NEW TREATMENT FOR CEREBRAL PALSY
Although there is no cure for cerebral palsy, the condition can be managed through a variety of therapies to help the child reach their maximum potential in growth and development. Even though there is still not a lot known about the origin and causes of cerebral palsy since its first documentation in 1861 by Dr. William Little, new treatments for cerebral palsy continue to break new ground and offer hope to the patients and families of this condition.
One of the new treatments for cerebral palsy is selective dorsal rhizotomy (SDR). SDR is the only surgical procedure that can provide permanent reduction of spasticity in cerebral palsy. During the operation, the neurosurgeon divides each of the dorsal roots in the spine into 3-5 rootlets and stimulates each root electronically. By examining the electrical responses from muscles in the lower extremities, they can identify the rootlets that cause spasticity. The abnormal rootlets are cut, leaving the normal rootlets in tact. This reduces messages to the muscles, resulting in better balance of activities of nerve cells in the spinal cord, and reducing spasticity.
The advantages of SDR over other new treatments of cerebral palsy can be significant. There is a reduced risk of spinal deformities in the later years of life, and reduced hip flexor spasticity by sectioning the first lumbar dorsal root. It also boasts less intense back pain than other surgical procedures and earlier resumption of vigorous physical therapy.
Of all the new treatments for cerebral palsy, SDR has undergone more intense scientific scrutiny than any other surgical treatment. SDR is a long and complicated neurosurgical procedure and complications such as paralysis of the legs and bladder, impotence, and sensory loss may occur.
Another one of the new treatments for cerebral palsy is hyperbaric oxygen treatment (HBO). HBO therapy is a medical treatment that uses the administration of 100% oxygen at controlled pressure for a time frame between 60 to 90 minutes. Although usually used to treat burns and difficult healing wounds, it is now realized as a new treatment for cerebral palsy. HBO therapy facilitates healing in these conditions by increasing the amount of oxygen in the blood by up to 2000%, depending on the treatment depth. This in turn drastically increases the amount of oxygen at the cellular level.
With brain trauma, some brain cells become dormant due to lack of oxygen, usually caused by reduced blood flow related to swelling. HBO therapy has been shown to reduce swelling of brain tissue by constricting blood vessels. By the increase of the amount of oxygen at the cellular level, it is believed that dormant, oxygen starved brain cells are revived.
When treating cerebral palsy children, HBO treatment is administered for one hour and one or two treatments per day, for five or six days a week. Depending on each case, the total number of treatments will vary. It is quite common for 40 treatments to be administered during the first phase of treatment. After the first phase, the medical team involved in each case can resolve question of further HBO therapy.
Studies have proven that HBO therapy can dramatically improve the condition of a cerebral palsy patient. A study in Brazil revealed a 50% reduction in spasticity in 94% of a 224 patient study. Improvements have also been seen with vision, hearing, and speech; however, improvement will vary from patient to patient. Minor ear discomfort is the most common complaint related to HBO therapy. Similar to an airline passenger, the patient’s ears have to adjust to a change in pressure.
New treatments for cerebral palsy are being constantly tested and refined. With the help of a medical group you can determine if one of the new treatments of cerebral palsy can help your child. After all, the goal is achieving independence for your child and yourself.
CEREBRAL PALSY TREATMENT
There is no cure for Cerebral Palsy (CP), but various forms of therapy can help a person with the disorder to function and live more effectively. In general, the earlier treatment begins the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them. The earliest proven intervention occurs during the infant's recovery in the neonatal intensive care unit (NICU). Treatment may include one or more of the following: physical therapy; occupational therapy; speech therapy; drugs to control seizures, alleviate pain, or relax muscle spasms (e.g. benzodiazepienes, baclofen and intrathecal phenol/baclofen); hyperbaric oxygen; the use of Botox to relax contracting muscles; surgery to correct anatomical abnormalities or release tight muscles; braces and other orthotic devices; rolling walkers; and communication aids such as computers with attached voice synthesizers. For instance, the use of a standing frame can help reduce spasticity and improve range of motion for people with CP who use wheelchairs. Nevertheless, there is only some benefit from therapy. Treatment is usually symptomatic and focuses on helping the person to develop as many motor skills as possible or to learn how to compensate for the lack of them. Non-speaking people with CP are often successful availing themselves of augmentative and alternative communication systems such as Blissymbols.
Early Nutritional Support
In one cohort study of 490 premature infants discharged from the NICU, the rate of growth during hospital stay was related to neurological function at 18 and 22 months of age. The study found a significant decrease in the incidence of cerebral palsy in the group of premature infants with the highest growth velocity. This study suggests that adequate nutrition and growth play a protective role in the development of cerebral palsy.
Physical therapy (PT) programs are designed to encourage the patient to build a strength base for improved gait and volitional movement, together with stretching programs to limit contractures. Many experts believe that life-long physical therapy is crucial to maintain muscle tone, bone structure, and prevent dislocation of the joints.
Occupational therapy helps adults and children maximise their function, adapt to their limitations and live as independently as possible.
