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As a non-progressive movement disorder, Cerebral Palsy can significantly impact a child’s life by hampering their ability to do voluntary movements. Introducing tailored physiotherapy early on, however, can address movement problems and even cure some of them. From coordination and balance to strength and muscle tone, there are several exercises to suit every need. Here, we offer a brief guide to the role of Physiotherapy in Cerebral Palsy treatment and how your child can make the most of it.

Understanding Cerebral Palsy

Cerebral Palsy refers to a group of non-progressive neurological disorders that affect movement, muscle tone, coordination, and gait. It occurs due to damage to the brain on account of an injury or infection before, during, or shortly after birth. Children with Cerebral Palsy experience a range of symptoms like unsteady gait, poor balance and coordination, pain, extreme muscle tone (hypertonia / hypotonia), speaking / swallowing difficulties, and cognitive delays. For Cerebral Palsy, early diagnosis and tailored rehabilitation give the child the best chance at a functional life. In addition to Cerebral Palsy Physiotherapy, the doctor will also recommend Occupational Therapy, Speech Therapy, and Stem Cell Therapy.

Symptoms of Cerebral Palsy

Depending on the severity and subtype of Cerebral Palsy, parents can detect it as early as a few months or as late as four or five years of age. Typical symptoms to watch out for at an early age include:

  • Exaggerated reflexes
  • Unusually stiff or floppy limbs
  • Delays in hitting developmental milestones like rolling over, or sitting up
  • Trouble holding head up without support
  • Poor balance and coordination
  • Unsteady or unusual gait such as walking on toes
  • Jerky involuntary movements or slow writhing movements
  • Favoring only one limb or one side of the body
  • Drooling
  • Trouble swallowing
  • Slurred speech
  • Learning and intellectual difficulties
  • Abnormal eye movements
  • Seizures

Benefits of Physiotherapy for Cerebral Palsy

Physiotherapy is the most critical component of any Cerebral Palsy program. It improves strength and flexibility, reduces pain from muscle contractures, and helps children move and get about as independently as possible. When introduced early, Cerebral Palsy Physiotherapy can avoid many bone and joint deformities down the line and help children improve their self-reliance. Over time, it helps them participate better at home and school and integrate with peer groups, boosting their psychological well being.

Physiotherapy is tailored to each individual case and thus there are specific benefits for each subtype. Some of these include:

  • Spastic Cerebral Palsy: Reduction in muscle tension and jerky movements as well as relieving stiffness through stretching
  • Athetoid Cerebral Palsy: Increasing muscle tone and acquiring more control over voluntary movements
  • Ataxic Cerebral Palsy: Improving balance, gait, and mobility

There are also special Physiotherapy exercises to target the associated conditions that often present with Cerebral Palsy, such as scoliosis, lumbar lordosis, pelvic inclination, knee or hand deformities, and shortened Achilles tendon.

Types of Cerebral Palsy Physiotherapy

Before commencing a CP Physiotherapy program, the child undergoes an extensive evaluation so that the therapist can understand the location, range, and severity of the child’s symptoms. Accordingly, a tailored course of therapy with exercises, stretching, special equipment, and muscle relaxation will be prescribed. There is a wide range of Physiotherapy activities that address specific needs and limitations and maximize functionality. These include:

  • Passive stretching: This is a manual activity that eases soft tissue tightness. Over time, it helps to relieve spasticity, enable easier walking, and enhance range of motion. There are three main types of stretches, namely fast / quick, prolonged, and maintained. Passive stretching can be accomplished in the following ways:
    • Manual stretching: The force of body weight is often enough to induce a good stretch. Care should be taken to exert enough force to overcome hypertonia. 
    • Weight-bearing exercises: Weight-bearing can successfully target tight muscles in the lower body, as long as the child is standing at the correct angle to make sure the knees remain extended.
    • Splints: Splints are often used to improve resting posture, reduce spasticity, and enhance range of motion. They enable long-duration, low-force stretching.
  • Static weight-bearing exercises: This employs devices like tilt-tables and standing frames to guide children through load-bearing activities. It strengthens the muscles and helps reduce spasticity.
  • Functional exercises: These involve exercises that combine both aerobic and strength training to improve functionality and fitness in ambulatory children. Static biking, walking, running, plyometric exercises, and yoga are all beneficial activities that the child may enjoy.
  • Bimanual training: This focuses on improving coordination in the upper body through structured activities that employ both arms. Both play and functional activities may be recommended.
  • Body weight supported treadmill training: This focuses on developing the stepping reflex that is required for getting around. Therapists support the child with a harness in an upright posture, to reduce overall weight-bearing, and help them walk on a slow-moving treadmill. 
  • Electrical stimulation: This aims to improve muscle strength and nerve function by providing stimulation in a safe, non-invasive fashion. Therapists can do this in the clinic or bring a portable device to the patient’s home.
  • Massage therapy: Periodic massages serve as an important complement to CP Physiotherapy by helping the muscles relax and acting as a breather for the child. Massage can also help with pain relief.

