For best result, the management of CP should be ideally undertaken by dedicated multidisciplinary team. As problems develop in response to growth in a child with CP, the more severely involved children tend to be kept under regular (e.g. annual review) until they reach skeletal maturity. The lack of provision of services to these children beyond maturity is a source of almost universal concern to their parents/guardians.
The principle of treatments include:
a) Range and strength of movement - Physiotherapy led, patient and parent delivered stretching and strengthening program
b) Maintain position & accommodate weakness - Appropriate orthoses and assistive devices
c) Decrease spasticity:
- Systemic (baclofen)
- Regional (selective dorsal rhizotomy (SDR)) Local (botulinum toxin)
d) Address deformity – tenotomies, tendon transfer, osteotomies and joints reduction.
It is GABA receptors inhibitor. It is usually used children who are too small or too young for a more effective treatment. Unfortunately the effective dose is associated with unpleasant side effects which often lead to discontinuation. Side effects include sedation, confusion, memory loss, dizziness, ataxia, weakness which are the cause of cessation. Intra-thecal Baclofen has less systemic side effects (although significant local risk) and the therapeutic dose is 1% than the oral dose.
It is a potent neurotoxin which prevents acetylcholine release reducing muscle spasm. This usually lasts for 3-4 months. The usual dose is 12 units per kg (400 units maximum).
Selective Dorsal Rhizotomy (SDR)
This is a surgical intervention performed by neurosurgeon. It has shown promising results in selected cases. Current criteria include children between four and eleven years of age with a diagnosis of spastic diplegia, usually following premature birth with adequate muscle strength in the legs and trunk and moderate to severe spasticity.
They are used;
- Maintain position
- Temporising measures
- Redirect forces
- Improve function
Various types of AFOs (Ankle Foot Orthoses). 1: sold AFO; 2: hinged AFO; 3: spring leaf AFO and 4: Ground reaction (GARFO).
Various orthoses. Top is KAFO (Knee, Ankle and Foot Orthosis); middle is SMO (supramalleolar orthoses) and bottom is UCBL (University of California Biomechanics Laboratory)
- Canes and crutches
- Walkers to help with balance: A rear walker is most often used as it promotes extension of the lower limbs and the back.
- Wheelchair (manual or motorized)
- Standers to maintain the child in an upright position which facilitates social interaction and some mechanical loading.