Cerebral Palsy (CP) is a developmental disability that affects movement. It can result from damage or dysfunction in the developing brain, and may present before or at birth. It is estimated the approximately one child in 500 born in Australia will be diagnosed with CP. The effects of CP are different for each individual. The effects can include problems with movement, muscle control, muscle coordination, muscle tone, reflexes, balance and posture.
TYPES OF CEREBRAL PALSY
Spastic Cerebral Palsy
Spastic Cerebral Palsy is the most common type of CP, accounting for 70% - 80% of cases. Spasticity is a form of hypertonia caused by damage to the motor cortex of the brain. Put another way, a person's muscle tone is increased when they have spastic CP, because the part of their brain controlling their body movements is damaged. Children may have difficulty moving from one position to another and controlling individual muscles to perform a movement task.
Dyskinetic Cerebral Palsy
- Dystonic - twisting and repetitive
- Athetoid - slow movements / uncontrolled rhythmic writhing movement
- Chorea - dance like / unpredictable
Dyskinetic CP results from damage to the basal ganglia. The basal ganglia are responsible for regulating voluntary movements.
Ataxic Cerebral Palsy (least common)
Children with Ataxia have movement that can appear clumsy, unstable or imprecise. Their movements are not smooth and can appear jerky, an effect caused by damage to the cerebellum, which is the balance centre of the brain.
Mixed Cerebral Palsy
Children with CP can have a combination of all the above. This is called Mixed Cerebral Palsy.
Classification of Cerebral Palsy
In addition to the above Types of CP, CP is further classified by the region of the body affected. These include :
- Quadriplegia - all 4 limbs affected, sometimes including face and mouth.
- Diplegia - both legs are affected and sometimes mild involvement of upper limbs (often dyskinetic movement)
- Hemiplegia - one side of the body affected (arm and leg)
CP is also further classified using the Gross Motor Function Classification System (GMFCS).
GMFCS uses a 5 level system that corresponds to the extent of ability and impairment limitation. Each level is determined by an age range and a set of activities a child can achieve on his/her own. The GMFCS is a universal classification system applicable to all forms of CP.
GMFCS Classification Levels
- GMFCS Level I: Walks without limitations
- GMFCS Level II: Walks with limitations
- GMFCS Level III: Walks with adaptive equipment assistance
- GMFCS Level IV: Self mobility with use of powered mobility assistance
- GMFCS Level V: Transported in a manual wheelchair
Manual Ability Classification System (MACS)
Eliasson AC, Krumlinde Sundholme L, Rosblad B, Beckung E, Arner M, Ohrvall AM, Rosenbaum P (2006)
MACS is a classification measure for children 4-18 years of age will Cerebral Palsy and was designed to highlight the importance of hand function for independence in daily life. MACS describes how children usually use their hands to handle objects in the home, school, and community settings (what they do), rather than what is known to be their best capacity.
I. Handles objects easily and successfully.
II. Handles most objects but with somewhat reduced quality and/or speed of achievement.
III. Handles objects with difficulty; needs help to prepare and/or modify activities.
IV. Handles a limited selection of easily managed objects in adapted situations.
V. Does not handle objects and has severely limited ability to perform even simple actions.
Treatments for Cerebral Palsy at Therapy for Kids
Individual Physiotherapy Assessment
Individual Physiotherapy Treatment
Group Activities - PT
Intensive Treatment Programmes
Go Baby Go / Enliten Harness System
Cuevas Medic Exercises (CME)
Hand & Upper Limb Taping
Taping & Serial Casting
Individual Treadmill Training
Universal Exercise Unit (Spider Cage)
Individual Physiotherapy Assessment
Individual Occupational Therapy Assessment
Individual Occupational Therapy Treatment
Group Activities - OT
School Holiday Programmes
Sensory based Intervention
Modified Contraint Induced Movement Therapy (mCIMT)
Equipment Prescription & Home Modifications
Individual Speech Assessment
Individual Speech Treatment
Augmentative & Alternative Communication
What you can do
Assisting a child with cerebral palsy can be a complex task for parents. Keeping a record of all clinic appointments, X-ray reports, medical reports etc is invaluable to assist in planning treatment and allowing preparation of reports as necessary. Build skill development into your child's day which will allow them to take ownership of their therapy and become more independent. The praise and acceptance of all new skills is very important even if sometimes they are performed in very unique ways.
Children with Cerebral Palsy need frequent practice of activities in order to build the strength and coordination required for specific activities and movements however some children will resist certain activities because they are difficult and this can be a challenge for some parents. Therapy activities practiced at home need to be done in a playful, fun and rewarding way, with great excitement even for the little achievements. Your therapist will be able to assist with ideas on how to make activities fun and how they can be built into your everyday life to make use of natural opportunities that the skill can be performed. Even simply passing your child food or a toy in a specific way can be a great way to encourage the correct reach and grasp worked on during therapy and may go unnoticed by your child.