pediatrics
Cerebral Palsy (CP)
Treatment of Cerebral Palsy
Physical and occupational therapy Braces, constraint therapy, medications, or surgery to treat spasticity Botulinum toxin injections Intrathecalbaclofen Assistive devices Physical therapy and occupational therapy for stretching, strengthening, and facilitating good movement patterns are usually used first and are continued. Bracing, constraint therapy, and medications may be added. Botulinum toxin may be injected into muscles to decrease their uneven pull at joints and to prevent fixed contractures. Baclofen, benzodiazepines (eg,diazepam),tizanidine, and sometimesdantrolenemay diminish spasticity. Intrathecalbaclofen(via subcutaneous pump and catheter) is the most effective treatment for severe spasticity. Orthopedic surgery (eg, muscle-tendon release or transfer) may help reduce restricted joint motion or misalignment. Selective dorsal rhizotomy, done by neurosurgeons, may help a few children if spasticity affects primarily the legs and if cognitive abilities are good. When intellectual limitations are not severe, children may attend mainstream classes and take part in adapted exercise programs and even competition. Speech training or other forms of facilitated communication may be needed to enhance interactions. Some severely affected children can benefit from training in activities of daily living (eg, washing, dressing, feeding), which increases their independence and self-esteem and greatly reduces the burden for family members or other caregivers. Assistive devices may increase mobility and communication, help maintain range of motion, and help with activities of daily living. Some children require varying degrees of lifelong supervision and assistance. Many children's facilities are establishing transition programs for patients as they become adults and have fewer supports to help with special needs. Parents of a child with chronic limitations need assistance and guidance in understanding the child’s status and potential and in dealing with their own feelings of guilt, anger, denial, and sadness (see Effects on the family ). These children reach their maximal potential only with stable, consistent parental care and the assistance of public and private agencies (eg, community health agencies, vocational rehabilitation organizations, lay health organizations such as 