal period.
  • Intrauterine infection: cytomegalovirus, syphilis, Zika virus, varicella, or toxoplasmosis. Bacterial infections may also play a role.
  • Postnatal trauma, infections, or hyperbilirubinemia.

In some cases, no identifiable cause is to be found. CP is usually diagnosed at 18-24 months based on neurobehavioral signs, developmental reflexes, and motor tone and posture. CP presents differently depending on the specific area of the brain that is affected and although CP does not get worse over time, it may change presentation as the brain grows and develops.

CP is usually diagnosed at 18-24 months based on neurobehavioral signs, developmental reflexes, and motor tone and posture.

Conventional Treatment

Treatment and management of CP is directed towards optimizing social development, communication, education, nutrition, mobility, and independence in activities of daily living. A multidisciplinary team is required to address the multiple needs of a child with CP. Medications or surgery may be used to manage physical manifestations.

Botulinum toxin, (Botox), Benzodiazepines, Dantrolene, or Baclofen are the primary drugs used to treat muscle spasticity or hypertonia. A procedure called Selective Dorsal Rhizotomy is the primary surgical treatment for spasticity. It involves dividing parts of the spinal cord roots, and may provide only a small gain in function. Muscle-tendon release surgery is an option for fixed contractures.​

Physical therapy and feeding management are an integral part of treatment. This involves the expertise of specialized healthcare professionals to assist with mobility, swallowing, and to ensure adequate nutrition. Gastrostomy feeding may be required to improve nutritional status and to reduce swallowing risks. Pharmaceutical or surgical intervention may be used to reduce drooling. Most children with CP are expected to survive into adulthood and life expectancy depends on the degree of disability. Survival of high functioning adults is similar to the general population.

Support

At The Brain Possible, our goal is to empower you to take a holistic approach to your child’s treatment. Below are ways in which you can support several aspects of your child’s recovery; before embarking on any, be sure to discuss them with your trusted health care providers.

Physical

A procedure called selective dorsal rhizotomy (SDR) is the primary surgical treatment for spasticity. It involves dividing parts of the spinal cord roots, and may provide only a small gain in function. Muscle-tendon release surgery is an option for fixed contractures. Orthopedic surgery can also be beneficial to reduce bone and joint pain.

Physical and occupational therapy and feeding management are integral parts of most CP treatment plans. Physical and occupational therapy can assist with mobility, swallowing, and to ensure adequate nutrition. Surgical intervention may be used to reduce drooling.

Therapies such as craniosacral, which regulates the flow of cerebrospinal fluid, myofascial release, which helps release tissue trauma, and scalp acupuncture, which encourages the flow of energy through meridians in the head and body, have helped children with CP experience greater ease, coordination and relaxation. Chiropractic treatment, which uses spinal manipulation to increase joint mobility and the flow of cerebrospinal fluid (CSF), has helped children with CP improve flexibility and experience pain relief. 

Emotional/Social

Cerebral palsy can exact a great emotional toll on children and their caregivers. Children may be bullied at school for their differences, and they may feel self-consciousness and shame because of their physical inability to keep pace with their peers. Additionally, because the condition exacts a toll on caregivers who must provide help with mobility and feeding, parents of children with CP can find their emotional resources strained. Individual and family counseling as well as support groups can be very beneficial for all family members. 

Children with CP have found emotional comfort in canine therapy and equine-assisted or hippotherapy, which can help them regulate their emotions and experience trust and closeness as they form bonds with animals and their therapeutic helpers.

Sensory

Cerebral palsy can cause extensive issues with disordered sensory processing. Children may be hyper- or under sensitive to sensory stimulation. Hearing, sight, taste, touch, smell, proprioception (sensing one’s body in space) and vestibular processing (balance and equilibrium) may all be impacted. 

Sensory integration therapies, such as the Wilbarger Protocol and Floortime, may include games, puzzles, and personal care or household tasks that help children regulate their states of sensory arousal. They also aid in building neuronal pathways for better integration of sensory input from multiple sources. Hydrotherapy, which uses water as a setting for occupational therapy and/or as a means of transferring heat or cold to the body, can also help with relaxation and neurological integration of sensory experiences. Additionally, olfactory and gustatory therapy strengthens children’s senses of taste and smell. These senses activate the brain’s hippocampus, which is where memory resides. These therapies, which can involve repeated timed sessions of experiencing a range of tastes and smells, are thought to help children strengthen memory and decrease impulsivity. Masgutova NeuroSensory Reflex Integration (MNRI) focuses on the integration of neuro physical reflexes that may have been missed in normal development, aiding in improved cognitive, physical and emotional functioning. In Napa suit therapy, (also called intensive suit therapy) children wear an orthotic suit fitted with adjustable straps and cords that can be manipulated to apply pressure on joints and muscle groups that need additional support. 

Intellectual

 Approximately half of those with CP have some variety of intellectual impairment. Those without intellectual impairment, however, may still struggle at school due to teachers and other students underestimating them due to their physical differences (which may include disordered speech). They may also struggle with the fine motor skills needed for writing and drawing, and they may not be able to complete assignments as quickly as others due to their physical challenges. 

Educational therapists, occupational therapists and learning specialists can help a child with CP find the right learning tools and accomodations, such as voice-activated word processing programs, large text readers and extra test-taking time. In addition, the Perceptual Enrichment Program is a short-term cognitive intervention that can help children with CP learn time-management and problem-solving skills. Brain Gym is another program used with CP kids. It is a series of exercises to help cognitive functioning. The exercises, which can be done at home, are thought to help children meet neurological milestones they may have skipped in their development.

Nutritional/Environmental

Meal time can present enormous challenges for children with CP.  

Gastrostomy feeding may be required for children who have difficulty swallowing and/or are unable to eat and drink their required calories each day. In gastronomy feeding (also called g-tube) a tube is surgically inserted to port formula, liquids and pureed foods directly into the stomach. 

May children with CP have different caloric needs - either fewer or more - than other children their age due to their amount of muscle tone. It is recommended that a family work with their occupational therapist and a nutritionist to determine their child’s dietary needs and restrictions.  Children with CP may benefit from supplements of vitamin D, calcium, and phosphorus for bone health and additional protein for tissue repair. 

The Ketogenic Diet is a high-fat diet that changes the brain metabolism and has been reported to help control seizures of children with CP.  Parents have also reported success with the Nemechek Protocol. The Nemechek Protocol inhibits bacterial overgrowth in the gut which has been linked to reduction of inflammation in the brain. 

Physiological

Botulinum toxin (BOTOX™), benzodiazepines, dantrolene, or baclofen are the primary drugs used to treat muscle spasticity or hypertonia. Homeopathy, which uses doses of plant and mineral essences to target symptoms, has been reported to reduce seizures and improve mobility in some children with CP. Cannabis therapy is one of the most promising new treatments to combat pain and other symptoms of CP. CBD oil has been shown to reduce seizures, and many states permit the use of medical marijuana to reduce spasticity. In laser reflex integration, cold lasers increase the amount of adenosine triphosphate (ATP) in cells, thereby stimulating the mitochondria and encouraging nervous system repair. Laser light therapy can improve muscle tone in children with CP and  promising studies have shown that stem cell therapy can reduce spasticity and improve mobility and bladder function. 

We understand that the categorization of conditions on The Brain Possible may not perfectly describe your child.

Our goal is inclusivity, opening the door to dialogue and information sharing.