Orthotic devices such as ankle-foot orthoses (AFOs) are often prescribed to minimise gait irregularities. AFOs have been found to improve several measures of ambulation, including reducing energy expenditure and increasing speed and stride length.
Speech therapy helps control the muscles of the mouth and jaw, and helps improve communication. Just as CP can affect the way a person moves their arms and legs, it can also affect the way they move their mouth, face and head. This can make it hard for the person to breathe; talk clearly; and bite, chew and swallow food. Speech therapy often starts before a child begins school and continues throughout the school years.
Hyperbaric oxygen therapy (HBOT), in which pressurized oxygen is inhaled inside a hyperbaric chamber, has been used to treat CP under the theory that improving oxygen availability to damaged brain cells can reactivate some of them to function normally. Its use to treat CP is controversial. A 2007 systematic review concluded that the effect of HBOT on CP is not significantly different from that of pressurized room air, and that some children undergoing HBOT will experience adverse events such as seizures and the need for ear pressure equalization tubes; due to poor quality of data assessment the review also concluded that estimates of the prevalence of adverse events are uncertain.
Nutritional counseling may help when dietary needs are not met because of problems with eating certain foods.
Both massage therapy and hatha yoga are designed to help relax tense muscles, strengthen muscles, and keep joints flexible. Hatha yoga breathing exercises are sometimes used to try to prevent lung infections. More research is needed to determine the health benefits of these therapies for people with CP.
Surgery for people with CP usually involves one or a combination of:
- Loosening tight muscles and releasing fixed joints, most often performed on the hips, knees, hamstrings, and ankles. In rare cases, this surgery may be used for people with stiffness of their elbows, wrists, hands, and fingers.
- The insertion of a Baclofen Pump usually during the stages while a patient is a young adult. This is usually placed in the left abdomen. It is a pump that is connected to the spinal cord, whereby it sends bits of Baclofen alleviating the continuous muscle flexion. Baclofen is a muscle relaxant and is often given PO to patients to help counter the effects of spasticity.
- Straightening abnormal twists of the leg bones, i.e. femur (termed femoral anteversion or antetorsion) and tibia (tibial torsion). This is a secondary complication caused by the spastic muscles generating abnormal forces on the bones, and often results in intoeing (pigeon-toed gait). The surgery is called derotation osteotomy, in which the bone is broken (cut) and then set in the correct alignment.
- Cutting nerves on the limbs most affected by movements and spasms. This procedure, called a rhizotomy, "rhizo" meaning root and "tomy" meaning "a cutting of" from the Greek suffix 'tomia' reduces spasms and allows more flexibility and control of the affected limbs and joints.
- Botulinum Toxin A (Botox) injections into muscles that are either spastic or have contractures, the aim being to relieve the disability and pain produced by the inappropriately contracting muscle.
A new study has found that cooling the bodies and blood of high-risk full-term babies shortly after birth may significantly reduce disability or death.
Cord Blood Therapy: There are no published randomized controlled trials or meta-analysis of this treatment modality in cerebral palsy.
In March 2008 a boy diagnosed with cerebral palsy appeared on the Today Show with his family. The parents noted that he could not walk on his own and appeared to be "swallowing his tongue" at times. He was eventually diagnosed with cerebral palsy and could only walk with the aid of a walker for a short time. Earlier that year he participated in a clinical trial involving his own cord blood that his parents had saved when he was born. His parents reported that within 5 days after the procedure he was walking on his own and talking, something his mother said he was not capable of on his own and it was doubtful he would ever be able to do on his own. They also reported that the doctors also told them that if his rate of progress continues uninterrupted until he is 7 he will be pronounced cured.
Conductive education (CE) was developed in Hungary from 1945 based on the work of András Pető. It is a unified system of rehabilitation for people with neurological disorders including cerebral palsy, Parkinson's disease and multiple sclerosis, amongst other conditions. It is theorised to improve mobility, self-esteem, stamina and independence as well as daily living skills and social skills. The conductor is the professional who delivers CE in partnership with parents and children. Skills learned during CE should be applied to everyday life and can help to develop age-appropriate cognitive, social and emotional skills. It is available at specialized centers.
Biofeedback is an alternative therapy in which people with CP learn how to control their affected muscles. Some people learn ways to reduce muscle tension with this technique. Biofeedback does not help everyone with CP.
Neuro-cognitive therapy. A new approach to treating cerebral palsy from Snowdrop. It is based upon two proven principles. (1) Neural Plasticity. The brain is capable of altering its own structure and functioning to meet the demands of any particular environment. Consequently if the child is provided with an appropriate neurological environment, he will have the best chance of making progress. (2) Learning can lead to development. As early as the early 1900s, this was being proven by a psychologist named Lev Vygotsky. He proposed that children's learning is a social activity, which is achieved by interaction with more skilled members of society. There are many studies, which provide evidence for this claim. there are however, as yet no controlled studies on neuro-cognitive therapy.
Patterning is a controversial form of alternative therapy for people with CP. The method is promoted by The Institutes for the Achievement of Human Potential (IAHP), a Philadelphia nonprofit, but has been criticized by the American Academy of Pediatrics. The IAHP's methods have been endorsed by Linus Pauling, as well as some parents of children treated with their methods.