Diagnosis
Signs and
symptoms of cerebral palsy can become more apparent over time, so a diagnosis
might not be made until a few months after birth.
If your
family doctor or pediatrician suspects your child has cerebral palsy, he or she
will evaluate your child's signs and symptoms, monitor growth and development,
review your child's medical history, and conduct a physical exam. Your doctor
might refer you to a specialist trained in treating children with brain and
nervous system conditions (pediatric neurologist, pediatric physical medicine
and rehabilitation specialist, or child developmental specialist).
Your
doctor might also order a series of tests to make a diagnosis and rule out
other possible causes.
Brain scans
Brain-imaging
technologies can reveal areas of damage or abnormal development in the brain.
These tests might include the following:
MRI. An MRI
scan uses radio waves and a magnetic field to produce detailed 3D or
cross-sectional images of your child's brain. An MRI can often identify lesions
or abnormalities in your child's brain.
This test
is painless, but it's noisy and can take up to an hour to complete. Your child
will likely receive a sedative or light general anesthesia beforehand.
Cranial ultrasound. This can
be performed during infancy. A cranial ultrasound uses high-frequency sound
waves to produce images of the brain. An ultrasound doesn't produce a detailed
image, but it may be used because it's quick and inexpensive, and it can
provide a valuable preliminary assessment of the brain.
Electroencephalogram (EEG)
If your
child is suspected of having seizures, an EEG can evaluate the condition
further. Seizures can develop in a child with epilepsy. In an EEG test, a
series of electrodes are attached to your child's scalp.
The EEG
records the electrical activity of your child's brain. It's common for there to
be changes in normal brain wave patterns in epilepsy.
Laboratory tests
Tests on
the blood, urine or skin might be used to screen for genetic or metabolic
problems.
Additional tests
If your
child is diagnosed with cerebral palsy, you'll likely be referred to
specialists to test your child for other conditions often associated with the
disorder. These tests can identify problems with:
Vision
Hearing
Speech
Intellect
Development
Movement
Treatment
Children
and adults with cerebral palsy require long-term care with a medical care team.
Besides a pediatrician or physiatrist and possibly a pediatric neurologist to
oversee your child's medical care, the team might include a variety of
therapists and mental health specialists.
Medications
Medications
that can lessen muscle tightness might be used to improve functional abilities,
treat pain and manage complications related to spasticity or other cerebral
palsy symptoms.
Muscle or nerve injections
To treat
tightening of a specific muscle, your doctor might recommend injections of
onabotulinumtoxinA (Botox, Dysport) or another agent. Your child will need
injections about every three months.
Side
effects can include pain at the injection site and mild flu-like symptoms.
Other more-serious side effects include difficulty breathing and swallowing.
Oral muscle relaxants
Drugs
such as diazepam (Valium), dantrolene (Dantrium), baclofen (Gablofen, Lioresal)
and tizanidine (Zanaflex) are often used to relax muscles.
Diazepam
carries some dependency risk, so it's not recommended for long-term use. Side
effects of these drugs include drowsiness, blood pressure changes and risk of
liver damage that requires monitoring.
In some
cases, baclofen is pumped into the spinal cord with a tube. The pump is
surgically implanted under the skin of the abdomen.
Your
child might also be prescribed medication to reduce drooling — possibly Botox
injections into the salivary glands.
Therapies
A variety
of therapies play an important role in treating cerebral palsy
Physical therapy. Muscle
training and exercises can help your child's strength, flexibility, balance,
motor development and mobility. You'll also learn how to safely care for your
child's everyday needs at home, such as bathing and feeding your child.
For the
first one to two years after birth, both physical and occupational therapists
provide support with issues such as head and trunk control, rolling, and
grasping. Later, both types of therapists are involved in wheelchair
assessments.
Braces or
splints might be recommended for your child to help with function, such as
improved walking, and stretching stiff muscles.
