Physical Therapy and Cerebral Palsy


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Physical therapy is a broad study that goes far beyond the realms of the widely known sports therapist. P.T.’s, as they are commonly called, can specialize in areas that confine them to a clinic or hospital, or they can deliver care to patients in their own homes. Physical therapy and its association with Cerebral Palsy allows therapists to work in all of those fields. Cerebral Palsy requires activities and education to improve flexibility, strength, mobility and function in order to progress a child’s functionality. Therefore, a physical therapy program will consist of a number of exercises that will include stretching, strengthening, and positioning. Cerebral palsy is just one example of how physical therapy is changing lives; and it is also the most common seen in pediatric care.



CEREBRAL PALSY:
Cerebral Palsy refers to a group of chronic conditions that affect body movement and muscle coordination."Cerebral" means Brain and "palsy" refers to muscle weakness and poor control. Cerebral Palsy is the most common disability in children and is caused by damage to specific areas of the brain. Such damage could occur during fetal development or before or after birth (during infantry) and is not "curable" but physical therapy can aid in retaining function.

Cerebral Palsy does not refer to a specific disease, it covers individuals who are handicapped by motor disorders. Its association with other diseases of the nervous system is prevalent by the fact that approximately 30 percent of cerebral palsy patients have mental retardation of severe degree. Convulsive seizures occur in about 35 percent due to aggregated convulsion lesions or
abnormal changes in structure of an organ or part due to injury or disease
. The original lesion has to have occurred early in life for it to have an effect on growth and development.


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Some children may require sprints or braces to allow them to get around; while some may be confined to a wheelchair due to severe brain damage. Braces wrap around the ankles, legs, feet or back and provide stability where they lack it.

TYPES OF CEREBRAL PALSY



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Typical positions while on back

SPASTIC
This is the most common form of cerebral palsy. Almost 80% of cases are considered spastic and can be identified by their characteristic stiff, jerky movements. Patients tend to be tense and have contracted muscles making it difficult to change positions. Every day activities such as grasping and releasing an object are a struggle.




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ATHETOID
About 10% of children with cerebral palsy have athetoid cerebral palsy. Athetoid cerebral palsy is caused by damage to the cerebellum or basal ganglia. These areas of the brain are responsible for processing the signals that enable smooth, coordinated movements as well as maintaining body posture.
A child will develop involuntary movements that
often interfere with speaking, feeding, reaching, grasping, and other skills requiring coordinated movements. Constant, uncontrolled motion of limbs, head and eyes in addition to involuntary grimacing and tongue thrusting may lead to swallowing problems, drooling and slurred speech. The movements often increase during periods of emotional stress and disappear during sleep. In addition, children with athetoid cerebral palsy often have low muscle tone and have problems maintaining posture for sitting and walking.



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ATAXIC
Children with ataxic cerebral palsy have poor coordination of movement and low muscle tone making them appear highly unsteady and shaky. This form makes up 5-10% of all cases and leaves children with a poor sense of balance, often causing falls and stumbles.
Because of the shaky movements and problems coordinating their muscles, children with ataxic cerebral palsy may take longer than other children to complete certain tasks such and writing a sentence. They may also have a unusually wide gait causing them to walk unsteadily.






MIXED
These children have both the tight muscle tone of spastic cerbral palsy and the involuntary movements of athetoid cerebral palsy.
Spasticity is prevalent due to
injuries to both the pyramidal and extra pyramidal areas of the brain
; however, with growth involuntary movements progress. About 10% of children have some combination of forms of the disorder; yet the
most common mixed form includes spasticity and athetoid movements
.

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DEVELOPMENT OF CEREBRAL PALSY
English Doctor William J. Little was the first to study Cerebral Palsy in the 1800's. Little predicted that the unusual babies did not get enough oxygen when they were born. After observing several cases, Little was the first to realize that exercise might help the children. However, it wasn't until many years later in 1937 that Winthrop Phelps started the first clinic for cerebral palsy patients. The start of his clinic led to physical therapy being widely used to improve patients performance. In the clinic physical therapists show patients how to do exercises or even something as simple as sitting up or crawling could be a major feat. Later the patients will learn to climb stairs and walk with walkers before progressing to everyday tasks like using a fork, toothbrush, and pens. His ideas soon caught on and children with cerebral palsy everywhere were given the opportunity to live a more normal life.


PHYSICAL THERAPY FOR CEREBRAL PALSY PATIENTS
Physical Therapy will include tasks and education to improve flexibility, strength, mobility and function. Through a series of stretches, strengthening work, and positioning, a patient will learn basic functions that will improve their lifestyle.

STRETCHING:
Cerebral Palsy patients tend to have increased muscle tone leading
to generally tight muscles. shanghai-cerebral-palsy-5.jpgStretching helps keep the child limber
so they can perform everyday tasks. To stretch the muscles, the arms
and legs must be moved in ways that produce a slow, steady pull on the muscles to keep them loose.

STRENGTHENING:
Therapists will work specific muscle groups to enable them to support the body better and increase function. A new technique for physical therapy is aquatic work. Water can help resist or assist in the performance of an exercise and also works on lengthening and stretching muscles by the mere force of gravity and suspension.

POSITIONING:
Braces, abduction pillows, knee immobilizers wheelchair inserts, sitting recommendations, and handling techniques are all ways of positioning a patient. Such techniques require the body to be placed in a specific position to attain long stretches and can help eliminate unwanted tone due to hyperactive muscles. This is potentially the most important aspect of therapy because it enables the body to do tasks it is being asked to perform. The ultimate goal of therapy is to make the patient more independent.

BIBLIOGRAPHY
Types of Cerebral Palsy
Treatment of Cerebral Palsy
Physical Therapy for Cerebral Palsy
Cerebral Palsy
Towbin, Abraham. The Pathology of Cerebral Palsy. Springfield, Illinois:Charles C Thomas, 1960.13-22.
Crothers, Bronson. The Natural HIstory of Cerebral Palsy. Cambridge, Massachusetts: Harvard University Press, 1959. 7-41.
Pimm, Paul. Living with Cerebral Palsy. Austin, Texas: Raintree Steck-Vaughn Publishers, 2000. 1-32.
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