Treating cerebral palsy is a lifelong team effort. Family members give the most care, with help from the primary care provider, therapists and orthotist (brace-maker). The team could also include a psychiatrist, neurologist, orthopedic surgeon or neurosurgeon. This care team works together to help your child achieve the most function possible.

Physical and Occupational Therapy

Your child may have regular sessions with a physical therapist or occupational therapist. The therapist guides the course of the sessions and monitors progress. The family makes therapy part of the child’s daily routine. Some types of therapy include:

• Stretching: Frequent stretching can prevent excessive tightening of the joints.
• Strengthening: The muscles affected by cerebral palsy are “on” all the time.The child can get better control over the muscles if they are stronger. Greater strength also helps lessen the spasticity (constant “on” activity) in the muscle.

A therapist or your health-care provider may suggest these therapies for your child:

• Electrical stimulation: A unit about the size of a deck of cards sends an electrical signal to the muscle through sticky pads placed on the skin. The pulse of electricity (like a static electric shock) causes the muscle to contract. This can be used to help kids that do not have good control over specific muscles, and can help them gain that control. It can be used in the arms or legs, and is often helpful after other treatments such as surgery or injection with botulinum toxin (often known by the brand-name Botox).
• Hydrotherapy: Your therapist may work with your child in a swimming pool to gain balance or learn to bear weight on his or her feet after surgery. Water provides some resistance for strengthening while taking some of the burden of body weight off the child. It’s fun, too!
• Hippotherapy: No hippos needed. This is actually horseback riding therapy. The rhythmic cadence of a walking horse is good for kids learning balance, and can help relax some of the spasticity.

Braces (Orthotics)

Muscles affected by cerebral palsy will constantly pull a joint in one direction until it gets tighter and eventually gets stuck there. Braces help maintain a gentle resistance against that pull while holding the braced part in the right position. A child may need:

• Hand braces
• Wrist braces
• Elbow braces
• Leg braces – ankle and foot are the most common
• Knee immobilizers
• Wedge or pillow to help with contracture that pulls a body part toward the body’s midline.
• Standing, walking and sitting hip (SWASH) braces.

Medications

• Oral medication: Muscle relaxing medicines such as tizanidine (Zanaflex) or baclofen work on all the muscles, even the neck and back muscles that might be too tight.
• Injected medication: If there is a muscle or two causing specific issues, this can be tackled with a medicine you can inject directly into the problem muscle. Anhydrous alcohol, phenol and botulinum toxin can be used in this manner.
• Implanted pumps: A pump can deliver medication directly to the nerves. The pump is about the size of a hockey puck and doctors implant it under the skin and muscle in the belly area. A tube from the pump bathes the nerves directly with medication. The result can be dramatic muscle relaxation. This is highly effective for managing moderate to severe spasticity in the long term.

Surgery

• Muscle-lengthening surgeries. Muscles sometimes are too tight in spite of therapy, braces and medication. A surgeon will have to take steps to maintain function. Common surgeries include hamstring lengthening , hip adductor lengthening , heel cord lengthening and forearm tendon transfers. After surgery, the limb is usually put in a cast in the stretched position to allow healing.
• Bone surgeries. Long-term stress on joints from tight muscles can mis-shape the bones. This is most common at the hip and foot in cerebral palsy. Common surgeries for this are VDRO and Salter Pelvic Osteotomy.

Neurosurgery

• Dorsal Rhizotomy is a procedure generally done by a pediatric neurosurgeon in the spine area.