Understanding Cerebral Palsy
Cerebral Palsy refers to a group of neurological disorders that affect movement, muscle tone, coordination, and motor skills caused by damage or abnormalities in the developing brain. It is a non-progressive condition that arises out of damage to the brain tissue incurred during pregnancy, childbirth, or early infancy. 

Some children may even acquire Cerebral Palsy later on, as a result of an accident, neglect, or abuse.

Typical Cerebral Palsy symptoms include exaggerated and involuntary movements, rigid or floppy limbs, awkward gait, poor balance, partial paralysis, and difficulty with speaking and swallowing. Intellectual impairments, vision problems, and seizures are other symptoms that may also arise. 

There are several types of Cerebral Palsy depending on which part of the brain was damaged and the severity of the damage. For the same reason, the nature and extent of Cerebral Palsy symptoms tend to differ widely from patient to patient, although signs of physical impairment will likely be visible in all of them. 

Physiotherapy treatment for individuals with Cerebral Palsy
The earlier a patient commences Cerebral Palsy treatment, the better their results. The benefits of physiotherapy intervention for Cerebral Palsy are manifold, and can help improve mobility as well as physical development in young children, making it easier for them to walk, sit, and crawl. The sooner the patient starts a physiotherapy regime, the sooner motor problems can be addressed and prevented from getting worse. 

Physiotherapy for children with Cerebral Palsy will typically take the form of a customized plan to decrease muscle tightness, improve muscle mobility, and encourage physical development through daily activities and games. As the child grows up, they will still require intervention to enhance their functional abilities. Physiotherapy for adults with Cerebral Palsy usually focuses on minimising abnormal movement patterns, improving mobility and balance, improving sensory abilities, reducing muscle spasms, and enhancing the individual’s quality of life. For both adults and children, physiotherapy intervention for Cerebral Palsy aims to improve their physical, mental, and emotional well-being in different environments, both at home and outside.

The type of Cerebral Palsy treatment plan followed depends on how severe the patient’s Cerebral Palsy symptoms are. Some may only have mild tremors and muscle stiffness and can overcome symptoms with physiotherapy. Others may be more severely affected to the point of being unable to move. Such children will need lifelong care and assistive devices in addition to physiotherapy. 

There are several types of physiotherapy treatment approaches that can be incorporated into Cerebral Palsy treatment for children. Some of the commonly prescribed types include:

Neurodevelopmental treatment
Also known as the Bobath Approach, neurodevelopmental treatment (NDT) is a form of Cerebral Palsy treatment that was developed by Karl and Berta Bobath in the 1940s. Based on their own experiences with children who had Cerebral Palsy, the Bobaths postulated that motor abnormalities are a result of atypical development of the child’s reflexes and posture because of the underlying damage to the nervous system. NDT aims to enable typical motor development that will help the child function better. It also reduces the risk of secondary injuries, joint and limb deformities, and muscle contractures.

Electrical stimulation
An effective form of physiotherapy for children with Cerebral Palsy that increases motor function and muscle strength is through the application of electrical stimulation. It involves the use of a Transcutaneous Electrical Nerve Stimulation (TENS) Unit, which applies currents that stimulate muscle contraction. Neuromuscular electrical stimulation as a form of Cerebral Palsy treatment enhances muscle strength by recruiting the type 2 muscle fibers and increasing the muscle’s cross-sectional area. 

Another method is to use functional electrical stimulation, where the current is applied during a specific task to the muscle that is expected to contract during the performance of that task. Studies have shown that electrical stimulation is particularly effective for ambulatory diplegic children, who may have trouble with certain types of resistive strength training. 

Hippotherapy
As a form of physiotherapy for children with Cerebral Palsy, hippotherapy (therapeutic horse riding) can improve the child’s gross motor coordination, balance, coordination, and overall range of motion. Hippotherapy is also one of the most enjoyable Cerebral Palsy exercises for children and can have cognitive and emotional benefits. It involves guided horseback rides as well as sessions where the child pets and feeds the horse in a safe environment and in the presence of the horse trainer. 

Hippotherapy is usually recommended as part of a broader program of Cerebral Palsy treatment. It is important to talk to your child’s therapist about any special equipment that may be needed for therapy, such as a specific type of saddle.

Constraint-Induced Movement Therapy
This is a type of physiotherapy intervention for Cerebral Palsy that specifically helps patients with hemiplegic Cerebral Palsy to improve their muscle strength and range of motion in the affected upper limb(s). It involves immobilizing the non-affected limb during the exercise, so as to force the patient to use their other limb. It helps to address inequalities in limb and muscle development and thus enhances the patient’s overall speed and dexterity in completing tasks that require both hands. 

Reflex integration therapy
Reflexes are the neurological building blocks of all the daily activities that humans perform. Children with Cerebral Palsy often do not have these reflexes, and reflex integration therapy is the ideal physiotherapy intervention for Cerebral Palsy in this case. It can train the brain to perform essential cognitive and motor tasks through a structured pattern of hands-on Cerebral Palsy exercises for children that stimulate the appropriate nerve responses. These exercises are designed to enhance motor control, boost core strength and coordination, and help the nervous system ‘learn’ the expected reflex. 

Another option is called Quantum Reflex Integration, which uses sounds and cold lasers to target specific points on the child’s body and is an effective form of Cerebral Palsy treatment for repairing nerve damage. The therapist will design and modify the reflex integration therapy program based on how the child’s Cerebral Palsy symptoms are progressing.

Goals of physiotherapy intervention for Cerebral Palsy
In Cerebral Palsy, the damage to the central nervous system is non-progressive. However, the muscle degeneration arising out of improper use or non-use is progressive. The more a child practices ineffective and unequal movements through repetition, the less the synaptic connections that control those movements will be used. This could ultimately lead to those synaptic connections being pruned. 

