Rehabilitation of children with cerebral palsy

About the disease


Cerebral palsy, which in Russia is commonly referred to as infantile due to the fact that the diagnosis is made early in life, is a multifactorial disease caused by various abnormalities in the development of the brain. Several body systems are involved in the pathological process in cerebral palsy, and the problems are most pronounced in the field of motor function. In addition, the patient may have impaired functioning of the organs of vision and hearing, as well as often reduced intelligence. The type and severity of clinical manifestations depends on the severity of the brain damage and on which areas are "affected". Thus, cerebral palsy is a collective term that generalizes a group of disorders caused by damage to the central nervous system.


Causes of the disease

Cerebral palsy can be either congenital or acquired, but it is always a period of early human development. In the first case, brain damage, which later leads to problems with motor and other body functions, occurs during intrauterine development, during childbirth, or immediately after.

Among the congenital causes of cerebral palsy:

• diseases of a woman during pregnancy (infectious, endocrine)
• conflict of blood groups and Rh factor of mother and fetus
• underdevelopment of the placenta and umbilical cord
• birth trauma
• error of the doctor delivering the baby

Acquired causes are injuries and infectious brain lesions that occurred in the first three years of a child's life. However, such cases are rare. Usually, the diagnosis is due to a congenital pathology.


Symptoms

The severity of cerebral palsy varies. Some patients practically do not differ from healthy people and face difficulties only with increased physical activity. Conversely, with severe brain damage, a person may be completely immobilized and helpless.
The global community of rehabilitologists identifies five groups of severity of the disease depending on the disorders of muscle tone, according to which doctors choose the method of rehabilitation.:

Level I: mild cerebral palsy, the child walks by himself.
level II: the child gets tired quickly when moving, and therefore sometimes needs support.
level III: movement only with the help of a support (walker) or in a wheelchair.
level IV: low level of independence. Motorized rehabilitation equipment (self-driving wheelchair) can be used.
level V: severe cerebral palsy. Transportation of a person in a manual wheelchair.
The reason for the difficulty of movement is, among other things, muscle hypertonia (muscle spasticity). 
Because of this, the segments of the patient's limbs may assume an uncharacteristically stiff position. If the tense muscles are not artificially relaxed, it may become an impossible task for the patient to simply bend or straighten his legs and arms.
Cerebral palsy is also characterized by skeletal and muscular imperfections, dislocations and contractures of joints, which may be a consequence of muscle hypertonia and general difficulty in movement. People with cerebral palsy often suffer from skeletal deformities, such as scoliosis. The clinical picture may be complemented by a delay in the development of the psycho-speech sphere (slurred speech can also be characterized by an inability to accurately control the position of the lips and tongue due to improper muscle function), epileptic seizures, visual and hearing disorders. Mental retardation is not observed in all cases.


Diagnosis of cerebral palsy

Although the diagnosis is made in infancy, the presence of cerebral palsy is not always obvious — there are situations when monitoring a baby during the first year of life is required. It is important not to confuse cerebral palsy with other diseases that have similar manifestations, including those that are inherited (cerebral palsy is not inherited), in order to immediately choose the right course of treatment. Sometimes a geneticist's consultation is required to determine the diagnosis. For the same purpose, an MRI scan of the child's brain is performed. It is not uncommon to find a combination of hereditary pathology and cerebral palsy (for example, Down syndrome and cerebral palsy).


Comprehensive rehabilitation program for cerebral palsy

Since the consequences of cerebral palsy are extensive, rehabilitation requires the involvement of an interdisciplinary team of doctors. The treatment process affects both the main problem — motor disorders, and concomitant ones, including those related to cognitive function. At the EMC Rehabilitation Center, the treatment program is designed individually for each patient and covers physical, cognitive, and social problems. The program aimed at developing the musculoskeletal system is divided into basic treatment methods, which are used in any case, and auxiliary (for example, surgical treatment).

The basic program includes:

• kinesiotherapy (physical therapy)
• mechanotherapy and other methods related to effects on the motor system
• the use of technical means of rehabilitation (orthoses, special shoes, walkers, canes, etc.)
• botulinum therapy.

The use of botulinum toxin type A (BTA) preparations has been recognized as the most effective method of overcoming spasticity. The combination of BTA injections and parallel limb plastering helps to achieve control over hypertension (while the muscles are relaxed by injection of BTA, the limb is brought to a physiological position and fixed with plaster).
Another important area of rehabilitation is occupational therapy (or teaching children basic household skills). It is important to achieve the level of independence of the child from outsiders that is possible (excluding severe cases of illness). Classes with an occupational therapist are aimed at improving various skills, both physical and psychological.

Occupational therapy focuses on the development of basic motor skills (printing, writing, etc.), improving coordination of movements, as well as learning necessary skills in everyday life (for example, how to brush your teeth, eat, dress yourself, and so on). If necessary, the occupational therapist trains the patient to use technical means of rehabilitation.


Terms of rehabilitation for cerebral palsy

Rehabilitation for cerebral palsy is a slow process that requires patience. It must be recognized that the complete restoration of bodily functions lost due to brain damage is almost impossible, so the main goals of rehabilitation are to prevent regression and improve the patient's life as much as possible. The prognosis depends on the severity of cerebral palsy, the timeliness of seeking help (rehabilitation in adulthood is more difficult) and the frequency of training. It is important to introduce rehabilitation measures into the life of a child with cerebral palsy from birth.


Conditions in the clinic

Rehabilitation at the EMC children's clinic is carried out in a comprehensive manner, taking into account not only the functional but also the psychological characteristics of patients of different ages. The program is developed for each patient individually. The clinic's space and the rehabilitation process are focused on restoring or creating an optimal level of independence in everyday life and improving the quality of life of the child and his family.