What Are the Treatment Options for Cerebral Palsy?

Cerebral palsy (CP) affects one in 345 children and is the most common motor disability diagnosed in childhood. People with cerebral palsy have trouble controlling their muscles, which leads to movement, balance, and coordination struggles. Treatments for CP can significantly improve a person's quality of life, but CP cannot be cured. Early diagnosis, treatment, and interventions are the best way to maximize a child's developmental potential and independence levels.

Cerebral palsy – how common is it?

Brain damage that occurs during pregnancy, delivery, or shortly after birth accounts for most cases of CP. This brain damage changes how the brain develops and coordinates movements, leading to various symptoms affecting movement, posture, and balance. There are three main types of CP. When symptoms of more than one type are present, a child is diagnosed with Mixed CP.

The three classifications are:

1. Spastic. Most common. Overly tight muscles make movement difficult.
2. Dyskinetic. Trouble with voluntary movements. Involuntary or repetitive muscle movements affect posture and balance.
3. Ataxic. Least common. Areas of the brain that control balance and coordination are more affected.

The location and extent of brain damage influences the severity of disability a child may experience. Early diagnosis and interventions are vital for a child to grow and develop to the best of their capabilities.

Disability severity varies widely, some people with CP live and work independently, while others require constant care. Children and adults with CP often have other co-existing conditions that also complicate growth and development, such as learning disabilities, behavioral problems, and seizures.

Can cerebral palsy be cured?

Cerebral palsy cannot be cured with treatment because the brain damage that causes CP is permanent. However, the developing brain has an amazing capacity to create connections and adapt to new situations. Children diagnosed early and referred to appropriate services maximize their developmental potential. Most children with CP will visit several medical and therapeutic specialties throughout their life.

Treatments options for CP

The most common treatments for cerebral palsy involve various medical, surgical, and therapeutic services. The overall goals of CP treatment are to allow children to grow and develop to the best of their ability. Treatment varies from person to person and is also dependent on age. Children with CP will visit many medical and therapeutic specialists as they grow and develop.

Early interventions aim to capitalize on neuroplasticity, the brain's ability to create new connections and form new pathways after certain areas are damaged. Research shows that early services and interventions lead to overall better developmental outcomes.

Medical specialists

Referrals to a neurologist are often the first step when a primary care health provider suspects CP. Then, neurologists perform in-depth examinations, perform tests such as MRI to support the diagnosis, and develop a treatment plan.

Orthopedic surgeons follow the child's development and can perform several procedures to improve mobility and comfort.

Children are also referred to hearing and vision specialists, as problems with both are common. In addition, referrals to other medical specialties may be indicated as your child grows and develops.

Common medications

Medications target symptoms of CP, aiming to reduce pain and improve quality of life. A few common medications include:

• Medications for spasticity. Onabotulinumtoxin A (Botox) injections control pain and reduce spasticity, which can lead to improved mobility. Baclofen (Lioresal) and diazepam (Valium) help relax muscles.
• Medications for dystonia. Carbidopa-levodopa (Sinemet) and clonazepam (Klonopin) target dopamine, a brain messenger that affects movement.

Surgical procedures

As children with CP grow, problems arise with how muscles and tendons connect to growing bones. Spastic, tight muscles can create contractures, a type of abnormal positioning that affects movement and causes pain.

• Muscle or tendon lengthening. These procedures "release" tight muscles to decrease pain and improve movement.
• Hip surgery. Hip displacement is also common and sometimes requires hip reconstructions to improve mobility.
• Nerve procedures. Sometimes, a neurosurgeon will cut selective nerve roots to reduce spasticity and improve the child's motor control. This surgery improves a child's ability to walk and improves overall range of motion.
• Feeding tube placement. People with CP can have difficulty eating, drinking and swallowing. Sometimes a feeding tube is needed to provide optimal nutrition.

Physical and occupational therapy

Once CP is suspected, referrals should be made to physical (PT) and occupational therapy (OT). High-quality PT and OT maximize a child's ability to master gross motor skills, such as walking, and fine motor skills, such as using a pencil or threading beads. Children referred early tend to function at higher levels and have more independence compared to children who were unable to access therapy early in life.

Speech-language therapy

Muscles that affect the ability to speak and eat are often affected by CP, making these activities difficult. Speech-language pathologists (SLP) assess and treat these conditions. They can help a person with CP strengthen and coordinate movements needed to speak and eat. SLPs can also work to use alternative communication, such as sign language or assistive devices, which are helpful for people with CP who cannot communicate through speech.

Other therapeutic teams

Recreation, art, and music therapy allow children and adults with CP to express themselves in meaningful ways. This can lead to greater self-esteem and develop relationships with others.

Assistive devices

Assistive devices can take many forms, from simple to complex, and significantly improve the quality of life for people with CP. For example, powered wheelchairs, braces, and canes can help with mobility. Communication devices directly affect relationships by allowing people with CP to communicate their needs and wishes to those around them. Many children with CP also have difficulty hearing and may use hearing aids or be candidates for cochlear implants.

Latest research and treatments for cerebral palsy

More than 1,100 clinical research studies are currently listed at various research stages on the NIH Clinical Trials website. A few emerging treatments that show promise include:

• Functional electrical stimulation (FES). Low-level electrical currents stimulate spastic muscles in this treatment. This stimulation can help strengthen muscles and improve movement.
• Constraint-induced therapy (CIT). A person's dominant arm or leg is restrained, forcing them to use the weaker limb. The goal is to strengthen the weaker limb. This treatment is already in use, but current research aims to determine if CIT works better when used part-time or around the clock.
• Stem cell therapy. Stem cells are cells capable of developing into many types of cells, including damaged brain cells. So far, stem cell therapy trials have shown gross motor function improvements, and much more research is in the works.

What support is available for cerebral palsy?

A cerebral palsy diagnosis is a life-changing moment for the whole family. Luckily, many types of support are available. A multi-disciplinary team of healthcare providers, therapists, social workers, and educational professionals will work with your family to provide the best care and developmentally appropriate treatments.

Caring for a child with significant physical and developmental disabilities creates a financial burden. Due to this, most children with CP qualify for Medicaid health insurance coverage, and many meet the requirements for social security disability income (SSI benefits). Your healthcare team can help you navigate and apply for these programs.

In addition, several local, national, and international organizations work with families to provide education and access to resources. Connecting with these organizations and other families creates a sense of community and support for families.

Cerebral palsy treatments vary based on an individual's symptoms, age, and access to resources. The most common treatments include medications, surgical procedures, and several therapies. CP treatment does not cure the disorder but can significantly improve a person's quality of life. Early diagnosis, treatment, and interventions are the best way to maximize a child's developmental potential and independence levels.