By Dr Indira Boddapati
Children grow and develop at their own pace, yet their developmental process is benchmarked with specific tasks for different ages, referred to as milestones. A delay in reaching developmental milestones is a sign that a child might have Cerebral Palsy or any other neurodevelopmental disorder, particularly if other signs co-exist.
The signs and symptoms can be seen from infancy, but most families report their confusion and fall into the “wait and see period” and get postponement in their child’s treatment process.
In India, it is recorded that the occurrence of cerebral palsy ranges from 2.1 to 3 per 1,000 live births. It is estimated that Cerebral Palsy affects 17 million people every year all around the world, prompting the need to learn more about it.
What Is Cerebral Palsy (CP)?
Cerebral palsy is a common neurodevelopmental disorder that appears in early childhood. CP also describes a group of permanent disorders that affect a person’s ability to move and maintain balance and posture. It can occur due to abnormal brain development or injury or infection to the parts of the brain before, during, or shortly after birth.
How To Identify CP?
The clinical signs and symptoms of CP emerge and evolve before the age of two. The important key sign to look out for is the child having a delay in attaining motor or movement milestones (such as head control, rolling over, sitting, standing, or walking) along with co-existing symptoms like stiff muscles, uncontrolled movements, and poor balance.
An early injury of the brain puts the child at a high risk of CP, and it requires thorough medical examination by neuroimaging, neurological examinations, and motor assessment for its identification.
Along with the motor problems, many children with CP might have other symptoms such as seizures, problems with hearing and vision, poor cognition, and communication delay.
This can significantly influence a child’s life by hampering their holistic developmental processes. So, It is highly recommended that if an early diagnosis is done, CP-specific treatment should be given to the child immediately for their best chance at life.
Treatment Management Of CP
A multidisciplinary approach is recommended in Cerebral Palsy management. Physiotherapy is one of them, it plays a key role in CP treatment by focusing on maximising individual motor function and participation.
What is done before the physiotherapy treatment? To start the CP-specific intervention program, the child undergoes a comprehensive PT evaluation so that the therapist can understand the location, range, and severity of the child’s symptoms. The treatment addresses specific needs and limitations through the tailored course of therapy at different development stages.
Early years, birth to age 4: During this early stage of a child’s development, effective early intervention shows a greater impact on the child’s brain development. Physiotherapists focus on movement development by working with the child’s caregivers and family. This includes hands-on training for body positioning, feeding, play, movement, and multimodal sensory stimulation. Later the early childhood intervention program focuses on play-based activities to improve strength, movement, and function. Over the period, this helps them to participate better at home and school and integrate with peer groups, enhancing their psychological well-being.
School years, ages 4 to 18: At this stage, the treatment plan and goals will focus on mobility and coordination and involve exercise therapy and any equipment necessary to maintain health and function. Physiotherapists will also train parents and caregivers to help the child achieve functional goals. Here the treatment strategies focus on addressing self-care, maintaining a daily routine, and promoting social interaction activities.
Adolescent age and above: Here PT emphasises preventing posture problems and joint mobility limitations. At this age, by evaluating a child’s interests, strengths, and abilities, the therapist will recommend and train for the right sport or activity that will promote physical fitness and socialization with peers. On the other hand, for cognitively independent children, the focus should be to get them ready for vocational training, which helps them to be moderately or completely independent, financially.
Many individuals with mild to moderate CP can live functional lives as adults. They can enjoy careers and be active in families, especially when appropriate interventions are started early.
Globally by incorporating The International Classification of Functioning, Disability and Health (ICF) framework Physiotherapy focuses on body function and movement as well as optimal use of the child’s activity and to promote participation, maintenance and restore physical, psychological, and social well-being within the environments including home, school, recreation and community environments.
Let’s pledge on this World Cerebral Palsy Day, 2022 to help children with Cerebral Palsy move as independently as possible by delivering the best rehabilitation practices.
The author is Dr Indira Boddapati, PT MPT – Paediatric Neurology and Assistant Professor at GITAM School of Physiotherapy
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