| Physical therapy, usually begun in the
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| | with physical maneuvers on special
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| first few years of life or soon after the
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| | equipment. The therapy, however, has not
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| diagnosis is made, is a cornerstone of
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| | been able to produce consistent or
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| cerebral palsy treatment. Physical
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| | significant improvements in study groups.
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| therapy programs use specific sets of
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| | Speech and language therapy. About 20
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| exercises and activities to work toward
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| | percent of children with cerebral palsy
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| two important goals: preventing weakening
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| | are unable to produce intelligible
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| or deterioration in the muscles that
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| | speech. They also experience challenges
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| arent being used (disuse atrophy), and
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| | in other areas of communication, such as
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| keeping muscles from becoming fixed in a
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| | hand gestures and facial expressions, and
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| rigid, abnormal position (contracture).
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| | they have difficulty participating in the
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| Resistive exercise programs (also called
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| | basic give and take of a normal
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| strength training) and other types of
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| | conversation. These challenges will last
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| exercise are often used to increase
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| | throughout their lives.
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| muscle performance, especially in
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| | Speech and language therapists (also
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| children and adolescents with mild
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| | known as speech therapists or
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| cerebral palsy. Daily bouts of exercise
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| | speech-language pathologists) observe,
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| keep muscles that arent normally used
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| | diagnose, and treat the communication
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| moving and active and less prone to
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| | disorders associated with cerebral palsy.
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| wasting away. Exercise also reduces the
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| | They use a program of exercises to
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| risk of contracture, one of the most
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| | teach children how to overcome specific
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| common and serious complications of
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| | communication difficulties.
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| cerebral palsy.
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| | For example, if a child has difficulty
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| Normally growing children stretch their
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| | saying words that begin with "b," the
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| muscles and tendons as they run, walk,
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| | therapist may suggest daily practice with
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| and move through their daily activities.
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| | a list of "b" words, increasing their
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| This insures that their muscles grow at
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| | difficulty as each list is mastered.
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| the same rate as their bones. But in
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| | Other kinds of exercises help children
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| children with cerebral palsy, spasticity
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| | master the social skills involved in
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| prevents muscles from stretching. As a
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| | communicating by teaching them to keep
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| result, their muscles dont grow fast
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| | their head up, maintain eye contact, and
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| enough to keep up with their lengthening
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| | repeat themselves when they are
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| bones. The muscle contracture that
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| | misunderstood.
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| results can set back the gains in
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| | Speech therapists can also help children
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| function theyve made. Physical therapy
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| | with severe disabilities learn how to use
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| alone or in combination with special
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| | special communication devices, such as a
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| braces (called orthotic devices) helps
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| | computer with a voice synthesizer, or a
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| prevent contracture by stretching spastic
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| | special board covered with symbols of
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| muscles.
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| | everyday objects and activities to which
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| Occupational therapy. This kind of
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| | a child can point to indicate his or her
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| therapy focuses on optimizing upper body
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| | wishes.
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| function, improving posture, and making
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| | Speech interventions often use a childs
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| the most of a childs mobility. An
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| | family members and friends to reinforce
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| occupational therapist helps a child
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| | the lessons learned in a therapeutic
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| master the basic activities of daily
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| | setting. This kind of indirect therapy
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| living, such as eating, dressing, and
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| | encourages people who are in close daily
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| using the bathroom alone. Fostering this
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| | contact with a child to create
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| kind of independence boosts self-reliance
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| | opportunities for him or her to use their
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| and self-esteem, and also helps reduce
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| | new skills in conversation.
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| demands on parents and caregivers.
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| | Treatments for problems with eating and
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| Recreational therapies. Recreational
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| | drooling are often necessary when
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| therapies, such as therapeutic horseback
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| | children with cerebral palsy have
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| riding (also called hippotherapy), are
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| | difficulty eating and drinking because
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| sometimes used with mildly impaired
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| | they have little control over the muscles
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| children to improve gross motor skills.
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| | that move their mouth, jaw, and tongue.
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| Parents of children who participate in
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| | They are also at risk for breathing food
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| recreational therapies usually notice an
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| | or fluid into the lungs. Some children
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| improvement in their childs speech,
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| | develop gastroesophageal reflux disease
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| self-esteem, and emotional well-being.
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| | (GERD, commonly called heartburn) in
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| Controversial physical therapies.
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| | which a weak diaphragm cant keep stomach
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| "Patterning" is a physical therapy based
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| | acids from spilling into the esophagus.
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| on the principle that children with
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| | The irritation of the acid can cause
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| cerebral palsy should be taught motor
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| | bleeding and pain.
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| skills in the same sequence in which they
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| | Individuals with cerebral palsy are also
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| develop in normal children. In this
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| | at risk for malnutrition, recurrent lung
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| controversial approach, the therapist
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| | infections, and progressive lung disease.
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| begins by teaching a child elementary
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| | The individuals most at risk for these
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| movements such as crawling -- regardless
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| | problems are those with spastic
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| of age before moving on to walking
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| | quadriplegia.
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| skills. Some experts and organizations,
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| | Initially, children should be evaluated
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| including the American Academy of
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| | for their swallowing ability, which is
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| Pediatrics, have expressed strong
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| | usually done with a modified barium
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| reservations about the patterning
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| | swallow study. Recommendations regarding
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| approach because studies have not
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| | diet modifications will be derived from
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| documented its value.
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| | the results of this study.
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| Experts have similar reservations about
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| | In severe cases where swallowing problems
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| the Bobath technique (which is also
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| | are causing malnutrition, a doctor may
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| called neurodevelopmental treatment),
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| | recommend tube feeding, in which a tube
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| named for a husband and wife team who
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| | delivers food and nutrients down the
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| pioneered the approach in England . In
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| | throat and into the stomach, or
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| this form of physical therapy,
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| | gastrostomy, in which a surgical opening
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| instructors inhibit abnormal patterns of
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| | allows a tube to be placed directly into
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| movement and encourage more normal
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| | the stomach.
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| movements.
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| | Although numerous treatments for drooling
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| The Bobath technique has had a widespread
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| | have been tested over the years, there is
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| influence on the core physical therapies
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| | no one treatment that helps reliably.
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| of cerebral palsy treatment, but there is
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| | Anticholinergic drugs such as
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| no evidence that the technique improves
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| | glycopyrolate -- can reduce the flow of
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| motor control. The American Academy of
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| | saliva but may cause unpleasant side
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| Cerebral Palsy and Developmental Medicine
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| | effects, such as dry mouth, constipation,
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| reviewed studies that measured the impact
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| | and urinary retention. Surgery, while
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| of neurodevelopmental treatment and
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| | sometimes effective, carries the risk of
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| concluded that there was no strong
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| | complications. Some children benefit
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| evidence supporting its effectiveness for
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| | from biofeedback techniques that help
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| children with cerebral palsy.
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| | them recognize more quickly when their
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| Conductive education, developed in
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| | mouths fall open and they begin to drool.
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| Hungary in the 1940s, is another physical
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| | Intraoral devices (devices that fit into
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| therapy that at one time appeared to hold
| |
| | the mouth) that encourage better tongue
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| promise. Conductive education
| |
| | positioning and swallowing are still
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| instructors attempt to improve a childs
| |
| | being evaluated, but appear to reduce
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| motor abilities by combining rhythmic
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| | drooling for some children.
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| activities, such as singing and clapping,
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