However, early physiotherapy intervention for Cerebral Palsy can guide the child towards performing efficient, repetitive movements that involve both the lower and the upper extremities, and use both sides of the body equally. 

Cerebral Palsy exercises for children should be tailored to be appropriately challenging for their present level of physical and cognitive abilities. Children should also be encouraged to experience both wins and failures so that they keep trying and learning. 

The therapist should try to not assist the child too much, but encourage self-initiated movements. By engaging in a variety of task-oriented Cerebral Palsy exercises that cover a variety of environments (such as soft and hard surfaces) and postures (such as sitting, kneeling, and standing), the child’s brain can reinforce and strengthen the relevant neural connections that will enable them to perform daily activities with greater ease. 

Over time, physiotherapy for children with Cerebral Palsy can improve cardiovascular fitness, enhance muscle strength and control, improve the child’s range of motion and flexibility, and preserve joint and muscle health.

Benefits of physiotherapy for Cerebral Palsy
Physiotherapy plays a considerable role in easing Cerebral Palsy symptoms in children. Through a combination of exercise and assistive devices, children become stronger and more flexible overall and have a better sense of balance. They can also develop better stamina, posture, and coordination, and improve their general physical health. 

Moreover, children with Cerebral Palsy experience a significant increase in their confidence when they successfully perform daily tasks on their own. 

How physiotherapists assess patients for Cerebral Palsy
Prior to recommending Cerebral Palsy exercises to patients, the therapist will assess the patient to determine the current degree of spasticity and any musculoskeletal deformities that might be present. They will also check if the patient has any gait, balance or trunk impairment, along with their overall physical fitness. This is essential to determining which types of Cerebral Palsy exercises to focus on for maximum improvement. For instance, while physiotherapy is generally sufficient for mild cases of spasticity, in more severe cases the patient may need surgery or other kinds of medical interventions. 

There are several scales and benchmarks available to assess patients on different parameters of fitness and muscle function. 

A Cerebral Palsy physiotherapy assessment is crucial for children prior to starting any form of physiotherapy, to determine their current level of gross motor function. Many therapists will also assess infants with Cerebral Palsy symptoms to predict the kinds of motor impairment that are most likely to occur and accordingly begin early physiotherapy intervention for Cerebral Palsy

Exercises for Cerebral Palsy patients

Physiotherapists will recommend a variety of Cerebral Palsy exercises that focus on muscle stretching and strengthening. These are particularly recommended for children with Cerebral Palsy in order to correct muscle imbalances and enhance strength as the child grows. A schedule of exercises for Cerebral Palsy patients will usually include some, or all, of the following:

  • Manual stretching: Prolonged manual stretches are one of the best Cerebral Palsy exercises to passively lengthen the affected muscle and improve hypertonicity. The stretch can rely on body weight or make use of a machine or splint. Stretching is one of the most effective forms of Cerebral Palsy exercises for children to improve soft tissue tightness and reduce spasticity
  • Splinting: Splints and casts distribute forces in a controlled manner to perform basic body functions and avoid tissue damage. They are extremely useful aids for Cerebral Palsy exercises focused on improving gait, posture, and range of motion. They can also reduce swelling, spasticity, and hypertonicity
  • Serial casting: This is a specialized form of Cerebral Palsy treatment that enhances the range of joint motion with the help of a padded, semi-rigid cast. This technique usually involves the repeated application of casts every few weeks as the patient’s range of motion improves. It is a highly effective form of treatment to manage spasticity-related muscle contractures 
  • Static weight bearing: Static weight-bearing exercises like Standing Frame and Tilt-Table are effective Cerebral Palsy exercises at home that have been demonstrated to reduce contracture in the lower limbs by means of prolonged stretches. It is essential to perform weight-bearing exercises at the right angle to ensure that the knees stay extended during the prolonged stretch, as the force exerted on the knees is quite considerable
  • Functional exercises: For children who have higher ambulatory capacity, functional Cerebral Palsy exercises that combine strength training with cardio activity can significantly improve overall fitness and enhance their quality of life. While training on static treadmills or bikes is good for gross motor development, plyometric exercises help improve walking ability and muscle strength, particularly in children with unilateral Cerebral Palsy symptoms
  • Bodyweight-supported treadmill training: The stepping reflex is what encourages young children to walk. In this type of training, the child is placed on a slow-moving treadmill with the support of a harness to limit load-bearing and encouraged to take slow stepping motions
  • Muscle strengthening: These Cerebral Palsy exercises focus on weak antagonist muscles as well as the corresponding spastic agonist muscles to enhance overall strength. Under a therapist’s guidance, patient’s can perform these with their own body weight or with strength-training equipment

There is no cure for the condition, but Cerebral Palsy is non-life-threatening, and most young children experiencing its symptoms are expected to enjoy the same lifespan as anyone else. Moreover, with the right Cerebral Palsy treatment patients can significantly improve their ability to function independently and live a complete, fulfilling life.

Frequently Asked Questions related to Speech Therapy

How much does Speech Therapy cost in India?
The cost of Speech Therapy in India varies between 500 and 1500 rupees per session.

Is Speech Therapy considered special needs?
Speech Therapy is an important wing of rehabilitation, both for children and adults with speech and swallowing difficulties.

How can you know if your child has delayed speech?
If your child is unable to respond to your commands or take part in a conversation with you as per their speech development milestones, there is a definite delay.

How to begin Speech Therapy at home?
Talk to a speech therapist, paediatrician, or neurologist and get a proper assessment before beginning Speech Therapy at home.