occupational-therapy-in-cerebral-palsy

Cerebral palsy (CP) is a group of disorders that is caused due to abnormal brain development, often before birth. It is a disorder affecting movement, muscle tone, and/or posture. Symptoms usually appear by early childhood, such as exaggerated reflexes, floppy or rigid limbs, and involuntary motions. Long-term treatment includes physical therapy, prescription drugs, and sometimes surgery. Therapies like speech therapy, occupational therapy, physical therapy, etc. can also play an important role in improving overall functioning.

Understanding Cerebral Palsy

The word “cerebral” means relating to the brain, while “palsy” means weakness or problems relating to muscle and its movement. Therefore, cerebral palsy affects the part of the brain that controls the ability to move muscles. The causes and effects of cerebral palsy vary from person to person. Some people can have mild symptoms such as problems with muscle control, while others can have severe symptoms such as inability to walk, intellectual disabilities, epilepsy, etc. Cerebral palsy is a lifelong disease that affects children before birth (“congenital” cerebral palsy) or can develop even after birth (“acquired” cerebral palsy).

The four main types of cerebral palsy are as follows:

  1. Spastic Cerebral Palsy: This is the most common type, affecting almost 80% of the patients. It affects the muscles, making them stiff (spastic), causing exaggerated reflexes and muscle spasms. It often entails walking abnormalities and may sometimes lead to paralysis.
  2. Dyskinetic Cerebral Palsy: This type causes problems in controlling body movements. The muscles either become too tight or too loose. Movements of the arms and legs become involuntary, jerky, or even slow and writhing. This causes difficulty in movements such as sitting, crawling, or walking. In some cases, it may also affect the face and the tongue, making it difficult to frown, eat, or talk.
  3. Ataxic Cerebral Palsy: This is the least common type. This form of cerebral palsy affects the balance and coordination of the person. It affects movements such as walking and fine motor skills such as grasping objects, writing, etc.
  4. Hypotonic Cerebral Palsy: This type greatly reduces the muscles tone, making them overly relaxed and floppy. The weakened muscles make it difficult to sit up straight. Children affected by this type may have trouble breathing, speaking, have poor reflexes or walking abnormalities.

Mixed Cerebral Palsy: Some people may experience symptoms of more than one type of cerebral palsy. In most cases, it is a combination of spastic and dyskinetic cerebral palsy.

Causes and Symptoms of cerebral palsy

Cerebral palsy usually occurs before birth and in some cases, at birth, or early infancy. It is caused due to abnormal brain development, or damage caused to the developing brain. In most cases, the causes are unknown, but there can be many factors that can contribute to problems related to brain development. Some of these factors include:

  • Maternal infections that can occur in the womb, directly affecting the fetus.
  • Gene mutations that cause problems during brain development and lead to genetic disorders.
  • Head injuries due to accidents, falling, or child abuse.
  • Bleeding in the brain (intracranial hemorrhage).
  • Brain infections leading to inflammation in or around the brain.
  • Lack of oxygen reaching the brain during labor and delivery.
  • Severe jaundice in infants.

The symptoms of cerebral palsy may differ greatly from person to person. Cerebral palsy can affect the whole body, one side of the body, or just one or two limbs. The symptoms can vary depending on which part of the brain is affected. The effects of cerebral palsy tend to become more obvious when the child is growing or developing motor skills. The symptoms can differ from person to person, ranging from very mild to very severe. Some of the common symptoms of cerebral palsy include:

  • Muscle movement disorders such as stiff muscles (spasticity), exaggerated reflexes, tremors, or involuntary jerking movements.
  • Lack of muscle coordination and balance (ataxia).
  • Variations in muscle tone, where muscles become too stiff or too floppy.
  • Difficulty in walking.
  • Difficulty in the development of fine motor skills such as sitting up, crawling, holding onto and picking up objects.
  • Delay in speech development. 
  • Difficulty in eating, excessive drooling, and problems with swallowing.
  • Delayed growth. 
  • Intellectual disabilities. 
  • Neurological problems such as seizures (epilepsy), abnormal touch, or pain sensations, etc.
  • Bladder and bowel problems.
  • Mental health issues such as behavioral problems and mental disorders.

Treatment for cerebral palsy

Treatments could vary depending on the type and the severity of the symptoms. Medications, assistive aids, therapy, and surgery can greatly help in managing symptoms, relieving pain, and making the child independent in performing daily chores and activities, thereby improving the quality of life. Even though cerebral palsy cannot be cured, a combination of treatments can greatly help the child in achieving a long and healthy life. 

Apart from medications, various types of therapies such as Stem Cell Therapy, Physical Therapy, Occupational Therapy, Speech Therapy, etc. can be included in the treatment program. Of these, Stem Cell Therapy is notably an emerging treatment for a variety of conditions, including cerebral palsy. Given its process of utilizing stem cells in the body that have the ability to grow and change into other types of cells, Stem Cell Therapy is a crucially important treatment and is also known as regenerative medicine. 

Many physicians will probably recommend Physical Therapy for children with cerebral palsy, regardless of how minor or severe the disorder is. Physical Therapy is also considered to be another important form of treatment for children with cerebral palsy. However, research increasingly suggests that Occupational Therapy is significantly beneficial for children with cerebral palsy in a number of ways. By optimizing upper body functions and improving the coordination of small muscles, Occupational Therapy can help children with CP master the basic activities of daily living.

