Physical therapy, occupational therapy, speech and language therapy, along with adaptive equipment, are popular forms of treatment for children with cerebral palsy. Used within a coordinated, comprehensive treatment plan, therapy plays a vital role in managing the physical impairment while optimizing mobility. Therapy is deployed to manage impairment (primarily spasticity, contractures and muscle tone), manage pain, and provide optimum quality-of-life by fostering functionality, self-care, and independence. Therapy also wields mental, emotional, academic, and social benefits for individuals with cerebral palsy.
If implemented as part of an early intervention program while the child is still developing, some therapy for cerebral palsy can lessen the impact of impairment and minimize the child’s potential for developing associative conditions.
Therapy can be used alongside other treatment options, such as drug therapy, surgery, assistive technology, complementary medicine and alternative interventions.
When the multidisciplinary team of practitioners determines the child’s care plan goals, they will determine appropriate therapy options. Over time, as the child develops and as conditions arise, other therapies may also be considered.
Therapy is not limited to the child. Therapy can be helpful to caregivers and parents, as well. For instance, nutrition counseling can help a caregiver understand the dietary needs of the child. Behavioral therapy can help a parent learn how to best reinforce the child’s therapy progress in a positive manner.
Therapy comes in many forms, for differing purposes, and may be applied at various stages of the child’s development or during adulthood.
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COMMON THERAPIES USED IN CEREBRAL PALSY TREATMENT
Acupuncture is a form of complementary medicine invented in China that is intended to treat disease and relieve pain. To some, acupuncture is a form of pain relief sought as an alternative to over-the-counter medicines, like acetaminophen or nonsteroidal anti-inflammatory drugs. The most common use of acupuncture is for pain relief from headaches, back pain, joint pain and neck pain. Although acupuncture has not been fully embraced by the medical community in the United States, it is widely considered to be a healing art as opposed to a medical treatment. For children and adults with cerebral palsy, acupuncture is a relatively new therapy. Studies are being conducted for various symptoms experienced by those with cerebral palsy, for example it is being studied for chronic pain relief, brain injury repair, and hypertonicity.
Aqua therapy (also known as Aquatic therapy), under the supervision of a trained and certified professional therapist, provides deep, intense exercise within a soothing and comforting environment. This form of therapy promotes physical functioning with the aid of water’s restorative and detoxifying properties. Water buoyancy makes aerobic and anaerobic exercises safe and effective by allowing an individual to ambulate freely in a way that doesn’t place undue stress on the musculoskeletal system from forces such as gravity and body weight. Aqua therapy takes place in both heated and non-heated environments, although warm water therapy provides a massage effect on muscles, joints and ligaments.
Behavioral therapy, also known as cognitive behavioral therapy, is rooted in the belief that emotional challenges and unproductive behaviors are learned and can therefore be changed. In behavioral therapy, troubling situations are identified and thoughts, emotions and beliefs about those situations are explored, challenged and ultimately altered. Behavioral therapy empowers the individual to respond to challenging situations in a more effective and acceptable manner.
Chiropractic care, a form of complementary or alternative (CAM) health practice, is technically considered a manipulative and body-based therapeutic method The Greek word “chiropractic” means “hand practice” or treatment done by hand. Chiropractic care is a hands-on approach to therapy that often centers around the adjustment to the spine and joints in a way that influences the body’s nervous system and natural defense mechanisms for the purpose of alleviating pain and improving health and well-being. Chiropractic care is becoming a sought-after remedy for pain management for children and adults for lower-back, neck, shoulder, hand and foot problems, as well as for specific health conditions such as cerebral palsy, fibromyalgia, attention deficit hyperactivity disorder. It has been used on specific symptoms such as headaches, sleep disorders, and drooling.
