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Cerebral Palsy

Cerebral Palsy (CP) is a neurological condition caused by damage to the brain which occurs before, during or after birth. The damage to the brain disrupts the brain's ability to control the muscles in the body meaning that CP causes problems with movement, posture and coordination.

Alongside the difficulties with the muscles there may also be other symptoms depending on which part of the brain was injured. As your child develops you may notice problems in aspects such as their hearing, vision, learning or behaviour.

Cerebral Palsy is not a progressive disorder which means that the extent of the damage to the brain will not develop further as you or your child grows, however, the effects of the injury to the brain may impact the body differently over time.

The specialist neurological physiotherapists at Liverpool Physio understand CP and how it can affect a person throughout a lifetime. Physiotherapy is essential for maximising independence and functioning through appreciating individuals' own goals and aspirations.





Our physiotherapist facilitating a patients step in order to improve their gait.Above: Our physiotherapist facilitating a patients step in order to improve their gait.



What is CP?



The term Cerebral Palsy itself can be broken down to better understand its meaning. Cerebral means the brain or more specifically the cerebral cortex and the word palsy refers to the loss or impairment of motor activity of the muscles.

The term, Cerebral Palsy, covers a wide variety of physical disabilities ranging from very mild and hardly noticeable to severe physical and mental impairments requiring life-long care.

It is thought that approximately 1 in every 400 children have Cerebral Palsy and those affected come from a variety of social and ethnic groups.

No two individuals with CP are affected in the same way so diagnosis of the condition is not usually made until after your child has completed his or her motor development in order for the doctor to assess the child through standard developmental stages such as crawling, sitting and walking.


Types of CP



There are three main different types of CP but many people affected present with a mixture of all three due to the wide spectrum of disabilities possible.

Spastic Cerebral Palsy

This is the most common type of CP and affects around 75% of people with the condition. The term spastic refers to an increase in muscle tone meaning that movement is made very difficult and joints may become very stiff through lack of normal movement. The muscles affected could be anywhere in the body and there are more specific categories dependent upon the limbs involved:

Quadriplegia: Both upper and lower limbs are affected.

Diplegia: Here only two of the limbs are affected (usually lower limb).

Hemiplegia or Unilateral CP:' where one side of the body is affected.

Individuals with spastic CP may also experience difficulties with speech and continence.

Athetoid Cerebral Palsy

Also known as Dyskinetic CP is found in approximately 15% of cases and is characterised by uncontrollable and spontaneous writhing movements which can involve the whole body. It is thought this unwelcome symptom is caused by the muscles changing vary rapidly from high to low tone.

Individuals with Athetoid CP usually have poor control of their posture and may also experience problems with speech due to poor muscle control.

Ataxic Cerebral Palsy

Ataxia is defined as the inability to activate the correct pattern of muscles during movement meaning that people with ataxic CP struggle to balance. The 4% of people with CP affected by ataxia may also have poor spatial awareness and find it difficult to know where their body is in relation to the surrounding environment.

Ataxia affects the whole body so walking will appear very unsteady and speech can also be affected.





One of our adult clients with cerebral palsy undertaking our CIMT porgramme to help her complete tasks like cutting food.Above: One of our adult clients with cerebral palsy undertaking our CIMT porgramme to help her complete tasks like cutting food.



What causes CP?



The causes of Cerebral Palsy can be multiple and complex. There may be no specific reason to explain why your child's brain has been injured or failed to develop as it should but we know that there are a number of known risk factors:
  • A traumatic birth
  • Premature birth
  • Deprivation of oxygen or asphyxia
  • Abnormal brain development
  • Multiple births e.g. twins & triplets
  • Neonatal stroke
  • Infection during pregnancy e.g. rubella or toxoplasmosis
  • Infections at a young age e.g. encephalitis or meningitis
  • Genetic factors
There may be multiple risk factors in one pregnancy and this can further increase the risk of CP occurring.


How is Cerebral Palsy diagnosed?



Diagnosis of Cerebral Palsy is usually made in early childhood when a specialist doctor has been able to assess the child's development over time.

