Treating cerebral palsy

Although there's no cure for cerebral palsy, a range of treatments are available to help treat many of the symptoms.

Treatment for cerebral palsy usually involves a team of health professionals with different areas of expertise.The team may include:

• a paediatrician
• a health visitor
• a social worker
• a physiotherapist who helps with movement and co-ordination
• an orthotist whospecialises in the use of devices (orthoses) tocorrect deformities andsupport weakened joints
• a speech and language therapist
• an occupational therapist who helps with the skills and abilities needed for daily activities, such as washing or dressing
• a teacher specialising in helping children with visual impairment
• an educational psychologist who specialises in helping people with learning difficulties
• an orthopaedic surgeon to monitor the hips, spine and sometimes for surgery
• a neurologist
• a neurosurgeon

The care team will help draw up an individual care plan to address any needs or problems your child has. The plan will be continually reassessed as your child gets older and their needs change.

You and your child will also be assigned a key worker, who will be the first point of contact between you and the various support services available. When your child is young, the key worker is likely to be a health visitor. As your child gets older and their needs become more complex, the key worker is likely to be a social worker.

There's no single treatment plan for a child with cerebral palsy. Instead, there are a wide range of treatments available, designed to improve your child's symptoms and let them be as independent as possible. Some of the main treatments are outlined below.

Physiotherapy

Physiotherapy is normally started when your child is diagnosed with cerebral palsy. It's one of the most important ways of helping your child manage their condition.

The main goalsof physiotherapy are:

• to encourage movement and improve capability this may involve a walking aid or orthotics
• to build on strength and to prevent the weakening of muscles that aren't normally used by your child
• to prevent muscles shortening and losing their normal range of movement (known as acontracture)

There's a risk of contracture in children who have problems stretching their muscles as a result of muscle stiffness. If the muscles can't stretch, they don't grow as fast as the bones. This can lead to deformities, causing your child pain and discomfort.

A physiotherapist will teach your child a number of physical exercises to strengthen and stretch their muscles, which they can carry out every day. Special arm or leg braces (orthoses) may also be used to help stretch their muscles and improve their posture.

Speech therapy

Speech therapy can help children who have trouble communicating by allowing themto practise their speech with exercises, or teaching them an alternative method of communication, such as sign language or pictures.

Special equipment to help your child communicate may also be available, such as a computer connected to a voice synthesizer.

Younger children can be given a device similar to a laptop that's covered with symbols of everyday objects and activities. The child then presses a combination of symbols to communicate.

Occupational therapy

Occupational therapy involves a therapist identifying problems that your childmay have carrying out everyday tasks.

They can advise your childon the best way to carry out tasks that require movement skills, such as going to the toilet or getting dressed.

Occupational therapy can be extremely useful in boosting your child's self-esteem and independence, especially as they get older.

Medications for muscle stiffness

If your child's muscles are particularly stiff, causing discomfort or preventing them from doing everyday tasks, medication to relax their muscles may be offered.

Diazepam

If fast and short-term treatment for muscle pain and stiffnessis needed, diazepam can be recommended.This medication can be taken in liquid or tablet form.

Side effects of diazepam can include:

• drowsiness
• slurred speech
• dizziness (lightheadedness)
• clumsiness or loss of co-ordination
• forgetfulness
• confusion

If diazepam doesn't work, there areother muscle relaxants that can be used, such asdantrolene or tizanidine.These have similar side effects to diazepam, although regular blood tests will be needed to check for more severe side effects, such as liver damage.

Baclofen

For longer-term treatment, baclofenmay be recommended.Like diazepam, this can be taken in liquid or tablet form.

Side effects of baclofen can include:

• drowsiness
• feeling sick
• constipation or diarrhoea
• confusion
• clumsiness or loss of co-ordination

In some cases, treatment with a baclofen pump may be recommended instead of tablets. This involvessurgically implanting a small pump under the skin near the waist, whichis connected through tubes to the spinal cord.

