Treatments and Therapies for Cerebral Palsy

Cerebral Palsy (CP) is a motor disorder associated with unusual or involuntary movements. The effects of cerebral palsy (CP) vary greatly from person to person.

There is no cure for cerebral palsy, but there are a variety of treatments and therapies that can improve function and minimize pain. These range from therapies that can help optimize an individual’s abilities, to surgical and medical interventions that can decrease symptoms of functional impairments and muscle tension.

A person with cerebral palsy will often benefit from combining multiple types of treatments and therapies into a comprehensive healthcare plan.

There are many different types of medications that can be used to treat the symptoms of cerebral palsy. Some of the most common types of drugs taken by people with CP include (1):

• Anticholinergic medications: These drugs can inhibit the parasympathetic nerve responses that cause involuntary muscle movements and excessive drooling.
• Anticonvulsant medications: Many people with cerebral palsy also have seizure disorders/epilepsy. Anticonvulsants can inhibit seizure activity by reducing excessive brain stimulation.
• Antidepressants: The physical and/or cognitive limitations imposed on people with cerebral palsy often lead to feelings of frustration and sometimes more serious mental health concerns such as depression (2). In such cases, antidepressants may be a necessary complement to therapy and other measures to promote mental and emotional well-being.
• Anti-inflammatory medications: Anti-inflammatories can be used to manage pain symptoms in people with cerebral palsy. These include anti-inflammatory corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs) and over-the-counter medications such as Tylenol.
• Muscle relaxants: These can treat spasticity, increase the range of motion, and inhibit excessive muscle contractions. Two very important muscle relaxants are botox and baclofen. Botox is injected by a medical professional and can be effective at relaxing certain muscles or groups of muscles for several months before an additional injection is needed. Baclofen (Lioresal) can be taken orally, transdermally, or through an intrathecal baclofen pump. A baclofen pump is a surgically-implanted device that delivers baclofen straight to the spinal cord, where it is needed. There are many reported advantages of baclofen pumps over the oral version, including that it is effective at much lower dosages and therefore results in fewer negative side effects.
• Laxatives: Used to treat a common cerebral palsy symptom, constipation.
• Painkillers: People with cerebral palsy may experience pain in their muscles or joints from difficulty moving them.
• Melatonin: People with cerebral palsy may experience sleeping difficulties as a result of pain and discomfort. Melatonin can be a helpful supplement.

The following types of medical equipment can improve health outcomes and/or physical abilities in people with cerebral palsy (1):

• Intrathecal baclofen pump: Please see “medications.”
• Feeding tubes: People with severe cerebral palsy may be unable to feed themselves and require a nasogastric (inserted through the nose) or gastronomy (inserted directly into the abdomen) tube.
• Hearing-related devices: Hearing impairment is a symptom for roughly 1-20% of children with cerebral palsy (3). About 5% of these children are deaf. Hearing-impaired individuals may benefit from hearing aids and cochlear implants.
• Vagus-nerve stimulators: A vagus nerve stimulator is a device used to control seizures. It is implanted in the chest, and a wire is then connected and wound around the vagus nerve (4). The stimulator prevents seizure activity by sending pulses of electrical energy to the brain.
• Breathing aids: Some people with cerebral palsy experience respiratory problems, such as daily coughing or wheezing, coughing with drinking, abnormal pulmonary exams, sleep apnea, or others (5). These issues can be caused by muscle weakness, swallowing dysfunction, decreased sensitivity of cough receptors, and gastro-oesophageal reflux, among other causes. Common treatments for breathing difficulties in people with CP include intrapulmonary percussion, cough assist devices, and chest physiotherapy (5).
• Vision-related devices: Roughly one-third to one-half of children with cerebral palsy also have vision problems, such as strabismus (“cross-eyes”), visual field defects, cerebral visual impairment (CVI), and others (3). Roughly 20% of children with CP are blind. Glasses and contact lenses can help correct some of these issues.

Although there are no surgeries that can cure cerebral palsy, there are many that can improve the health and quality of life for people with the disorder. It is important to note that some of these surgeries require extensive post-operative rehabilitation and care in order for the patient to reap the benefits of the procedure itself. Therefore, surgical intervention should be considered a complement to, rather than a replacement for, other forms of treatment and therapy.

Some types of surgery that may benefit people with cerebral palsy include the following:

• Insertion of intrathecal baclofen pump: Please see “medications.”
• Gastroenterology surgery: Some people with cerebral palsy struggle with chewing, swallowing, or digesting food. In certain cases, gastroenterologic surgery may be necessary to alleviate these issues (6). Some examples include feeding tube insertion and myotomy (a surgery designed to improve swallowing).
• Hearing correction surgery: Individuals whose cerebral palsy causes hearing impairment may benefit from cochlear implant surgery or a stapedectomy, which changes the bone structure of the ear (6).
• Neurosurgery: There are certain procedures that can improve the symptoms of cerebral palsy by addressing the root neurological problems. These surgeries involve modifying connections in the nervous system. One example is selective dorsal rhizotomy (SDR), which is a surgery that may help people with spastic cerebral palsy (7). During an SDR, physicians test sensory nerves in the lower spinal cord in order to identify the ones that are misfiring. They can then selectively destroy these nerves, which can decrease spasticity and improve muscle tone. SDR is associated with small, but measurable, improvement in motor function in patients with spastic CP (8).
• Orthopedic surgery: Orthopedic surgeries can help to improve musculoskeletal abnormalities, spasticity, and issues with balance and walking. Some examples include hip muscle release, tendon lengthening, and lumbar spinal fusion (to improve spinal stability) (6).
• Vision correction surgery: People with visual impairments may need strabismus correction, which can restore binocular vision in people with strabismus, or “cross-eyes.” Those with nearsightedness, farsightedness, or astigmatism may benefit from other types of surgery, such as LASIK eye surgery (1).

There are many types of therapy that can alleviate the symptoms of cerebral palsy and improve long-term function. With regard to therapy, early intervention is crucial because it can stop certain problems from developing in the first place and minimize the severity of other issues. People with cerebral palsy may benefit from the following types of therapy:

• Occupational therapy: The goal of occupational therapy is to identify problems that a patient has doing everyday tasks. An occupational therapist can then advise best practices for that person to carry out those activities and boost the person’s self-esteem and independence (1).
• Physical therapy: Physical therapy can increase the range of motion, strength, coordination, and other aspects of motor control (8). Therapy sessions may include exercises, massage, and other activities. Usually, some work can also be done at home.
• Speech therapy: Cerebral palsy can affect the control of the face and upper airway, resulting in issues with speaking and swallowing. Speech therapy can improve both of these problems by helping people find alternative methods of communication, providing special equipment to aid in speech, or offering speech exercises catered to the needs of the patient (1).
• Complementary and alternative therapy: There are many other types of alternative therapies that may help people with cerebral palsy (although efficacy has not been proven for all such treatments). These include hippotherapy (therapeutic horseback riding), acupuncture, yoga, hydrotherapy, hyperbaric oxygen therapy, threshold electrical stimulation, and more (9).