Tips to make the most of Physiotherapy for Cerebral Palsy

Every child’s symptoms are unique, which is why a Cerebral Palsy Physiotherapy program will look different for everyone. In addition, the program will have to evolve to keep pace with the child’s growth and changing physical needs. By taking extra care throughout the program, a child can maximize the benefits and see results as soon as possible. Here are our top tips for patients undergoing CP Physiotherapy.

  • Always choose a Physiotherapist who has experience working with children who have Cerebral Palsy. Ask your doctor for recommendations. 
  • Create a safe home environment for your child’s Cerebral Palsy Physiotherapy. Cover any slippery floors with non-slip mats and remove any sharp objects.
  • Always start slow with any new exercise. For instance, with strength training, help the child through bodyweight exercises before introducing equipment.
  • Use assistive devices like braces, guard rails, or anti-slip gloves wherever necessary.
  • Keep an eye out for signs that your child is struggling or in pain. Encourage the child to speak up if they feel any kind of discomfort. Ensure that your child stops immediately in case of pain.
  • Always incorporate stretching exercises after any form of Physiotherapy. This will help ease muscle pain while maintaining a healthy muscle tone. Stretching, in fact, can be done multiple times a day for best results.
  • Ask the therapist to incorporate play activities as much as possible. Children may resist exercises that feel too much like hard work, but with a play component, they can relax and approach the exercise with more motivation.
  • Always keep encouraging the child and praising their wins, no matter how small.
  • Consult the doctor about any corrective surgeries that could help to fix prominent bone or joint deformities that can’t be overcome with Cerebral Palsy Physiotherapy alone. A cast or brace could also help correct deformities.

FAQs

  • How can Physiotherapy help with Cerebral Palsy?

Physiotherapy for Cerebral Palsy helps patients learn how to move correctly and without pain or lack of coordination. It enhances both gross and fine motor skills and thus enables the patient to participate in various activities at home, school, and elsewhere.

  • What exercise is good for Cerebral Palsy?

Stretching is a vital exercise for any patient with Cerebral Palsy, as it helps relieve pain, reduce swelling, and elongate tight muscles.

  • Does stretching help Cerebral Palsy

A regular stretching regime as part of CP Physiotherapy has been demonstrated to ease spasticity and avoid joint deformities.

  • Is walking good for Cerebral Palsy?

For children who are able to use both legs, walking is an ideal form of aerobic exercise for Cerebral Palsy. Often, therapists may recommend the use of a brace or a walker to enable mobility.

  • How can I walk better with Cerebral Palsy?

Regular Physiotherapy with stretching and muscle training will help improve strength and mobility in the legs for better walking.

  • What is the meaning of PNF stretching?

Proprioceptive Neuromuscular Facilitation (PNF) is an advanced type of flexibility training. It entails stretching as well as activation of the target muscle group so as to promote as much static flexibility as possible.

  • How do you position a child with Cerebral Palsy?

Maintaining a proper upright sitting and standing position enables maximum functionality, especially in the upper body.

  • Is Physiotherapy medical treatment?

Physiotherapy is a form of medical treatment. It focuses on rehabilitation and sustainable living for people with movement disorders like Cerebral Palsy.

  • How do physical therapists treat spasticity?

The Physiotherapist will guide the patient through focused stretching exercises and various other tone inhibition techniques to reduce spasticity. Assistive devices like splinting, casting, or bracing can also help depending on the child’s needs.

  • Does massage help with spasticity?

Massage can help to reduce pain, relax the muscles, and improve range of motion for patients with spasticity.

  • What is the most common therapy to help CP?

Cerebral Palsy treatment involves a range of therapies including Physiotherapy, Speech Therapy, Occupational Therapy, and Stem Cell Therapy.

  • How do you prevent tightness in Cerebral Palsy?

Tightness of the muscles or joints is a result of spasticity. Tailored CP Physiotherapy including stretching and strength exercises can ease tightness and improve range of motion over time.

In conclusion, Physiotherapy for Cerebral Palsy is one of the most effective forms of early intervention for the condition. If your child has received a CP diagnosis, talk to the doctor about the best forms of Physiotherapy for symptom reversal and management. In addition, be sure to make the experience as fun as possible for the child. The more they look forward to their CP Physiotherapy sessions, the more inspired they will be to try harder each time.

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.