Following your child's interdisciplinary assessment, the professionals providing care for your child will develop recommendations for his or her treatment. Many treatments are available to help a child function at the highest level possible. Although many treatments are available, we will touch upon a few of the most basic approaches used today to help a child achieve their optimal level of functioning.
Since no two children are affected by cerebral palsy in exactly the same way, individual treatment programs vary widely. But because all children with cerebral palsy have movement problems, you can expect that an important component of your child's treatment will be a therapeutic exercise program. Depending on your child's needs, a physical therapist, an occupational therapist, and a speech-language pathologist will work with your child to help him or her improve posture and movement.
At first, your child will likely see his or her therapist quite often, sometimes at least twice a week. As your child grows, he or she may need a less intensive program. The therapists will probably expect you to work on the child's movement skills at home, and will train you in special exercises and handling techniques. Because the time commitment to a therapy program is tremendous, it is wise for both parents, or other caretakers, to be involved. In general, it is considered very early intervention if a baby begins therapy before six months of age. Most infants are not referred until later in the first year or sometime in the second year of life. Of course, the age at which your child is referred will depend to some extent on how quickly the physicians diagnose cerebral palsy, or other problems requiring therapy. Researchers are still studying the long term benefits therapy can offer. But it is generally agreed that children who receive good treatment not only have fewer movement limitations, but also have better postures, better muscle development, and better abilities in toileting, feeding, and dressing themselves. Furthermore, therapy programs enrich children's lives by enabling them to explore and experience activities that they might not otherwise be able to do independently.
Physical Therapy
A physical therapist specializes in improving the development of the large muscles of the body, such as those in the legs, arms and abdomen (gross motor skills). Physical therapists help children learn better ways to move and balance. They may help children with cerebral palsy learn to walk, use a wheelchair, stand by themselves, or go up and down stairs safely. Physical therapists will also work on fun skills such as running, kicking and throwing, or learning to ride a bike. Physical therapy usually begins in the first few years of life, or soon after the diagnosis of cerebral palsy is made. These therapists use specific sets of exercises to work toward the prevention of musculoskeletal complications. An example of this is preventing the weakening or deterioration of muscles that can develop with lack of use. Also, physical therapy will help avoid contractures, in which muscles become fixed in a rigid, abnormal position. Physical therapy will help prevent muskuloskeletal problems, as well as helping your child perform common everyday activities.
Occupational Therapy
An occupational therapist specializes in improving the development of the small muscles of the body, such as the hands, feet, face, fingers and toes. These therapists also teach daily living skills such as dressing and eating, as well as making sure children are properly positioned in wheelchairs. They may teach your child better or easier ways to write, draw, cut with scissors, brush their teeth, dress, and feed themselves. Occupational therapists will also help your child find the right special equipment to make everyday jobs a little easier.
Speech / Language Therapist
A speech and language therapist helps develop better control of the jaw and mouth muscles, which can improve speech and language skills and eating abilities. They also help develop creative communication methods for those who can not speak. A speech and language therapist will work with your child on communication skills. This means talking, using sign language, or using a communication aid. Children who are able to talk may work with a speech therapist on making their speech clearer, or on building their language skills by learning new words, learning to speak in sentences, or improving their listening skills. Children who can not talk may learn sign language, or how to use special equipment such as a computer that actually talks for you.
Surgery
Surgery is not always necessary, but it is sometimes recommended to improve muscle development, correct contractures, and reduce spasticity in the legs. Before selecting any surgical procedure, make sure the doctor thoroughly discusses the risks involved, long-term effects and postoperative follow-up. Also, always get a second opinion and speak with other parents whose children have had the same surgical procedure.
Children with cerebral palsy often walk on their toes. This may indicate a tight heel cord. When other treatments for this fail, such as splints and braces, surgery may help correct it by lengthening the tendon. This surgery may help improve the child's ability to walk, improve balance, and prevent further deformity. Surgery is also available to relieve spacticity in the legs and hips of children. This surgery involves identifying sensory nerve fibers being the spinal cord, and then selectively cutting those nerve fibers therefor reducing spacticity. Research on this surgery is still being conducted. The adductors are muscle groups that bring the legs together. If a child's physician determines that the adductors are causing deformities or problems with walking, he or she may suggest a surgical procedure to cut the tendon, which can release muscle contractures and improve mobility. Again, surgery may not always be necessary, but in many instances it can help your child achieve his or her optimal level of functioning.
Drug Therapy
Your child's doctor may prescribe drugs to prevent or control seizures associated with cerebral palsy. These drugs are very effective in preventing seizures in many children. Because there are different types of seizures, different drugs may be prescribed because no one drug prevents or controls all types of seizures. Such drugs may include Tegretol, Dilantin and Phenobarbital. Drug therapy can also help reduce spacticity associated with cerebral palsy. These drugs include Diazepam, Baclofen, and Dantrolene. If surgery is contradicted, these drugs can help reduce spacticity for short periods, however, their long term value is still being researched. Although drug therapy may not completely correct complications associated with cerebral palsy, evidence does show that it helps manage problems such as seizures and spactisity. Consult with a physician to find out if drug therapy is appropriate for your child.
Sensory Integration Therapy
One other approach to help children with cerebral palsy achieve their optimal level of functioning is Sensory Integration Therapy. This therapy helps to overcome problems experienced by many young children in absorbing and processing sensory information. Encouraging these abilities ultimately improves balance and steady movement. Therapies include stimulating touch sensations and pressures on different parts of the body. With the use of certain items, such as Styrofoam chips, water, or textured toys, this therapy will also motivate children to learn sequences of movements.
Adaptive Equipment
Special equipment is also available for children with cerebral palsy. Because of the muscle problems children with cerebral palsy have, your child's doctor or therapist may recommend that they use some special equipment to help them get around or do everyday activities.
A Wheelchair is sometimes used when a child cannot walk. This will allow the child to move from one place to another. Many children with cerebral palsy can use their arms to roll the wheels of their wheelchair themselves, and can move around without much difficulty at all. There are also wheelchairs available that are motorized. This type of wheelchair has a motor that moves the wheels for the child. There may be a joystick on one arm rest that the child can operate on his or her own.
A Walker is a piece of equipment usually made out of light metal. It most often will have four legs that are adjustable in height. Some children with cerebral palsy can walk, but have poor balance and may fall. They use a walker to help them balance and get around without the use of a wheelchair. You may also see a walker with wheels on it, as well as a basket to put some of the child's belongs in.
Because of the fine motor problems often associated with cerebral palsy, children may have a hard time using utensils for eating. Special handles or grips are available for children who have trouble holding onto small objects, such as a fork or spoon. You may also find eating utensils that are specially designed for children with fine motor problems. They may be curved or bent, and are usually designed to fit the child's needs. Special grips and handles are also used on pencils and pens to make them easier for the child to hold and use.
Communication Aids are available for children who are hard to understand, or who have difficulty talking with others. A communication aid might be a book or poster with pictures that show things the child might want, or an alphabet board that the person can use to spell out their message. There are also computers that are used as communication aids that actually talk for the child.
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