Cerebral Palsy and Spasticity Treatment and Rehabilitation

Although there is no cure for CP, a number of treatment options exist that can alleviate the symptoms and, in some cases, allow a patient to gain greater functioning in the affected limb. Many children go on to enjoy near-normal adult lives if their condition is properly managed. Physical therapy, occupational therapy, therapeutic recreation and speech and language therapy provide significant benefits. The earlier treatment begins, the better the chance a child has of overcoming developmental disabilities or learning new ways to accomplish challenging tasks.

At the Texas Comprehensive Spasticity Center, our affiliated physicians collaborate to provide personalized care for each patient, choosing the best treatment for each individual. The comprehensive team consists of a pediatric neurologist who specializes in movement disorders, three pediatric neurosurgeons, pediatric orthopedists and a pediatric physical medicine and rehabilitation specialist, plus physical and occupational therapists, a clinical trial program manager and physician assistants and medical assistants who coordinate care. This multidisciplinary approach ensures the most comprehensive specialized treatment for each patient, beginning with evaluation – observation, videos and medical tests – and continuing through treatment and therapy.

If your child is diagnosed with CP, a multidisciplinary team of affiliated physicians and specialists will perform additional tests to identify vision and hearing impairment, speech delays or impairments, intellectual disabilities, movement disorders and other developmental delays.

Treatments range from oral medications – the least invasive – to select dorsal rhizotomy, and depend on the child’s specific condition.

Oral baclofen or muscle relaxants relax stiff or contracted muscles but may not always be effective. Because they have side effects ranging from drowsiness and changes in blood pressure to the risk of liver damage, their use requires continuous monitoring. They’re appropriate for children who need only mild improvement in muscle tone or who have widespread spasticity.

Botulinum toxin (Botox®), administered by local injection, relaxes contracted muscles by keeping nerve cells from over-activating them. Muscle relaxation occurs within days and peaks after a month, with the effect of the injection lasting three to four months.

Intrathecal baclofen therapy (ITB) requires a surgically implanted programmable pump, which uses a small catheter to deliver a concentrated form of baclofen directly to the intrathecal space surrounding the spinal cord, where the medication mixes with the cerebrospinal fluid and circulates throughout the central nervous system. Because the medication is administered continuously and directly into the intrathecal space, an ITB can be effective in providing a steady relief of symptoms without the drowsiness that is normally associated with oral baclofen. Potential side effects include increased weakness, cerebrospinal fluid leaks, and the risk of infection around the device, which is implanted below the skin in the abdomen. The pump does require regular maintenance by a physician, and because it is battery powered, the pump will need to be replaced every 5 to 7 years.

For cases of severe spasticity, selective dorsal rhizotomy (SDR) is a surgical procedure recommended when more conservative treatments – physical therapy, oral medications and drug infusion – have failed to reduce spasticity. A neurosurgeon locates and selectively severs overactivated nerves at the base of the spinal column. The procedure is most commonly used to relax muscles and decrease chronic rigidity in one or both of the lower or upper limbs.

During SDR, a neurosurgeon locates and selectively severs overactivated nerves at the base of the spinal column. The procedure is most commonly used to relax muscles and decrease chronic rigidity in one or both of the lower extremities. Benefits of SDR include immediate reduction of spasticity in patients ages 2 to 40 with spastic diplegia or spastic hemiplegia and reduced risk of spinal deformities in later years. Potential side effects include sensory loss, numbness, or uncomfortable sensations in limb areas once supplied by the severed dorsal nerve rootlets. A large surgical case series (approximately 2,700 cases) showed a minimal risk of a cerebrospinal fluid leak or need for surgical fusion.

Physical therapy (PT) focuses on basic mobility, such as rolling, sitting, standing, walking, climbing stairs, reaching or operating a wheelchair, and can help individuals:

• Develop coordination
• Normalize muscle tone and build strength
• Improve posture and balance
• Maintain or increase flexibility
• Improve gait
• Optimize physical functioning levels
• Maximize independence
• Minimize pain and discomfort

Children with CP may also experience difficulty communicating, as CP often affects the language centers of the brain that control speech. Speech therapy:

• Supports learning and education
• Improves literacy
• Increases confidence and independence
• Improves socialization
• Eliminates self-consciousness
• Reduces shyness

Occupational therapy (OT) is an integral part of a Cerebral Palsy patient’s overall treatment program. By applying the proven techniques and latest technologies, our occupational therapists enable individuals with a variety of challenges to achieve as much independence as possible in their daily lives.

For additional information on spastic cerebral palsy, visit the Centers for Disease Control and Prevention page or the National Institute of Neurological Disorders and Stroke page.