Although every child develops at slightly different rates there are certain developmental milestones that should be reached by certain ages for example crawling, walking and talking. A slow progress may indicate CP.

Some symptoms a baby or young child may display are:
  • High or low muscle tone (or a combination of both)
  • Abnormal body posture
  • Trembling of the arms or legs
  • Reduced alertness
  • Poor feeding
  • Seizures



Our CIMT programme helps both adults and children become more confidence using their non affected hand and can significantly imporve an individuals quality of life.Above: Our CIMT programme helps both adults and children become more confidence using their non affected hand and can significantly imporve an individuals quality of life.



Following a thorough physical assessment, doctors may also carry out scans of the brain. A Magnetic Resonance Imaging (MRI) scan can be used to determine any damaged areas of the brain or a Computerised Tomography (CT) scan could also be used to create an image of the brain highlighting any abnormalities.

There are a number of conditions which could be the cause of the symptoms listed so doctors must rule out other possible causes before making the diagnosis.


What problems caused by CP can physiotherapy help with?



Physiotherapy is able to minimise the impact of the physical symptoms of Cerebral Palsy and therefore play a very large role in promoting good quality of life and daily functioning.

Our physiotherapists work on the following problems:
  • Reduced balance & co-ordination
  • Altered movement patterns
  • Muscle weakness
  • Muscle contractures
  • Reduced arm, leg and head control
  • Reduced joint mobility
In order to maximise potential it is important to begin specialist physiotherapy treatment as early as possible so that children affected are encouraged to correct the way in which they move and consequently prevent deformities and contractures.


How does physiotherapy help CP?



Physiotherapy is essential for any individuals with Cerebral Palsy because it can help improve symptoms and allows correct management of the condition. With early and regular treatment we can work together to promote independence through maximising function, mobility and postural control.

Physiotherapy promotes correct movement patterns, facilitating movement through key points of the body and maintaining muscle strength and muscle length to improve alignment of the body.

Unfortunately it may be the case that your local health authority has a long waiting list for specialist physiotherapy treatment. Liverpool Physio has the ability to assess your child very quickly and can treat them either until you receive NHS intervention or long-term if you desire.

Physiotherapy can help to:
  • Increase independence
  • Improve mobility
  • Reduce pain
  • Increase quality of life
  • Maximise function
These are all achievable through a combination of therapy techniques and education.

Although CP is not a progressive condition (the brain injury itself does not get worse) the impact the injury has on the body increases over time. The reason for this is that the body of an individual with CP is put under mechanical stresses due to the abnormalities in muscle tone and coordination. Physiotherapy can help to reduce the stress the body is put under through a variety of techniques and long term management to maintain function into old age.


What would treatment for CP involve?



Treatments for cerebral palsy vary depending upon the age of the patient and also the severity of the condition.

Our specialist physiotherapists are experts at assessing and treating individuals with CP from birth to adulthood and will work with you to help achieve your own personal goals.

A physiotherapy treatment plan may include:
  • Manual therapy
  • Gait re-education
  • Postural control
  • Hydrotherapy
  • Stretching exercises
  • Strengthening exercises
  • Balance exercises
  • Education
  • Specialist equipment
  • Orthotics
  • Clinic appointments
  • Home visit
Treatment for Cerebral Palsy is goal orientated and driven by the results of a thorough initial assessment and the severity of each individual's condition.

Treatment sessions are a safe and supervised environment where parents and carers' are encouraged to practice handling techniques to ensure that they are confident to use these at home as part of a daily routine to enhance your child's abilities.


How do I arrange a physiotherapy assessment for CP?



To arrange a physiotherapy assessment for CP with one of our highly experienced neurological physiotherapists you can call 0151 558 0077 or e-mail office@liverpoolphysio.co.uk


Summary



Cerebral Palsy is a lifelong condition caused by injury to the brain before, during or after birth.' It affects the ability to control movement, posture and coordination and may involve other problems such as poor vision, hearing or learning difficulties.

Physiotherapy plays a vital role in managing the symptoms of Cerebral Palsy to improve function, independence and quality of life.

If you would like to make an appointment for yourself or someone you know with CP please email office@liverpoolphysio.co.uk or call us on 0151 558 0077.

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