Conductive education is a comprehensive method of learning by which individuals with neurological and mobility impairment, like cerebral palsy, learn to specifically and consciously perform actions that children without such impairment learn through normal life experiences. Founded in the 1940s by Hungarian physician Professor Andras Peto, conductive education takes the position that motor disorders are learning disabilities, children are taught to see themselves as active participants in their own education; they are encouraged to be problem-solvers and develop a self-reliant “orthofunctional” personality that fosters participation, initiative, determination, motivation, independence, and self-sufficiency. Because of this, conductive education programs are not medically-based, but task oriented. The most striking difference between conductive education and conventional treatment is that it’s not a therapy, or a treatment. This approach takes into account that those with special needs have extra and different learning needs to accomplish actions. The program relies on a child’s natural abilities, not corrective, modified or adapted.
Hippotherapy is a form of physical, occupational and speech therapy that uses equine (horse) movement to develop and enhance neurological and physical functioning by channeling the movement of the horse. This further develops physical and cognitive abilities. Hippotherapy is not to be confused with therapeutic horseback riding, in which individuals are taught specific riding skills. Hippotherapy is built on the concept that the individual and variable gait, tempo, rhythm, repetition and cadence of a horse’s movement can influence human neuromuscular development in humans. Horseback riding triggers a series of complex physical and mental reactions; such as making physical adjustments to maintain proper alignment on the horse. Riders must also plan movements to maintain balance on the horse, and be able to interact with the animal.
Massage therapy embodies the power of bodywork. The human body contains 11 major organ systems; massage can manipulate these systems in differing ways, based on the momentary needs of the individual. Massage therapy uses the power of human touch for therapeutic purposes, as well as pampering and rejuvenation. Therapeutic benefits are wide ranging and include controlling stress levels, reducing pain, releasing muscular tension, improving digestion, stimulating sensory receptors, stimulating circulation, providing flexibility, and enhancing range of motion.
With the majority of individuals with cerebral palsy reporting feeding or digestive difficulties, a dietary counseling program can be highly beneficial. Skilled practitioners work with primary care physicians to adjust diet, intake, substance, and supplements in ways that contribute significantly to an individual’s overall health. Most dietary concerns for those with cerebral palsy focus on what to feed, how to prepare food, how to feed and when to feed. Dietary therapy can be structured to meet the individual’s unique needs.
Occupational therapists provide skills required in daily living for those with impairment. These professionals focus on assessing and developing an individual’s ability to function in normal daily activities at home, in school, out in public, and at work. The goal is to foster independence, productivity, and self-care. Occupational therapists will help a person improve strength, dexterity, and coordination while performing tasks, but they will also assist in decision-making, abstract reasoning, problem-solving, perception, memory, sequencing, and more. When an individual requires environment design changes or assistive technologies at home, school, work, or play, an occupational therapist will help secure the necessary items and train the individual and his or her family how to use the equipment.
Playing is the activity that brings the most joy into the young lives of children. It’s an activity that allows children to build self-confidence, interact with other children, and learn about him or herself. It’s an experience that exemplifies what it means to be a child; and one that no young person should be excluded from. Play therapy is a therapeutic and psychological intervention that uses play to help children with cerebral palsy develop a better sense of inclusion using both directed and non-directed play. This allows children to not only learn how to interact with others and develop relationships, it also provides physical strategies children can use to perform. Play therapy incorporates the child’s physical abilities, cognitive functioning levels and emotional needs in a safe, supportive environment.
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Though the terms are often used interchangeably, physical therapy and physiotherapy are forms of the same profession practiced in slightly different ways. These forms of therapy are part of the branch of rehabilitative health devoted to restoring, maintaining, and promoting optimal movement, physical function, and health. Physical therapy and physiotherapy provide therapeutic intervention to treat activity limitations, participation restrictions, and environmental barriers experienced by those with physical impairment. They are considered two of the most important therapies for the treatment of cerebral palsy. Physical therapy or physiotherapy begins soon after diagnosis is made and is an integral part of early intervention and maintenance programs. They optimize physical functioning. They can incorporate functional training, manual therapy, assistive technologies, and electrotherapeutic modalities.
