Treatment of cerebral palsy takes an interprofessional approach. The treatment includes physicians, therapists, behavioral health specialist, social workers and educational specialists. Interventions should focus on maximizing the quality of life and decreasing disability burden. Oral and injectable like botulinum toxin is used to treat tone abnormalities. Medications used for spasticity mainly include benzodiazepine. Dystonia is often treated with gabapentin, carbidopa- levodopa. In this section we will discuss the aspects of physical therapy in treating cerebral palsy. There are many benefits of physical therapy, from improving mobility to preventing future issues such as contractures and joint dislocations by keeping the body strong and flexible. Some therapeutic approaches to cerebral palsy are:
• Constraint Induced Movement Therapy: CIMT is used predominantly in individuals with hemiplegic cerebral palsy to improve the use of affected upper limb.
• Passive stretching: It is the manual application of spastic muscles to relieve soft tissue tightness. Manual stretching may increase range of movements, reduce spasticity, or improve walking efficiency in children with spasticity.
The types of stretching include
1. Fast / quick
Fast/quick stretching: stretch for facilitation. Produce a short-lived contraction of the agonist muscle and short-lived inhibition of the antagonist muscle which facilitates a muscle contraction.
Prolonged stretching: use of stretch to normalize the tone and maintain soft tissue length. Passive stretching may be achieved through a number of methods which include:
Manual stretching: Prolonged manual stretch may be applied manually, using the effect of body weight and gravity or mechanically, using machines or splints
Weight bearing: weight bearing has been reported to reduce the contracture in the lower limb through the use of Tilt-tables and standing frames through a prolonged stretch.
Splinting: splints and casts are external devices, designed to apply, distribute or remove forces to or from the body in a controlled manner.
Serial casting: serial casting is a common technique that is used and most effective in managing spasticity related contractures. It provides increased range if joint motion.
• Functional exercise: Training programs on static bicycles or treadmill have shown to be beneficial for gait and gross motor development but have not shown any effect on spasticity.
• Electrical stimulation: The goal of electrical stimulation is to increase the muscle strength and motor functions. Electrical stimulation is provided by Transcutaneous Electrical Nerve Stimulation (TENS) Unit which is portable, invasive and can be used in home settings. Neuromuscular Electrical Stimulation (NMES) involves application of transcutaneous electrical currents that result in contractions. NMES has been postulated to increase the muscle strength by increasing the cross- sectional area of the muscle and by increased recruitment of type 2 muscle fibers. Functional Electrical Stimulation refers to application of electrical stimulation during a given task or activity when a specific muscle is expected to be contracting.