Cerebral palsy

Diagnosis

Cerebral palsy symptoms and signs can worsen over time, thus a diagnosis may not be obtained for few months to a year after birth. When the symptoms and indicators are minor, the diagnosis may take longer to come.

If there is a suspicion of cerebral palsy, your child’s family doctor or pediatrician will evaluate your child’s symptoms, monitor their growth and development, review their medical history, and conduct a physical examination. Depending on the assessment, the doctor may refer you to a pediatric neurologist, a pediatric physical medicine and rehabilitation specialist, or a child developmental specialist. These professionals are experienced in treating children with neurological and developmental disorders.

To confirm a diagnosis and exclude other possible causes, your doctor may also order a series of tests.

Brain scans

Technologies for brain imaging can show where the brain is damaged or developing abnormally. These examinations could involve the following:

• Magnetic Resonance Imaging (MRI). An MRI creates finely detailed 3D or cross-sectional images of the brain using radio waves and a magnetic field. Your child’s brain lesions or other abnormalities can frequently be found with an MRI. It takes up to an hour to complete this painless but noisy test. A sedative or mild general anesthetic will probably be administered to your youngster beforehand.
• Cranial ultrasound. This can be done in an infancy period. High-frequency sound waves are used in cranial ultrasonography to create images of the brain. Although an ultrasound doesn’t produce a detailed image, it may still be used because it is quick and can offer a useful initial evaluation of the brain.

Electroencephalogram (EEG)

An EEG can further assess the disease if seizures are detected in your child. Children with epilepsy may experience seizures. A number of electrodes are fastened to your child’s scalp during the EEG test. The electrical activity of your child’s brain is captured by the EEG. Changes in the typical brain wave patterns are frequent in epilepsy.

Laboratory examination

Blood, urine, or skin tests may be done to check for genetic or metabolic issues.

Additional tests

After receiving a cerebral palsy diagnosis, your kid will probably be tested by specialists to rule out other disorders that are frequently linked to the disorder. These examinations can reveal issues with:

• Vision
• Hearing
• Speech
• Intellect
• Development
• Movement
• Other medical problems

Although multiple movement disorders can coexist, the primary movement disorder experienced determines the type of cerebral palsy. Spastic cerebral palsy is the most prevalent kind and is characterized by rigid muscles and hyperactive reflexes. Other forms of cerebral palsy include dyskinetic (difficulty coordinating voluntary muscles) and ataxic (poor balance and coordination) movement problems.

Your doctor may use a rating scale tool, such as the Gross Motor Function Classification System, to assess the function and severity of movement, posture, and balance after diagnosing you with cerebral palsy. Making treatment decisions may be aided by this knowledge.

Treatment

Cerebral palsy may require lifelong care from a medical care team for both children and adults. The team may include a number of therapists and mental health professionals, in addition to a pediatrician, physical medicine and rehabilitation expert (physiatrist), and a pediatric neurologist to manage your child’s medical care. These specialists can collaborate with your main physician and pay particular attention to requirements and problems that are more prevalent among people with cerebral palsy. You can create a treatment strategy jointly.

The condition cerebral palsy is incurable. However, there are numerous treatment options that may help your child function better on a daily basis. The type of care chosen will depend on the individual’s particular symptoms and needs, which may change over time. Results can be improved with early intervention.

There are various options for treating cerebral palsy, including medication, therapy, surgery, and other forms of treatment.

Medications

Medications that can alleviate muscle stiffness may be prescribed to manage the consequences associated with spasticity or other symptoms of cerebral palsy. These medications aim to improve functional abilities and reduce pain.

• Muscle or nerve injections. Your doctor might suggest Botox or similar medication injections to alleviate tightness in a particular muscle. It will be necessary to repeat the injections every three months or so.

Pain at the injection site and flu-like symptoms are possible side effects. Breathing and swallowing issues are among the more serious adverse effects.

• Oral muscle relaxants. Muscle-relaxing medications include baclofen, tizanidine, diazepam, and dantrolene.

Baclofen may occasionally be injected intrathecally, or directly into the spinal cord. The pump is surgically inserted beneath the abdominal skin.

• Medications to reduce drooling. One approach involves injecting Botox into the salivary glands.

Discuss the advantages, disadvantages, and potential adverse effects of the prescription drug alternatives with your doctor.

Therapies

The following therapies are significant in the treatment of cerebral palsy:

• Physical therapy. Your child’s strength, flexibility, balance, motor development, and mobility can all benefit from muscle building exercises and training. You’ll learn how to feed and bathe your child securely as well as how to take care of their other basic needs at home. You can continue working out at home in between therapy sessions with the help of your therapist.

Physical and occupational therapists focus on issues like head and trunk control, rolling, and gripping for the first one to two years following birth. Later, wheelchair assessments are performed by both varieties of therapists.

Your child may need braces, splints, or other supportive devices to help with function, such as better walking, and to stretch tight muscles.

• Occupational therapy. A child’s independence in daily tasks and routines at home, school, and in the community is the goal of occupational therapy. You may be advised to get your child walkers, canes with wide bases, standing and seating aids, or electric wheelchairs.
• Speech and language therapy. The capacity of your child to speak coherently or use sign language can be improved with the aid of speech-language pathologists. If communication is a problem, they can also teach how to use tools like a computer and a voice synthesizer. Speech therapists can help with issues with swallowing and eating.
• Recreational therapy. Some kids gain advantages from participating in competitive or adaptive sports, such therapeutic skiing or horseback riding. The motor, speech, and emotional development of your child can all be helped by this kind of therapy. Regular physical activity and exercise are beneficial for both adults and children’s overall health and fitness.

Surgical procedures

Surgery might be required to treat bone abnormalities brought on by spasticity or to alleviate muscular tightness. These remedies consist of:

• Orthopedic surgery. Surgery on bones or joints may be necessary for children with severe contractures or abnormalities in order to realign their arms, spines, hips, or legs. Additionally, muscles and tendons that have been shortened by contractures can be lengthened or repositioned through surgical procedures. These adjustments can reduce pain and increase mobility. The operations may also make it simpler to utilize crutches, a walker, or other aids.
• Cutting nerve fibers (selective dorsal rhizotomy). When other treatments have failed to control severe cases of spasticity, a surgical procedure called selective dorsal rhizotomy is frequently employed. By relaxing the muscles in the legs, this reduces discomfort, but it could also make you feel numb.

Other treatments

For epilepsy, pain, osteoporosis, mental health concerns, issues with sleep, oral health, food and nutrition, bladder incontinence, vision, or hearing, drugs and other therapies may be prescribed as needed.

Adults with cerebral palsy

The health care requirements for your grown up child with cerebral palsy may change as they age. Regular health care includes examination and treatment for conditions that are particularly common in people with cerebral palsy in addition to the general health exams that are advised for all adults. These may consist of:

• Problems with eyesight and hearing
• Treatment for epilepsy (seizure)
• Pain and exhaustion management
• Preservation of muscular tone
• Orthopedic issues include osteoporosis, arthritis, and contractures
• Mental health conditions like depression
• Problems with the teeth
• Lung and heart issues