ASSESSMENT AND IDENTIFICATION
ASSESSMENT AND IDENTIFICATION
OF CEREBRAL PALSY
MAIN CONTENTS:
1. Treatment methods of cerebral palsy according to various physical problems and disorders
2. Assessment, evaluation and testing of cerebral palsy
3. Identification of the types of cerebral palsy according to the problems
4. What things should be kept in mind during therapy of children with cerebral palsy
5. Therapy Therapeutic exercises and techniques according to the condition of cerebral palsy
6. Precautionary steps and measures during pregnancy to avoid maximum cases with cerebral palsy
7. Diagnosis of cerebral palsy - outcome of treatment
8. Conclusion
1. Treatment methods of cerebral palsy according to various physical problems and disorders
a. OCCUPATIONAL THERAPY:
"Occupational therapy is a unique combination of the art and science of providing support and developmental care for cerebral palsy children through various tasks, activity based training and active participation, restoring their abilities to overcome the condition of disability, Strengthens and enhances.
Occupational therapy begins with an assessment of a child's physical and mental functioning, both of which are majorly involved in the child's ability to function. Occupational therapists are skilled at analyzing daily activities and tasks, and they work to design therapy programs that enable individuals to more satisfactorily participate in daily integration tasks.
Occupational therapy interventions and organization of specific therapy programs are coordinated with the work of other professional and health care personnel.
The role of occupational therapists in physical development:
- Maintaining skills for day-to-day activities
- Improve muscle coordination
- Eye-Hand coordination activities
- Reflex development
- Regain power
- Developmental activity training
- Control and positioning of object movements
- Transformational activity
- Acquire the ability to play and learn
- Daily living activity training
- Sensory development
- Build concentration
b. PHYSIOTHERAPY:
Physiotherapy helps to restore the functions of the body when one is affected by injury, disease or any disabling condition. It takes a holistic approach that involves the therapy intervention directly in their care. Physiotherapy includes rehabilitation, as well as injury prevention, and promotion of health and fitness.
Physiotherapists often work in teams with other healthcare professionals to help meet a person's health care needs.
Physiotherapists can help a child with a cerebral palsy child develop strength, flexibility, balance, motor development and mobility through muscle training and exercises.
C. SURGERY:
Surgery can help reduce muscle stiffness, increase flexibility, and function in children with cerebral palsy. However, it is important to note that surgery is not a suitable option for every child with cerebral palsy, and it also comes with risks. After surgery, most children should be able to participate in post-operative physical therapy and rehabilitation. Sometimes, this is not an option for some children.
Your doctor will do a complete history and physical exam to determine if your child could potentially benefit from surgery.
There are many types of surgeries performed for children with cerebral palsy. These include procedures on the feet, ankles, feet, hips, wrists, arms or shoulders, as well as the spine and joints.
Each child's situation is unique, and treatment will be individualized to his or her needs. Surgery will be recommended if the benefits outweigh the risks that come with it.
Some operations have the potential to cause serious medical complications such as infection, bleeding, and loss of function.
It's important to remember that surgery won't magically cure your child's cerebral palsy, but it can help make the disorder more manageable, which can improve functioning in daily activities, school, and home life.
Note - Many parents think that the surgery, once performed, will completely cure the deformity in the cerebral palsy child. But that is not true. Surgery only helps physiotherapists and occupational therapists to provide more systematic therapy to achieve maximum physical improvement within a limited period of time. Therefore, the immediate focus should be on therapy after the wound has healed from surgery so that muscle tightness does not reoccur.
Major improvements visible after surgery:
- Reduce muscle stiffness
- Correct curvature of the spine (scoliosis)
- Correct foot deformity
- Reduce limb tremors
- Improvement in physical condition
- Improve balance and coordination
- Relief from physical pain due to muscle stiffness
- Fix joints and tendons
- Correction of spinal deformity
- Relax a tight muscle (contraction)
DRUG AND MEDICATIONS:
A wide assortment of drugs are used to treat cerebral palsy. Some ease symptoms, while others address complications. Drug therapy is used to control body movements, prevent seizures, treat depression, relax muscles, aid digestion, and manage pain. Medication is often adjusted for tolerability and effectiveness.
