Clinical features in cerebral palsy|Physiotherapy management of cerebral palsy

Clinical Feature of CP

Primary : -  (due to the brain lesion)  Muscle tone (spasticity, dystonia)

                                                   Balance

                                                         Strength

                                                         Selectivity

                                                         Sensation

Secondary  :  - due to the primary impairments causing the movement disorder)

Contractures (equinus, adduction)

Deformities (scoliosis)

Tertiary : -  Adaptive mechanisms (knee hyperextension in stance)

Problems / deformities commonly seen in CP

Upper limb

Shoulder - flexion, adduction and internalrotation deformity

Elbow – flexion and pronation of forearm                                         

Wrist – flexion and ulnar deviation

Lower limb

Windswept deformity (hip joint)

Occiput side – limb in flexion, abuction and external rotation

Face side – limb in flexion, abduction and internal rotation

Knee joint

Flexion deformity

Valgus

Genu recurvatum

Ankle joint

Equinus

Valgus/ Varum deformity

Clinching of toes

MANAGEMENT OF CP

PHYSIOTHERAPY ROLE

P.T. especially when started early in life, is helpful in promoting normal motor development, and preventing deformity and contractures.

A) Medical MX

Management of Spasticity

Drugs

a. Baclofen

b. Diazepam

c. Botulinum toxin

Surgical

Tendon lengthening and transfer and arthrodesis are some of the procedures commonly performed.

Dorsal rhizotomy: which involves selective resection of posterior nerve roots from L2 to S2. It may be helpful in children with severe lower limb spasticity, with sufficient trunk control and some form of forward locomotion.

B)PhysiotherapyMX

1.Handling and positioning

2. Therapeutic exercise

- Gentle range of motion exercises

- Strengthening exercises

- Functional progressive resistance exercises

- Stretching

3.Therapeutic handling

- To influence the quality of motor response

- To use sensory information and adapt movements

4. Facilitation

- Process of intervention which uses postural tone in a goal directed activity

5. Proprioceptive neuromuscular facilitation[PNF]

PNF uses the body’s proprioceptive system to facilitate or inhibit muscle contraction. 

CP is the major the problem seen in young child, so different techniques has been and one of them is Bobath technique, roods approaches and play therapy.

Bobath technique is used to improve neuromotor development.

Roods approaches for muscle tone management by inhibitory technique (Slow rolling, prolong stretch, slow stroking) and facilitatory technique(fast stroking, quick icing, joint compression/weight bearing, stretching).

Play therapy will encourage the child to move on.

As the aim of physiotherapist should be on functional activity to make the child practice it in a real life situation.

6. Assistive and adaptive devices

Angled spoons: two handled cups

Old stools and boxes: to provide support during sitting

Standing frames: are used in the stage of mobilization

Parallel bars: for gait training

Splints, Casts and Calipers: Specially designed shoes, ankle-foot orthoses (AFO) and calipers