Fact Sheets     Evidence Based Practice     Anecdotal Reports     Client Handout     Web Links

Fact Sheets

Cerebral Palsy (CP). Cerebral palsy syndromes is used broadly to describe a number of motor disorders. These disorders are characterized by impaired voluntary movement resulting from prenatal developmental abnormalities or perinatal or postnatal central nervous system damage occurring before age 5 years. The term cerebral palsy is not a diagnosis but identifies children with non-progressive spasticity, ataxia, or involuntary movements (Reed, 2001). While this condition is neurologically non-progressive, there are changes in function seen with aging and changes in body mechanics secondary to growth.

Clinicians categorize cerebral palsy into following types:

• Spastic patterns occur most commonly, alone or in combination with other atypical patterns. Spasticity, which reflects impairment to the motor cortex of the brain, may range from mild to severe. The spastic type of cerebral palsy is often categorized by the part of the body affected such as hemiplegia, quadriplegia, or diplegia. Because the neurological impairment in this type of cerebral palsy is in the highest brain levels, persons with this condition often also have impairments in cognition.
• Athetoid or dyskinetic patterns occur in about 20 percent of cases and result neurological impairment at the level of the basal ganglia. This is a lower (midbrain) area of the brain, that is sensitive to oxygen deprivation. The cognitive impairments associated with spastic cerebral palsy are less common with athetosis, because the higher brain centers may be spared. Slow, writhing involuntary movements may affect the extremities (athetoid form) or the proximal parts of the limbs and trunk (dystonic form); abrupt, jerky, distal movement (choreiform form) may also occur. The movements increase with emotional tension and disappear during sleep.
• Ataxic patterns occur in about 5-10 percent of cases and result from dysfunction of the cerebellum or its pathways. As with athetosis, this type of impairment is seldom associated with cognitive impairment, because the higher brain centers may not be involved. Weakness, incoordination, and intention tremor produce an unsteady, wide-based gait and difficulty with rapid or fine movements.
• Dystonic patterns, in particular persistent hypotonia, are present in a small percentage of individuals. Many children who have low muscle tome in infancy development voluntary movement and are not categorized as having this condition. When hypotonia persists and interferes with the development of functional movement, it is categorized as a sub-type of cerebral palsy.
• Mixed forms are common, especially spasticity and athetosis. Less often, Dystonia and athetosis occur together (Reed,2001).

Common Symptoms/Course of disease

• Decreased motor skills, with limitations varying by type and degree of motor involvement
• Seizures
• Visual impairment
• Hearing impairment
• Sensory impairments and perceptual impairments
• Small stature (Stein & Roose, 2000)

Age of Onset: Always begins during childhood before the age of five.

Sex Bias: None.

Cultural Bias: None.

Current Medical Treatment: Drug therapy has been found to be effective with preventing or controlling seizures associated with cerebral palsy. Due to variation in types of seizures, different drugs may be prescribed because no one drug prevents or controls all types of seizures. Some drugs often used to control seizures include Tegretol, Dilantin and Phenobarbital. Drug therapy can also help reduce spacticity associated with cerebral palsy. These drugs include Diazepam, Baclofen, and Dantrolene. If surgery is contradicted, these drugs can help reduce spacticity for short periods of time (Nolan, 2000).

Surgery is sometimes recommended to improve muscle development, correct contractures, and reduce spasticity in the legs.

Common surgical procedures to control spasticity are:

• Selective dorsal root rhizotomy: This form of surgery has been proven to be a safe and effective method of reducing spasticity in the legs by decreasing the amount of stimulation interfering with the acquisition of motor skills in the developing child. During the procedure, doctors try to locate and selectively sever over-activated nerves controlling leg muscles. Recent research suggests that this technique can reduce spasticity in some patients, particularly those who have spastic diplegia (USA Today, 95).
• Chronic cerebellar stimulation: In this type of surgery electrodes are implanted on the surface of the cerebellum (the part of the brain responsible for coordination of movement) and are used to stimulate certain cerebellar nerves. It was hoped that this technique would decrease spasticity and improve motor function, but the results of this invasive procedure have been mixed (Way, 2003).
• Stereotactic neurosurgery: This surgery is most frequently used to treat those with Parkinson’s disease but it can be used when treating various forms of cerebral palsy. Stereotactic neurosurgery is used to facilitate the management of abnormal movements, therefore dealing with the symptoms and not the disease itself. Depending on the side and part of the body in which improvement is desired, the neurosurgeon focuses on the area of the brain to be altered. This surgery consists of taking X-rays to map a structure within the brain. Once this is done, the coordinates are moved to a stereotactic frame, which will guide an electrode to the exact location of the brain that needs to be altered (Way, 2003).

