PHYSIOTHER IN CEREBRAL PALSY

What is cerebral palsy?

  • Cerebral palsy is the most common childhood impairment affecting approximately 3/1000 live births in our country. 'Cerebral' – refers to the brain. 'Palsy' – can mean weakness or paralysis or lack of muscle control.
  • Cerebral palsy is a disorder of muscle control which results from some damage to part of the developing brain early in life.
  • Different muscles are controlled by different parts of the brain. Damage to parts of the brain or lack of development of some parts of the brain causes muscle weakness, stiffness, awkwardness, slowness, shakiness, and difficulty with balan
  • These problems can range from mild to severe. In mild cerebral palsy, the child may be slightly clumsy in one arm or leg, and the problem may be barely noticeable. In severe cerebral palsy, the child may have a lot of difficulties in performing everyday tasks and movements

Cerebral palsy is described in terms of

  • 1. Severity
  • 2. Part/ parts involved

How severe is the movement disorder?

  • 1. The Gross Motor Function Classification System (GMFCS) is a method of describing the range of gross motor function in children with cerebral palsy.
  • 2. The GMFCS describes five ‘levels’ of motor function, with a particular emphasis on abilities and limitations in the areas of sitting, standing and walking.
  • 3. Children with GMFCS levels I and II walk independently, children with GMFCS level III require sticks, elbow crutches or walking frames, and children with GMFCS levels IV and V usually require a wheelchair.

Which part of the body is affected?

What are the causes of cerebral palsy?

Cerebral palsy occurs in about twoin every thousand children. There aremany different risk factors and someknown causes. A problem with thebrain can occur:

  • 1. If the brain does not grow or form properly. The result is that children may have brain malformations.
  • 2. In the early months of pregnancy, for example, if the mother is exposed to certain infections such as Rubella (German measles), or Cytomegalovirus (CMV).
  • 3. During labor or at birth, for example, if the baby does not receive enough oxygen.
  • 4. In the period shortly after birth, for example, when an infant develops a severe infection, such as meningitis, in the first few days or weeks of life.
  • 5. In children having accidents in the early years of life, causing permanent brain injury. These children are also considered to have cerebral palsy

How is the diagnosis made?

  • Cerebral palsy is a clinical diagnosis based on the recognition of delays in reaching motor milestones, for example, delays in sitting, standing or walking, and changes in muscle tone and/or reflexes.
  • A brain MRI is recommended if the cause is not apparent. The MRI may provide information about the approximate time at which the brain injury occurred. In about 10% of children with cerebral palsy, the brain MRI is normal.
  • Sometimes further metabolic and genetic tests are undertaken to establish the cause of cerebral palsy.

What other problems may the child have?

  • Since it is a brain disorder, it affects all aspects of brain functions.
  • Although it predominantly affects mobility, it can impair other functions such as vision, speech, sensation, bladder control, hearing, learning & behavior which can affect the child’s quality of life.
  • Some of these conditions may be related to Cerebral Palsy, while others are unrelated, but are commonly associated with Cerebral Palsy.

Remember! No one child has all these problems. There are treatments available to help manage them.

Is it a lifelong condition? What is the cure?

As it is a developmental impairment which causes functional limitations and not a disease, there are no curative solutions in the traditional health model of disease and cure but early diagnosis & interventions by multi or transdisciplinary professionals from fields of medicine, therapy, psychology, special education, assistive technology & psychosocial sciences, can lessen their limitations & improve the quality of life of persons with cerebral palsy and their families.

What is the treatment / therapy in cerebral palsy like?

Children with cerebral palsy need a system of health care across the lifespan. All modalities of treatment depend on the ability of brain cells to increase their connectivity if environments are enriched and result in optimal compensation in the early years of life when brain growth is maximal and concentrate on decreasing limitations in the later years.

They also need inclusive policies at all levels of governmental & societal action in all spheres of life.

How does physiotherapy help? When to start? How long is it needed? What is therapy like?

Physiotherapy in cerebral palsy begins as early as in the NICU and continues as the child turns from a toddler to preschooler through childhood… teenage life and adulthood.

The focus of therapy varies with the demands of the age of the child. Initial therapy involves more sensory based approach followed by handling and positioning

As the child grows the focus moves to alignment, gait training, specific skill training etc. As per the child’s functional status the child assessed under different domains and a functional goal is formed. Goal attainment scale is used to assess the goal during therapy.

  • Neurodevelopmental therapy(NDT)
  • Sensory integration (SI)
  • Visual rehabilitation
  • Oromotor therapy
  • Cardio-respiratory endurance training
  • Orthopedic prescription

All of the above are done in during the course of therapy. Often two of three domains are covered in a single session. E.g. NDT and SI therapy is often used in combination – co-activation is facilitated during activities that involve vestibular input and thus improve postural control.


  • Assesing the child’s functional status and participation. Designing goal to enhance function. GMFCS is used to classify the child and GMFM is used as an out come measure In addition specific Setting a sessional goal on the basis of the short term goal of the child.
  • Conducting a task analysis and understanding critical components required to achieve the goal.
  • Handling and positioning the child in sucha way that the desired muscle groups are activated with appropriate alignment of the trunk and proximal and distal limb segments.
  • Using appropriate equipment (static equipment- ramp, steps, mat etc. and dynamic equipment- vestibular ball, bolsters, swings etc) to facilitate movement.
  • Use of sensory cues/toys as required.
  • Reassses goal after session using Goal attainment scale (GAS).
  • Give a home based goal for parents to work on at home and assess carry over effect.

Breathing Exercises

Treadmill Training

Spirometer Exercises

Can children with cerebral palsy attend school?

50-60% of children with cerebral palsy have normal intelligence and can be educated in normal schools and pursue wide range of careers like any other person in spite of their mobility limitations and become contributory members of society.

In case of difficulties with learning they may require a special educator/shadow teacher.

What are the expenses involved in the lifespan of a child with cerebral palsy?

Expenses include doctor’s fees, medicines, therapy charges, cost of adjuncts, adaptive equipments, walking aids, cost for surgery /Botox / hospital admissions etc.

Social costs of cerebral palsy much bigger than the medical costs which means we need to do much more for these persons at a societal & administrative levels. Social costs refer to the caring, housing, education, employment and recreational expenses.

Adaptive equipments

Prone stander

Supine stander

Walking aids

Quad cane

Elbow crutches

Walker

Posterior walker

Posterior walker + Harness

Anterior walker

Wheelchair

Adjuncts

Orthoses and Splints

Ankle foot orthosis

Supra-Malleolar orthosis

Pediwraps/gaiters

Shoulder brace

Oromotor tools

Chewy tubes

Z-vibes