Understanding the Causes, Effects, and Management of Cerebral Palsy
Roy C. Maynard, M.D., is the Medical Director for PHS. He serves as PHS’s clinical leader, working with the team to provide consultation and advice to ensure quality and effective care to children and their families in their own homes. He also leads implementation of clinical policies, procedures and programs to further enhance the best possible care for each child. He is a Neonatologist and Pediatric Pulmonologist, and serves as a staff physician at Children’s Hospitals and Clinics in Minneapolis, Minn.
Cerebral palsy (CP) is a permanent disorder that involves movement and posture. Multiple causes can contribute to the development of this disorder, and may begin with issues that start in-utero or later up to age three. Cerebral palsy is considered a non-progressive disorder, but patients may also have altered cognition, perception and sensation.
Causes of cerebral palsy include prematurity, chromosomal and brain abnormalities, hematologic and metabolic disorders, infection, and trauma. Birth trauma accounts for less than 2% of patients with CP and most CP patients do not have a history of prematurity. Premature infants with birth weights < 1500 grams have a 25-30 fold increased risk over the general population. One in three very-low birth weight infants (<1500 grams) are at risk for CP.
Effects of cerebral palsy
Clinical features of cerebral palsy include muscle tightness and spasm, involuntary movements, and disturbances in gait and mobility. Other comorbidities may accompany CP and include impairments in vision, hearing, speech and intellectual ability. Seizure disorders are present in 30-40% of children with CP.
A Gross Motor Function Classification System (GMFCS) is often used to stratify CP patients into 5 different levels based on mobility, capacity for involvement in life-situations and possibility of living independently. The GMFCS is a better prognostic predictor for life skills then physical classification schemes.
Medical therapies for management
Medical management of CP may include diazepam or baclofen to help reduce spasticity and associated pain. Intrathecal baclofen pumps are implanted for patients with more severe symptoms refractory to oral medications to ameliorate spasticity and dystonia. Botulinum injections also have a role in selected patients.
Additional medical therapies may be prescribed to manage feeding difficulties, drooling, and bowel/bladder dysfunction. Surgical interventions have included selective dorsal rhizotomy for selected patients to help improve ambulation and decrease spasticity. There is an increased risk for scoliosis and hip dislocation in CP patients that may warrant orthopedic surgery.
A 2010 article described unethical therapies for CP patients that included hyperbaric oxygen therapy, dolphin-assisted therapy and Adeli suit therapy. Current investigational studies that may provide benefit in the future include the use of stem cells and neuromuscular or deep brain electrical stimulation.
A focus on goal setting
Setting realistic goals for each patient is imperative – goals may involve:
- Monitoring nutritional status and intake without compromising health status (malnutrition, aspiration)
- Minimizing pain associated with spasms
- Optimizing communication skills
- Activities associated with daily living
Improvements in medical care have contributed to 30 year survival rates now greater than 80% in CP patients. PHS provides services to benefit this population allowing patients to thrive at home in our communities.
Originally published: April 27, 2016