Respiratory therapy is an intervention that, for children with cerebral palsy, is a lifeline. The goal of all respiratory therapists is to ensure that a child can breathe, eat, drink, and maintain a high level of physical functioning and respiratory heath for a lifetime. The majority of children with cerebral palsy have oral-motor dysfunction which affects the way they eat, breathe and communicate. Although cerebral palsy does not cause respiratory distress, associative conditions can lead to life-threatening respiratory issues, such as pneumonia, aspiration, and choking. A child’s respiratory health must be diligently monitored to treat symptoms and conditions before they become unmanageable. Proper management of respiratory health can improve quality of life.
Recreation therapy, also known as therapeutic recreation, focuses on designing ways in which an individual can fully participate in recreational activities of their choice. When children with impairment are presented with an obstacle to perform a life-enhancing activity, recreation therapists work to identify the interest level, capabilities, adaptive approaches, and in some cases modified processes required to complete the activity successfully. Inclusion in life-enhancing activities improves a child’s physical, mental and social experiences.
Children with cerebral palsy or those born prematurely can display symptoms of sensory integrative dysfunction, an abnormal degree of sensory processing, whether decreased or increased. Sensory integrative dysfunction can make a child appear clumsy when he or she walks, or create difficulty with fine motor skills such as pencil control, which, in turn, can lead to delay in writing ability. Sensory dysfunction can also cause over-sensitivities or under-sensitivities that lead to mental and physical distraction or fatigue. Problems with sight, hearing and balance can be addressed through sensory integration therapy.
Children with impairment may experience any number of social challenges, such as social anxiety, relationship problems, dependent personality disorders or social skill difficulties. Anxiety, panic, shyness, or emotional pain can be replaced with emotional growth and new ways of perceiving, thinking and interacting. Social therapy can provide a child with new skills to use towards healthier relationships with others and within their surroundings. The effect of social therapy can be empowering. Often, pain is recognized and released. The child then develops new ways to respond to people, situations and moments in his or her life.
Language, speech, breathing, chewing and swallowing difficulties can be present with various health conditions, including brain injury, cerebral palsy, cognitive impairment, hearing loss, and learning disabilities. Oral motor dysfunction, facial muscle impairment, is common in children with cerebral palsy. Oral motor functioning depends on an intricate process of sending and receiving messages to various facial, throat and neck muscles to coordinate breathing while talking, chewing, swallowing and digesting. Speech-language pathologists use augmentative or alternative communication methods with those who have little or no ability to speak. With assistance, children can learn to improve communication by strengthening muscles, making sounds, improving voices, correcting accents, and using compensatory strategies. Speech and language pathologists also address swallowing disorders, which, untreated, can lead to aspiration, malnutritian, respiratory distress, digestion difficulties, and pneumonia. They work closely with respiratory therapists, registered dietitians, and gastroenterologists to improve various associative conditions.
Most children wouldn’t take kindly to wearing a brightly-colored, banded suit over their clothing. But what if that suit, as different as it may look, restored the physical mobility? What if the suit provided a child proper posture, muscle tone, and patterns of movement previously lost to disability? That’s the premise made by practitioners of intensive suit therapy, a complex intervention that makes use of an orthotic suit comprised of a hat, vest, knee pads, and specifically-designed shoes that are worn by children and adults in a therapeutic setting. According to devotees of suit therapy, multiple adjustable rings and elastic bands on the garment can be adjusted to provide pressure and support to the muscle groups and joints affected by cerebral palsy that need more support than a child can provide. Strategically-placed bungee cords can be adjusted to typical flexor and extensor muscle groups; the entire suit acts as a soft exoskeleton that brings a child’s body into proper alignment by adjusting limbs to correct abnormal muscle tone and re-train a child’s brain to recognize correct muscle movements.
Vocational counseling assesses an individuals intelligence, aptitude, interests, abilities and skill levels in order to assist with career pathing. Much satisfaction is derived from being a productive and contributing member of society. Employment allows an individual the ability to earn income and provide financially for his or her self and, at times, others. Vocational therapists partner with businesses, government agencies, educational institutions and the employment industry to develop mutually beneficial opportunities for those with special needs. Vocational therapists work with employers to create and fund inclusionary workspaces. They also assist in assessing, training and developing individuals for positions that suit his or her skill levels.