Occupational Therapy Involvement

Occupational Therapists will treat individuals with cerebral palsy in the following areas:

• Facilitating the development of normal movement patterns
• Development of age appropriate daily living skills
• Development of exploratory and imitative play skills
• Development and support of independent locomotion
• Adaptation of tools and the use assistive technology
• Sensory processing, sensory modulation, and sensory discrimination
• Psychosocial skills: self-perception, coping skills, and social skills
• Architectural and environmental modification
• Augmentative communication
• Stress management (Reed, 2001)

References

• Nolan, J., Chalkiadis, G., Low, J., Olesch, C., & Brown, C. (2000). Anaesthesia and pain management in cerebral palsy. Anaesthesia, 55, 37-41.
• Reed, K. (2001). Quick Reference to Occupational Therapy. Gaithersburg, Maryland: Aspen Publishers.
• Stein, F., Roose, B. (2000). Pocket guide to treatment in occupational therapy. San Diego, California: Singular Publishing Group.
• Unknwon. (1995, February). New Procedure Helps Speed Recovery. USA Today, 123, 5.
• Way, L., Doherty, G. (2003). Current Surgical Diagnosis and Treatment. McGraw-Hill Companies.

How OT Makes a Difference: Evidence-Based Practice

In the article titled The Effect of Occupational Therapy Intervention on Mothers of Children with Cerebral Palsy through the use of interview explores the opinions of mothers that have had direct contact with occupational therapists as they work with their children. All of the responses were positive as the participants described at length the therapists’ abilities to effectively work with their children and to facilitate improvement in their function. They were pleased with the way occupational therapists had developed rapport with their children, motivated them and challenged them during therapy.One testimonial stated that the occupational therapist showed a child how to be independent as far as living and performing the basics. "My child learned how to feed herself, how to dress by herself, how to get in and out of chairs, and how to hold a pencil as well as a crayon." “I see really, really good responses from the therapist.”

Case-Smith J., and M.A. Nastro. 1993. The Effect of Occupational Therapy Intervention on Mothers of Children with Cerebral Palsy. American Journal of Occupational Therapy 47, no. 9: 811-817.

Anecdotal Reports

“Nancy” was born with cerebral palsy of unknown etiology. She currently receives occupational therapy for multiple reasons and has received treatment in an outpatient facility for the past three years. In addition, “Nancy” receives speech therapy to improve articulation through the use of oral exercises. “Nancy” visits the outpatient facility two times per week to receive treatment. She feels that she receives all that she wants during treatment and more. She said that “the therapists and I work together to make and meet my goals”. “Nancy” feels that due to occupational therapy she has been successful because she has accomplished many things in life such as going to school, dressing, communicating her needs, and most importantly getting married. She has a caregiver at home that helps her with her activities of daily living (ADL’s) and to translate what she wants to say. “My occupational therapist helped me utilize my electric feeder, and adapted a head pointer so that I could write, draw, and type.” She said “Occupational therapy has adapted my computer and trained me to use it!”

“Nancy” stated that “since I am 100% involved in my treatment plan, I understand very clearly how therapy is structured, and I feel that my therapists have made a lot of progress through grading all sorts of activities that have helped me to reach my current level of independence.” “Nancy” feels that occupational therapy is a great discipline because it has allowed her to achieve a lot of her goals that she never thought possible. She also stated that it is important to be involved in all aspects of your treatment plan and know exactly how it is working for you. In her opinion, it is important to have a good relationship with the therapy provider.

Client Handout

• POSITIONING A LOW TONE BABY FOR MEALS (PDF File)

Web Links

• United Cerebral Palsy
  http://www.ucpa.org
  United Cerebral Palsyhas a mission to advance the independence, productivity and full citizenship of people with cerebral palsy and other disabilities. The national organization and its nationwide network of 110 affiliates strive to ensure the inclusion of persons with disabilities in every facet of society—from the Web to the workplace, and from the classroom to the community.
• Cerebral Palsy Source
  http://www.cerebralpalsysource.com/
  A dependable one-stop site for persons looking to gain education and support.
• The Bobath Centre
  http://www.bobath.org.uk
  Specializes in the treatment of cerebral palsy and acquired neurological conditions in children & adults, as well as the training of postgraduate therapists and doctors in the Bobath approach. This site is well organized and carries out research into these conditions and the ways of mitigating their effects.
• Cerebral palsy: A guide for care
  http://gait.aidi.udel.edu/res695/homepage/pd_ortho/clinics/c_palsy/cpweb.htm
  Gives a brief description of cerebral palsy in the early stages of life, the prognosis and possible future goals.
• Treatment for children with infantile cerebral palsy
  http://www.healingarts.org/children/cp/cpsurgery.htm
  Provides the reader with the various names and descriptions of possible surgical procedures as well as techniques that can be performed on individuals with cerebral palsy.