Management of cerebral palsy in children

The management of cerebral palsy is a two-pronged approach, and is provided by a variety of multidisciplinary services with a focus on maximising individual function, choice and independence (1,2)

• the first of these is optimising movement and posture while minimising potential secondary musculoskeletal deformity
  
  
• the second aspect of management is recognising and intervening to address the many developmental and clinical comorbidities that are associated with cerebral palsy

The management of children with cerebral palsy is based on a multi-disciplinary approach because of the multiple problems that may afflict the patients with this condition.

• physiotherapy, which aims to encourage normal motor development, to inhibit abnormal motor development and to prevent contractures. Parents are taught how to perform these exercises with their children at home
  
  
• botulinum toxin therapy in cerebral palsy:
  • a systemic review concluded that there is "..limited evidence that Botulinum toxin type A (BoNT-A) is more effective than placebo or a non-placebo control at improving gait, joint range of motion, satisfaction, and lower limb spasticity in children with CP, whereas the results for function were contradictory.
    
  • The rate of adverse events with BoNT-A is similar to placebo. BoNT-A is not more effective than ankle serial casting to treat ankle contractures for any of the assessed outcomes, but is more effective than orthotics at improving range of motion and spasticity.." (3)
    
    
• learning disabilities: about 50% of children have a learning disability (2). Note that many children with severe cerebral palsy have normal intelligence, particularly in dyskinetic cerebral palsy
  
  
• neurologic problems:
  • epilepsy occurs in 20-40%; it is most common among the hemi- and tetraplegics (4)
  • visual impairment occurs in about 20% due to errors of refraction, diffuse amblyopia or optic atrophy
  • hearing loss - about 20% of patients have a degree of hearing loss, usually sensorineural. There is a strong association between dyskinetic cerebral palsy and the development of deafness
  • a high incidence of speech disorders among patients with cerebral palsy, due to problems of incoordination of tongue, palate and lip muscles, as well as a result of hearing losses or perceptual defects
    
    
• speech therapy to help with drooling, speech or communication with sign
  
  
• occupational therapy to address problems such as dressing and adaptation of the home environment

Reference:

• NICE (January 2017). Cerebral palsy in under 25s: assessment and management (NG62)
• https://www.nhs.uk/conditions/cerebral-palsy/symptoms/ (accessed December 10th 2017)
• Blumetti FC et al. Botulinum toxin type A in the treatment of lower limb spasticity in children with cerebral palsy. Cochrane Database Syst Reviews 08 October 2019
• Odding E et al. The epidemiology of cerebral palsy: incidence, impairments and risk factors.Disabil Rehabil. 2006 Feb 28;28(4):183-91.