Occupational Therapy and Cerebral Palsy

(CP-OT)

Occupational therapy (OT) for Cerebral Palsy (CP) involves developing one’s ability to perform daily functions and activities. CP occupational therapy aims at improving one’s strength, dexterity, and coordination when performing day-to-day activities. It also helps in improving cognitive abilities such as decision-making, problem-solving, reasoning, perception, memory, etc. In this way, simple day-to-day tasks such as eating, bathing, brushing teeth can be performed with relative ease. 

Benefits of Cerebral Palsy Occupational Therapy

Occupational therapy for cerebral palsy helps to ensure the maximum capacity of functional performance in day-to-day activities, which helps to enhance the quality of life and helps the person to live life as independently as possible.

Occupational therapy for CP can help with issues in various ways:

  • Performing everyday tasks independently
  • Adapting better to abilities
  • Developing thinking and learning skills
  • Coping and responding to the demands and challenges of everyday life
  • Coping with emotions and adapting

Various techniques and exercises are used in occupational therapy with cerebral palsy. Some of these exercises and techniques include:

Improving fine motor control: These exercises improve hand dexterity. Simple exercises such as grasping and sorting toys, sorting coins, and making jewelry are practiced to improve hand muscle strength, finger isolations, thumb opposition and pincer grasp, in-hand manipulations, etc.

Upper body strength and stability activities: These activities focus on strengthening and stabilizing the trunk and upper body. Simple activities that increase strength and improve balance such as crawling, playing catch while kneeling, lying on the tummy and reading are also carried out.

Bilateral coordination: This focuses on improving control of both sides of the body at the same time. Activities and movements such as pulling apart constructive toys, catching a ball with two hands, riding a bike, etc. can be helpful.

Improving visual motor skills: These activities help in improving hand-eye coordination. Activities include drawing, stringing beads, catching and throwing the ball, etc.

Visual perception: These activities help in improving the ability to understand, evaluate and interpret what one sees. Activities like playing with puzzles, shape and color matching games, connecting the dots, etc. contribute to improving this skill.

Constraint-Induced Movement Therapy (CIMT): CIMT involves restraining the stronger counterpart of the body so as to improve the ability to move the weaker part. For example, restraining the stronger arm so that the weaker arm can perform activities independently.

Sensory Integration Therapy: This therapy helps to improve the ability to use all the senses together – touch, taste, smell, sight and hearing – thus improving the ability to receive, register, interpret, and act on the information that the brain receives through sensory receptors. These activities include playing with play dough, sand and water, finger paints, etc.

FAQs

  • What activities help cerebral palsy?

Activities improving the child’s fine motor skills, hand-eye coordination, balance, visual, and sensory perception can help with cerebral palsy. Activities may include drawing, playing puzzles, playing with play dough, catching and throwing the ball, etc.

Spasticity of the muscles can be reduced by increasing the range of motion, flexibility, and increasing the strength of muscles. Occupational therapists help to reduce spasticity by recommending activities that include positioning, muscle stretching, motor-level stimulation, sensory stimulation, etc. 

  • What kind of therapy is done to improve grip for a child with cerebral palsy?

Activities that help to improve fine motor skills and hand dexterity can be used to improve the grip of a child with cerebral palsy. These activities can include simple tasks like picking up and sorting toys, eating with a spoon, picking up and sorting smaller objects such as coins and puzzles, making jewelry such as stringing beads, macaroni, etc.

  • What are the four treatments for cerebral palsy?

Various treatments can be used to manage the symptoms and limit complications of cerebral palsy. The four types of treatments that can benefit cerebral palsy are the use of medications, assistive aids such as eye glasses, hearing aid, walking aids like braces, wheelchairs, etc., surgery and different kinds of therapies such as stem cell therapy, physical therapy, occupational therapy, speech therapy, behavioral therapy, aqua therapy, massage therapy, etc.

  • How does physical therapy help cerebral palsy?

Physical therapy is an important aspect of treatment for children with cerebral palsy. It greatly helps to increase muscle control, muscle strength, balance, mobility, and flexibility. This helps the child to overcome physical limitations in day-to-day life, helps to reduce physical discomfort and pain and helps the child to perform activities independently. 

In conclusion, it is greatly beneficial to combine treatments to improve the overall health and functioning of children with cerebral palsy. Along with medications, it is worthwhile to make use of therapies such as physical therapy, speech therapy, behavioral therapy, occupational therapy for cerebral palsy. These therapies can help children to increase the ability to learn, work and play, make them more independent in performing everyday activities, improve their emotional well-being by boosting their confidence and self-esteem and improve their quality of life in general. 

Dr Na'eem Sadiq is a respected stem cell specialist at Plexus, and a prominent neurologist in Bangalore. He studied neurology and clinical neurophysiology in London, and worked with some of the most prestigious medical institutions in England, and the Middle East. He completed his MBBS at Bellary Government Medical College, and a postgraduate degree in psychiatry from NIMHANS in Bangalore.

Dr Na'eem has perfected his knowledge and expertise in Continuing medical education (CME), and training in tissue culture, Stem Cell Therapy, and neurology. Dr Na'eem Sadiq possesses an undying passion to improve people’s lives. This led to the creation of Plexus, a neuro and Stem Cell Research centre in Bangalore in neurosurgery, and neurorehabilitation.