Occupational therapy. Occupational
therapists work to help your child gain independence in daily activities and
routines in the home, the school and the community. Adaptive equipment
recommended for your child can include walkers, quadrupedal canes, seating
systems or electric wheelchairs.
Speech and language therapy. Speech-language
pathologists can help improve your child's ability to speak clearly or to
communicate using sign language. They can also teach the use of communication
devices, such as a computer and voice synthesizer, if communication is
difficult.
Speech
therapists can also address difficulties with eating and swallowing.
Recreational therapy. Some
children benefit from regular or adaptive recreational or competitive sports
activities, such as therapeutic horseback riding or skiing. This type of
therapy can help improve your child's motor skills, speech and emotional
well-being.
Surgical procedures
Surgery
may be needed to lessen muscle tightness or correct bone abnormalities caused
by spasticity. These treatments include:
Orthopedic surgery. Children
with severe contractures or deformities might need surgery on bones or joints
to place their arms, hips or legs in their correct positions.
Surgical
procedures can also lengthen muscles and tendons that are shortened by
contractures. These corrections can lessen pain and improve mobility. The
procedures can also make it easier to use a walker, braces or crutches.
Cutting nerve fibers
(selective dorsal rhizotomy). In some severe cases, when
other treatments haven't helped, surgeons might cut the nerves serving the
spastic muscles in a procedure called selective dorsal rhizotomy. This relaxes
the muscle and reduces pain, but can cause numbness.
Alternative medicine
Some
children and adolescents with cerebral palsy use some form of complementary or
alternative medicine. These therapies aren't accepted clinical practice.
For
example, hyperbaric oxygen therapy is widely promoted for cerebral palsy
treatment despite limited evidence of benefit. Controlled clinical trials
involving therapies such as hyperbaric oxygen therapy, resistance exercise
training using special clothing, assisted motion completion for children and
certain forms of electrical stimulation have been inconclusive or showed no
benefit to date.
Stem cell
therapy is being explored as a treatment approach for cerebral palsy, but
research is still assessing whether it's safe and effective.
Coping and support
When a
child is diagnosed with a disabling condition, the whole family faces new
challenges. Here are a few tips for caring for your child and yourself:
Foster your child's
independence. Encourage any effort at independence, no matter how
small.
Be an advocate for your child. You're an
important part of your child's health care team. Don't be afraid to speak out
on your child's behalf or to ask tough questions of your physicians, therapists
and teachers.
Find support. A circle
of support can make a big difference in helping you and your family cope with
cerebral palsy and its effects. As a parent, you might feel grief and guilt
over your child's disability.
Your
doctor can help you locate support groups, organizations and counseling
services in your community. Your child might also benefit from family support
programs, school programs and counseling.
Preparing for your appointment
If your
child has cerebral palsy, how you learn about your child's condition can depend
on the severity of the disabilities, when signs and symptoms started, and
whether there were risk factors during pregnancy or delivery.
Here's
some information to help you get ready for your child's appointment with his or
her doctor.
What you can do
Make a
list of:
Symptoms that
concern you and when they began
All medications, vitamins and other
supplements your child takes, including doses
Your child's medical history, including
other conditions with which he or she has been diagnosed
Questions to ask your
doctor
Take a
relative or friend with you, if possible, to help you remember the information
you receive.
Questions to ask your doctor
What
tests will my child need?
When will
we know the results of the tests?
What
specialists will we need to see?
How will
you monitor my child's health and development?
Can you
suggest educational materials and local support services regarding cerebral
palsy?
Can my
child be followed through a multidisciplinary program that addresses all of his
or her needs on the same visit, such as a cerebral palsy clinic?
Don't
hesitate to ask other questions.
What to expect from your
doctor
Your
doctor is likely to ask you questions, including:
What
concerns do you have about your child's growth or development?
How well
does your child eat?
How does
your child respond to touch?
Do you
observe favoring of one side of the body?
Is your
child reaching certain milestones in development, such as rolling over, pushing
up, sitting up, crawling, walking or speaking?
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