The pump delivers regular doses of baclofen directly into thefluid surrounding the spinal cord. This meansit has fewer side effects thanbaclofen tablets and is better at reducing muscle stiffness.

Botulinum toxin

If your child has muscle stiffness affecting a specific muscle or group of muscles, injections of botulinum toxin can be offered.

The effects ofbotulinum toxin injections normally last between three and six months,but repeat injections can be given. The treatment is most effective when a programme of stretching and physiotherapy follows the injections.

In rare cases,botulinum toxin can cause serious side effects, such as swallowing difficulties. Your child's care teamwill explain how to recognise these problems andyou'll be advised to go to the hospital immediately if they happen.

Medications for dyskinetic cerebral palsy

If your child has dyskinetic cerebral palsy, other medications may be trialled, such as:

• trihexyphenidyl
• gabapentin
• clonidine

Both of these can be potentially serious and require treatment.

If your child has problems swallowing their food ( dysphagia ), there's a risk that small pieces of food could enter their lungs. This can damage the lungs and cause an infection ( pneumonia ). If feeding and swallowing are difficult, it may also be hard to get proper nutrition.

If your child's dysphagia is mild, it may be possible for a speech and language therapist to teach them techniques to deal with it. A dietof soft foods may also be advised.

If the problem is more serious, a feeding tube may be needed. This can be placed into their stomach, either through their nose and throat (nasogastric tube) or directly through their abdominal wall (gastrostomy tube).

If your child has drooling problems, the excess saliva can irritate the skin around the mouth, chin and neck. This will increase the risk of these areas becoming infected.

Anumber of treatments can help children control their drooling, including:

• anticholinergic medicationgiven as a tablet or skin patch, which reduces the body's production of saliva
• botulinum toxin injections into the salivary glands (although this is only a temporary solution)
• surgery to redirect the saliva glandso the saliva runs towards the back of the mouth, rather than the front
• devices placed in the mouthto encourage a better tongue position and regular swallowing
• biofeedback trainingwherea child is taught to recognise when they're drooling and to swallow accordingly

This may be recommended if your child's cerebral palsy is causing them pain when they move. It can also improve their posture and movement,as well as their confidence and self-esteem.

Orthopaedic surgery may involve either:

• soft tissue surgerysuch astendon release or muscle lengthening
• bone surgery such as treating hip dislocation

If the two are combined, it's known as multilevel surgery.

However, it can take a while for your child to experience the full benefits of orthopaedic surgery, and a long course of physiotherapymay be needed after the operation. For example, if your child has surgery to improve their ability to walk, it may take up to two years for the full effects of the treatment to be achieved.

Surgery can also be used to treat other problems, including curvature of the spine ( scoliosis ) and urinary incontinence. See treating scoliosis and surgery for urinary incontinence for more information.

Your child will be routinely monitored and may need regular hip and spine X-rays to check for any problems that need to be corrected with surgery.

Selective dorsal rhizotomy (SDR)

Selective dorsal rhizotomy (SDR) is a surgical procedure that can help children with severe muscle spasticity in their legs to improve their walking. It's usually only recommended if scans have shown damageto the brain's white matter (periventricular leukomalacia) and other treatments for muscle stiffness have failed.

The operation involves cutting some of the nerves in the lower spinal column, which can help relieve leg stiffness.

However, extensive physiotherapy lasting several months will be needed after the operation, to help your child "relearn" how to control their leg muscles.

As with all types of surgery, the SDR procedure also carries the risk of complications, including:

• temporary difficulty emptying the bladder (urinary retention)
• scoliosis (abnormal twisting and curvature of the spine)
• a change in the way their legs feel

You and your child (if they're able to understand the implications of surgery) should discuss the potential benefits and risks with your surgeon.

For more information about SDR, see the guidelinesfrom the National Institute for Health and Care Excellence (NICE) on selective dorsal rhizotomy for spasticity in cerebral palsy . This operation is not currently available on the NHS.