A wide assortment of medications are used for cerebral palsy to reduce symptoms and address complications. Children who have epilepsy, spasticity and involuntary or uncontrolled limb activity, such as athetosis and chorea, are often prescribed medications to reduce activities. Some drugs are used to relax muscles, increase comfort, and facilitate better body positioning.
The most common drugs used to treat cerebral palsy include:
- Anticholinergic (uncontrolled body part movement)
- Anticonvulsants (used to treat or prevent convulsions as in epilepsy)
- Antispastic (muscle relaxant)
- Anti-inflammatory (pain management)
- Stool laxatives (to treat constipation, dry hard stools)
SPECIFIC MEDICAL TESTS:
Cranial ultrasound - Cranial ultrasound is a type of neuroimaging test used to capture images of the brain via soundwaves in babies. Cranial ultrasound is a better approach in the first month of life, as it is the least invasive of neuroimaging techniques. Cranial ultrasound uses reflected sound waves to create pictures of the brain and internal chambers. A radiologist studies by moving a transducer to the soft spot on the top of the baby's head (a space between the bones of the skull in infants—between the frontal and parietal bones), and over the brain and its internal fluid. The cells are displayed on a monitor.
CT scan - computerized tomography, is a test involving a special X-ray machine that is used to take pictures of the baby's brain, skull, and blood vessels in the brain. The baby is placed in a scanner, which will then take the images. The procedure typically lasts about 10 to 15 minutes, or sometimes longer, depending on whether sedation is needed and how many images are being taken.
MRI - MRI (magnetic resonance imaging) is a type of neuroimaging that uses magnetic fields to take pictures of a baby's brain and spine. MRI scans will look at structures in greater detail and produce more definitive results than ultrasound or CT. If only an MRI of the brain is needed, the images will indicate any abnormalities in the brain's structure. If an MRI of the spine is conducted, it helps to reveal any abnormalities that lead to leg spasticity problems, bladder issues, and bowel complications. An MRI can also detect additional problems in the brain, such as a brain tumor, bleeding or swelling.
Electroencephalogram (EEG) - An EEG is a relatively painless procedure that can determine whether a child has epilepsy. Epilepsy is one of the commonly associated disorders of cerebral palsy. During an EEG, several electrodes are attached to the baby's head, which can detect the electrical activity of the brain. Children with epilepsy usually show abnormal changes in brain waves.
AIDS AND APPLIANCES SUPPORT:
Gaiters – The gaiter is like a cricket pad that is wrapped around the foot from the mid-thigh to the ankle joint. The main function is to reduce the tightness around the knee joint and bring the leg to a straight position. By wearing these gaiters, the child gets support to sit and can stand against the wall. It stabilizes the foot and helps to break the tightness of the leg muscles. It is ideal for foot positioning.
Knee Ankle Foot Orthosis (KAFO) - KAFOs extend from under the middle hip to the toes and stabilize the ankle joint as well as the knee. It reduces the stiffness around the knee joint. It reduces deformity around the knee and ankle joint. It helps in improving the efficiency of the gait.
Calipers - Calipers are a very important aid in the care of a child with cerebral palsy. It can prevent contractions. Calipers are also used to reduce pain and prevent deformities of the foot and ankle. Calipers can improve range of motion of joints and reduce muscle stiffness.
Hand splints - The main function of a hand splint is to reduce stiffness in the joints of the wrist and hand, to reduce pain in the wrist and hand, to keep the wrist and hand in the correct position, to reduce swelling and morning stiffness. For increases the strength of your fingers etc.
Major evaluations include:
- Interview with the parent and observation of the child
- Assessing the child's history and maternal history and medical reports to reveal a possible cause of cerebral palsy
- child physical assessment and examination
What questions does the therapist ask parents about the birth and development of the child during the evaluation?
a. When the therapist asks the mother some questions related to the birth of the child during the evaluation such as:
- Where was your baby born, hospital or home?
