Welcome back to the ThreeSpiresPhysiotherapy blog, I thought that this time we would take a break from looking at our services in Lichfield and Staffordshire and instead have a brief look at a condition that affects a large number of children (and adults) in the UK - cerebral palsy.

What is Cerebral Palsy?

Cerebral Palsy is an extremely varied neurological condition that affects approximately 2.5 children per 1000 births (Parkes & Hill 2010), the term cerebral palsy is an umbrella term used to describe a wide range of motor and movement deficits and problems that occur in this condition. The effects can range from very mild changes in balance and strength to needing complete care for all activities of daily living.

What Causes Cerebral Palsy?

The exact causes of Cerebral Palsy are probably beyond the scope of this article but in general the cause is thought to be from damage to the motor centres of the brain during pregnancy. This likely occurs through a lack of oxygen to the foetal brain at some pint which causes damage to the brain cells.  

How Is Cerebral Palsy Diagnosed?

A formal diagnosis of Cerebral Palsy will be made by a paediatrician after a period of investigation and assessment. Cerebral Palsy is not usually immediately diagnosed and it tends to show through delayed motor development early in childhood. Delayed development in terms of sitting or crawling ability (for example) will usually be noticed by parents or health visitors at some point and this will then be investigated initially by a paediatric physiotherapist. Often this delayed development will resolve (it is important to recognise that children develop and very different rates and there is a wide spectrum of “normal” development). Eventually a paediatrician will make a formal diagnosis of Cerebral Palsy if the delayed development does not pass and it has become clear that there are significant issues regarding motor development that are unlikely to fully resolve.

 What Are The Effects of Cerebral Palsy?

As mentioned earlier Cerebral Palsy is an umbrella term that covers a wide range of difficulties in terms of motor development. As such it is very difficult to cover all the effects that Cerebral Palsy may cause.

However, Cerebral palsy typically causes difficulty with movement, balance and posture - its effects range from a small disturbance in gait to spastic quadriplegia causing high dependency and extremely limited mobility. Often children with cerebral palsy will have a large increase in muscle tone (spasticity) especially in their flexors which can cause the characteristic knees in gait of a child with cerebral palsy and the toe walking (walking with heels raised) which also affects many children. Speech and swallow functions are also commonly affected in those with more severe effects, making both communication and feeding challenging. Although cerebral palsy is primarily a condition affecting movement and muscle co-ordination, it is also linked to reduced intellectual development, epilepsy, hearing loss and vision problems.

What Professionals Help With Cerebral Palsy?

Clearly with such a wide ranging condition, children with Cerebral Palsy will require help from a large number of medical professionals. Below is a brief look at some of the professionals likely to be involved with helping a child with Cerebral Palsy:

Doctors: A child with Cerebral Palsy will usually have a paediatrician assigned who will make the formal diagnosis of Cerebral Palsy and overall manage their case. As well as the paediatrician the GP will also play a key role in ensuring any child with Cerebral Palsy has access to all the relevant services and any medication is being well managed.

Occupational therapists: OTs (for short) play a vital role in assisting both the parents of a child with Cerebral Palsy and also the child with Cerebral Palsy. The role of the OT is extremely varied from assisting with fine motor control exercises and strategies to looking at the equipment needs of the child including items such as a wheelchair.

Speech and Language Therapists: (SALT) Some children (not all) with Cerebral Palsy will have swallowing and feeding difficulties or may have difficulties with the motor control of some of the muscles that are important for speech. In these cases a speech and language therapist will play a vital role looking at appropriate feeding strategies and speech techniques.

Social Workers: Often a family with a child with Cerebral Palsy will have a social worker assigned to help navigate the myriad of services and funding that the family is likely to need to access. Social workers can play a vital role here in ensuring that the family and child are able to access all the help they need.

Support Workers: When attending school often children with Cerebral Palsy will have a support worker specifically attached to them to help them engage and access lessons.

Special School Teachers: Children with cerebral palsy will often receive therapy at school - which in many cases will be a special school as this will have the flexibility to meet their often high level of needs. The teachers at the school will have a large amount of experience of assisting children with complex needs

Physiotherapists:Your child’s physiotherapist will be a vital part of any therapy input and will be involved with helping with exercises and designing a home exercise programme.

Physiotherapy both at home and at school is a key requirement for any child with cerebral palsy and can help address many of the physical difficulties that both the children and parents face. Physiotherapy aims to promote the independence of children with cerebral palsy, improve their motor function and at its best takes a holistic view of how the needs of the child can be best served. Typical physiotherapy interventions can be stretching and mobilisation of limbs with high tone - this can assist in reducing fixed contractures from the increased tone in affected limbs and help maintain a normal range of motion at a joint. 

Gait and walking practice are also critical interventions to maximise independence and promote physical strength, especially in those children with less severe impairments- physiotherapy here can make a large difference to overall quality of life of both children and parents. Functional movement training and skilled therapeutic handling from a physiotherapist to promote normal movement patterns can also assist in achieving increased levels of independence and improved ability at tasks such as reaching, grasping and feeding. Exercise programmes specifically designed to maximise function in a child with cerebral palsy can be prescribed by a physiotherapist and are vital both in terms of the development of the child and also to ensure that parents feel able to assist their children with therapy. 

Okay, I hope that this very brief introduction to the highly complex topic of Cerebral Palsy has been of some use and has maybe given you a small insight into the condition. If your child or someone you know has Cerebral Palsy and you would like help with this, then please get in touch. We are a home visit physiotherapy service based in Lichfield and serving Sutton Coldfield, Tamworth. Rugeley, Cannock and Walsall.