You and your child will be introduced to a team of many different health professionals who will be involved in your child's care.
The team may include:
- a paediatrician
- a health visitor
- a social worker
- a physiotherapist, who improves a person's range of movement and coordination
- a speech and language therapist
- an occupational therapist, who helps with the skills and abilities needed for daily activities, such as washing or dressing
- an incontinence advisor
- an educational psychologist, who specialises in helping people with learning difficulties
An individual care plan will be drawn up to address any needs or problems that your child has. The plan will be continually reassessed as your child gets older and their needs and situation change.
You and your child will also be assigned a key worker, who will be the first point of contact between you and the various support services available. While your child is young, the key worker is likely to be a health visitor. As your child gets older and their needs become more complex, it is likely the key worker will be a social worker.
There is no single treatment plan for a child with cerebral palsy. Instead, there is a wide range of treatments, which are all designed to help your child achieve as much independence as possible. Some of these treatments are outlined below.
Physiotherapy is normally started as soon as your child has been diagnosed with cerebral palsy. It is one of the most important ways of helping your child to manage their condition.
There are two main goals of physiotherapy:
- to prevent the weakening of muscles that are not normally used by your child
- to prevent muscles getting stuck in a rigid position, known as contracture
Contracture is a risk in children who have problems stretching their muscles because of muscle stiffness. If the muscles cannot stretch, they do not grow as fast as the bones. This can lead to deformities, causing your child pain and discomfort.
A physiotherapist will teach your child a number of physical exercises that they can carry out every day to strengthen and stretch their muscles. Special arm or leg braces may also be used to help stretch their muscles.
Speech therapy can help children with communication difficulties by teaching them a series of exercises that can improve their ability to speak clearly.
If their communication difficulties are severe, the therapist may be able to teach them an alternative method of communication, such as sign language.
Special equipment to help your child communicate may also be available, such as a computer connected to a voice synthesizer.
Younger children can be given a device similar to a laptop that is covered with symbols of everyday objects and activities. The child then presses a combination of symbols to make themselves understood.
Occupational therapy is designed to improve your child's posture and to make the most of what mobility they already have.
They will be given advice on the best way to carry out daily tasks that require movement skills, such as going to the toilet or getting dressed.
Occupational therapy can be extremely useful in boosting your child's self-esteem and independence, especially as they get older.
If your child's muscles are particularly stiff and overactive, it can cause them frustration and pain. If your child experiences these problems, they may require medication to help relax their muscles.
Intrathecal baclofen therapy
Intrathecal baclofen therapy involves surgically implanting a small pump on the outside of the body that is connected to the spinal cord.
The pump delivers regular doses of a medicine, known as baclofen, directly into the nervous system. Baclofen blocks some of the nerve signals that cause muscle stiffness.
Your child may be prescribed muscle relaxant medicine such as diazepam, which is usually taken in tablet form.
Side effects of diazepam include:
- slurred speech
If diazepam is not effective, a number of alternative muscle relaxants can be used, such as dantrolene or tizanidine. These have similar side effects to diazepam.
If muscle relaxants are not effective, an injection of botulinum toxin may be given. Botulinum toxin works by blocking the signals from the brain to the affected muscles.
The effects of the injection normally last for up to three months. The treatment is most effective when a programme of stretching and physical therapy follows the injections.
Treating feeding and drooling problems
Children who have problems controlling their mouth will often have problems swallowing food, as well as difficulty controlling their production of saliva. Both of these problems can be potentially serious and require treatment.
If your child has problems swallowing their food (dysphagia), there is a risk that small pieces of food could enter their breathing tubes and lungs. This can damage the lungs and trigger an infection (pneumonia).
If your child's dysphagia is mild, it may be possible to teach them techniques to overcome the problem. A modified diet using soft foods may also be required. If the problem is more serious, a feeding tube may be needed, which can be placed down your child's neck or connected directly to their stomach.
If your child has drooling problems, the excess saliva can irritate the skin around the mouth, chin and neck. It can also cause the top layer of skin to break down, which can lead to an infection.
A number of treatments can help children control their drooling, including:
- anticholinergic drugs, which reduce the body's production of saliva
- surgery to redirect the saliva gland so the saliva runs towards the back of the mouth rather than the front
- intraoral devices placed in the mouth to encourage a better tongue position and regular swallowing
- biofeedback training, where the child is taught to recognise when they are drooling and to swallow accordingly
Orthopaedic surgery is designed to correct problems with bones and joints. It may be recommended if your child's cerebral palsy is causing them pain when they walk or move around. It can also improve their posture and mobility skills, which may improve their confidence and self-esteem.
During surgery, the surgeon will lengthen any muscles and tendons that are too short and are causing problems.
It takes a week or so for the scars to heal, but it can take 12-18 months for your child to be able to walk properly after surgery.
Surgical procedures are normally staggered over your child's life, taking into account their likely physical development.
Selective dorsal rhizotomy (SDR)
Selective dorsal rhizotomy (SDR) is a surgical procedure that is normally only recommended when other treatments for muscle stiffness and overactivity have been tried and failed.
It is a major operation used to treat lower limb spasticity, which involves cutting some of the sensory nerves in the lower spinal column. This can reduce muscle stiffness in the legs, as well as cramps and spasms.
However, children who have SDR will require extensive physiotherapy, lasting three to nine months, to 'relearn' basic motor skills such as walking.
Also, this type of surgery has caused complications in some children, including:
- an unpleasant tingling sensation, like pins and needles, in the part of the body that the removed nerves used to be connected to
- problems urinating
Less common complications include:
- breathing difficulties
- lung infections
You and your child (if they are able to understand the implications of surgery) should discuss the potential benefits and risks of this procedure with your surgeon.
Read the 2010 NICE guidelines on selective dorsal rhizotomy for spasticity in cerebral palsy.