What is the treatment for cerebral palsy?
Children with cerebral palsy should be under the care of a specialised team which includes various healthcare professionals such as doctors, nurses, physiotherapists, occupational therapists and speech therapists. There is no cure for cerebral palsy but much can be done to limit the degree of disability that may have occurred if treatment had not been given.
Physiotherapy and occupational therapy
These are the mainstays of treatment. One main aim of physiotherapy is to (as far as possible) prevent or limit the contractures and limb deformities that can occur with spastic cerebral palsy. Physiotherapists also focus on range of movement, power and mobility.
Various techniques may be used, such as exercises, mobility training, braces, splints, etc (orthotics), and other equipment. A physiotherapist can show parents and carers the correct positioning of joints and which stretching exercises to do. If advised, these must be done regularly for the best chance of minimising problems.
An occupational therapist can enhance children's independence skills, such as moving on the floor, dressing and feeding independently. Occupational therapists can help with wheelchair recommendation and housing options to enable the person to live life to their maximum potential.
What about medication?
Medicines usually have a limited role. For example, botulinum toxin injections (in conjunction with physiotherapy) are used in some cases to relax spastic muscles. The most commonly injected muscles are the hamstrings, calf muscles and muscles that pull the hips together (hip adductors). The effect of a botulinum injection lasts 3-6 months.
Other muscle-relaxing medicines such as baclofen are sometimes used. Children with associated epilepsy need medicines to prevent fits (seizures).
Depending on the type and degree of muscle contracture, an operation may help - for example, an operation to loosen tight muscles or to correct a joint deformity. The aim is to give more flexibility and control to the affected limbs and joints. Most operations are performed on the muscles around the hips, knees and ankles.
What about other treatments and therapies?
These may include speech therapy, vision aids, dentistry, communications aids, nutritional advice and promoting sport. Assistive technology is being increasingly used. There is a range of devices and gadgets that can help with communication, mobility and daily tasks.
Further reading and references
Cerebral palsy in under 25s: assessment and management; NICE Guidance (January 2017)
Spasticity in children and young people; NICE Clinical Guideline (July 2012, updated Nov 2016)
Hadders-Algra M; Early diagnosis and early intervention in cerebral palsy. Front Neurol. 2014 Sep 245:185. doi: 10.3389/fneur.2014.00185. eCollection 2014.
Fairhurst C; Cerebral palsy: the whys and hows. Arch Dis Child Educ Pract Ed. 2012 Aug97(4):122-31. doi: 10.1136/edpract-2011-300593.
Surman G, Hemming K, Platt MJ, et al; Children with cerebral palsy: severity and trends over time. Paediatr Perinat Epidemiol. 2009 Nov23(6):513-21. doi: 10.1111/j.1365-3016.2009.01060.x.
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