Cerebral palsy is a condition that affects an infant’s developing brain causing potential movement disorders and affecting the development and maturation of different systems such as sensory, behavioural, social or emotional. It is classified according to distribution: hemiplegia (one sided weakness), diplegia (legs more affected than the arms) or quadriplegia (both arms and legs affected) as well as type: spastic (tightness and resistance to movement), dyskinesia (too much movement), ataxia (decreased coordination of movement and balance) or hypotonia (low tone or floppiness).
The damage does not worsen with age but the child’s condition is seen to differ or worsen as they grow, particularly during adolescence and early adulthood. Every child will move as much as possible and in any way possible, but a child with cerebral palsy may not choose the most efficient movement or may move with minimal variety. This atypical movement will help movement initially but may hinder reaching later milestones.
Neurodevelopmental therapy (NDT) can assist both children and adults with cerebral palsy. The brain is an amazing organ that can respond, adapt and change to the environment and experiences. It is important to start therapy for your child as soon as possible so that typical movement sequences can be reinforced and your child can be stimulated in the most appropriate way so that they gain milestones timeously, become more independent and reach their potential, whilst looking to the future and trying to prevent later complications.
Physiotherapy focuses on:
- The child as part of a family unit. The caregivers and significant others are key in any child’s development and should be involved in decision making, goal setting, therapy sessions and stimulation at home. It is often beneficial to become part of a Cerebral Palsy Support Group to connect with other families in similar situations for emotional support and friendship.
- Short and long term goals are set with the aid of family members, and the child if possible, to direct therapy sessions to a goal or functional gain that is both relevant and measurable.
- All therapy is done on the background of normal development and how a child reaches different milestones such as sitting, rolling and walking. NDT looks at what is needed to do these activities and to progress onto the next stage. We assess your child and how they move, seeing if specific movement or muscle activity is lacking, how your child may compensate to complete a task and how will this affect later milestones. Therapy will then focus on key areas specific to your child.
- Training on 24 hour management of your child such as carrying, bathing, nappy changes, sleeping positions and play ensures carry over through the day to optimise independence and decrease problems such as muscle tightness or shortening.
- Hands on therapy assists your child to use more typical patterns of movement to assist with reaching milestones such as sitting, rolling, standing.
- Therapy focuses on play that is fun and age appropriate, including activities to stimulate your child to gain good trunk control which provides a stable base for any movement.
- Activities should be functional and aim to maintain optimal muscle length, improve muscle strength and coordination, assist with balance, stability as well as mobility.
- Assistive devices such as walking aids, foot or hand orthoses, may assist with gaining independence. Referrals for botox can be done and then we can do serial casting.
- Home visits in Roodepoort, Randburg
As a child grows, treatment shifts to maintaining their level of independence. Therapy is forward looking and attempts to foresee future problems before they arise so that these can be compensated for. Therapy for older children or adults reviews correct positioning, both for functioning and preventing problems. NDT helps your child to function with as little help as possible and to reach their potential. The child or adult with cerebral palsy must always be an active participant in therapy!
At Anne Knowles Physiotherapy, Rehabilita in Roodepoort, Johannesburg, we have some specialised equipment that could benefit you:
- Therapeutic electrical stimulation (Reduce pain and build muscle strength)
- Functional Electrical Stimulation (help you walk if you have muscle weakness in the lower legs)
- Theratrainer Active passive exercise bike (assist you to turn the pedals if you would otherwise not be able to cycle, you can either try and build up muscle strength or just let the bike do the work and get the benefits of your legs being moved and stretched). You can also use it for arm strengthening as it has upper limb attachments.
- Tilt Table (if you are wheelchair bound and would like to stand up, this piece of equipment will stand you up safely to get some weight through your legs with no effort required by the patient)
- Parallel bars (practice walking and balancing in a safe environment)