Cerebral palsy (CP) is a complex neurological condition causing motor movement disability in childhood. In reality, cerebral palsy is a condition of collective neurological disorders and disabilities, causing not just one movement disability but changes in movement, balance, and posture to some degree. A wide range of physiotherapy treatment or therapeutic interventions has been in use for the management and treatment of children with cerebral palsy.
There are reports to support the benefit of neuromuscular electrical stimulation and neurodevelopmental treatments in the case of cerebral palsy in children. Other interventions like hyperbaric oxygen therapy and physiotherapy, involving body-weight support treadmill training, contain-induced therapy, sensory integration, etc. have also helped in benefitting cerebral palsy cases.
Cerebral Palsy pediatric rehabilitation requires a multidisciplinary approach in order to promote the healthcare of children with cerebral palsy, both functionally and psychologically. Physiotherapy plays a major role in this multidisciplinary health management venture. The main aim of Physiotherapy is to improve the quality of life by supporting children with Cerebral Palsy for achieving physical independence and potential fitness levels by minimizing the adverse effects of their physical impairments.
Physiotherapy treatment focuses on improving movement, function, and use of the affected child’s physical potential to maintain and restore physical and psychological well-being. A physiotherapist works on a wide range of approaches involving gross motor skills, functional mobility, motor deficit management, body positioning like sitting and standing, walking, using mobility assisting devices like wheelchairs, and position transfers.
Physiotherapy Treatment Or Physiotherapeutic Interventions
Constraint-Induced Movement Therapy (CIMT) and Serial Casting
Constraint-induced Movement therapy is predominantly used to improve the use of the affected upper limb in the case of cerebral palsy. In this therapy, the better or non-impaired upper limb is forcibly immobilized for a variable duration to pressurize individuals in using the impaired upper limb slowly over time. In CIMT, using a cast showed positive effects in the quality of functional upper limb use, time to complete specific tasks, and dexterity.
Serial casting is also a slightly similar technique where a particular joint or tight joints are immobilized with a semi-rigid, well-padded cast. This involves managing spasticity related contracture to provide an increased range of joint motion.
Manual stretching is applicable for spastic muscles to relieve soft tissue tightness. Passive manual stretching might increase walking efficiency, enhance the range of moments, and reduce spasticity in children with cerebral palsy.
When the stretch is used for facilitation, a fast/quick stretch is applied that produces short-lived contraction of the agonist’s muscle and short-lived inhibition of the antagonist’s muscle. The presence of increased tone can finally lead to the joint contracture and muscle length changes. When the stretch is used to normalize tone and maintain the length of soft tissue, a slow prolonged stretch is applied to maintain range of motion.
The slow prolonged stretch produces inhibition of the muscle responses that might help in reducing hypertonus. Prolonged manual stretch may be applied using the effect of body weight or mechanically, using weight-bearing machine or splints. Moreover, static weight-bearing exercises like standing frame and tilt table might be useful in achieving stimulation of antigravity muscle strength, improved motor functions, reduction in spasticity, and bone mineral density improvements.
Exercises based on specific functional activities with the aerobic and anaerobic capacity of children with cerebral palsy. Training programs on static bicycles or treadmills have been also beneficial for proper gait and gross motor development to improve walking performances.
In physiotherapy routine, electrical stimulation plays a role to increase the muscle strength and motor function of children with cerebral palsy. Electrical stimulation is generally done by Transcutaneous Electrical Nerve Stimulation (TENS) Unit. This unit is non-invasive, portable, and can be used in the home setting. Functional Electrical Stimulation (FES) refers to the application of electrical stimulation during some given activity or task when some specific particular muscle is supposed to be contracting.
These techniques of physiotherapy treatment have been researched and have been assured to be beneficial by the scientists and experts in the field of cerebral palsy. Thus, physiotherapy treatment has been a strong support system for children with cerebral palsy in order to reduce their spasticity and enhance motor functions of the body. But alongside physiotherapy treatment, alternate medicine like stem cell therapy has been proven to be beneficial for repairing tissue damage and reversing disease conditions for improving the health condition of the patient.