- Was the baby born by caesarean delivery or normal delivery?
- In how many months was the baby born?
- Was the baby born before the 32nd week of pregnancy?
- Post-date pregnancy or a pregnancy that is longer than the standard gestation period (37-42 weeks)
- Did the baby cry immediately after birth?
- Did the mother give birth to more than one child?
- Did the baby come out first during the birth instead of the head first?
- Was the baby's neck stuck with the umbilical cord?
- Did the body turn blue at the time of birth?
- Was the baby affected by jaundice after birth?
- Was the baby affected by fits or cramps after birth?
- Was the child suffering from any other disease like malaria, typhoid within 2 years of birth?
- Was the child affected by an infection of the brain, for example, meningitis or encephalitis?
- Was the child affected by a heart defect that was present at birth, or sickle cell disease?
- Was the child affected by a stroke or bleeding in the brain associated with a blood clotting problem?
2. Questions asked by doctors or therapists to the mother related to the timing of pregnancy such as:
- What was the mother's weight during pregnancy?
- Was the mother still affected by vomiting after 3 months of pregnancy?
- Did the mother suffer any traumatic injuries or fell down during pregnancy?
- Was there any tension in the family or in the mother during the pregnancy?
- Did the mother smoke or drink alcohol during pregnancy?
- Was the mother affected by high blood pressure, blood sugar or thyroid during pregnancy?
- Was the mother given some wrong medicines during pregnancy?
- Was the mother conceiving more than one child during the pregnancy?
3. When the therapist asks the mother some questions related to the physical development of the child such as:
- Is your baby raising his head?
- Is your child moving on his own?
- Is your child visually and audibly alert?
- Is your child able to sit on his own?
- Is your baby crawling within a reasonable time frame?
- Is your child able to walk within a reasonable time frame?
- Is your child picking up small objects on his own?
4. A specific neurological examination of the child by the doctor or therapist may include:
- General and brain physical activity skills
- Speaking ability and mental function test
- Motor system exam, which includes testing muscle tone and strength
- Includes sensory system exam, vibration and pin prick test
- Coordination and gait test
- Sensory touch test
- Developmental awareness
- Limb and brain coordination
- Cognitive skills
- Perceptual skills
5. General physical examination of the child by the doctor or therapist such as:
- Head size
- Baby weight
- Abnormal neck or groin tone
- Asymmetric body position
- Abnormal muscle strength
- Unusual gait
- Abnormal coordination
- Abnormal gait type
- Spine deformities such as scoliosis and humpback
- Voluntary physical activity control
- Stiffness, contractures and deformities in the limbs
- Involuntary reflexes
- Limb leg anomaly (differential)
- Loss of symmetry of voluntary limb movements
- Decreased range of motion of the joints
6. Testing the child for common problems such as:
- Difficulty eating, drooling and difficulty swallowing
- Constipation problem
- Problems with speaking and communication
- Seizures or fits (epilepsy)
- Trouble sleeping
- Eye problems - low vision
- Abnormally curved spine (scoliosis)
- Controlling the bladder (urinary incontinence)
- Deafness
- Difficulty falling asleep and/or staying asleep
7. Check for problems with the child's brain physical activity such as:
- walking on toes
- Trembling of hands
- uncontrolled organ activity
- Muscle spasms
- jerky movement of limbs
- Limbs appeared to be too rigid or too crooked
- Weak arms or legs (hypotonia)
- Delay in reaching physical development - eg, not sitting by 8 months or walking by 18 months
- Bone and joint movement
8. Testing of developmental reflexes (ability and disability) such as:
- balance while walking
- balance while standing
- body balance
- neck balance
- external tension of muscles
- abnormal neck movement
9. Examination of psycho-social functioning in the child such as:
- community orientation
- socialization
- leisure activity
- hobbies
- goal attainment
- identifying family members
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13. What things should be kept in mind during therapy of children with cerebral palsy?
a. No Massage - We have seen mother massage her newborn baby so that his muscles and bones remain strong and healthy. But in case of cerebral palsy baby there is an opposite indication of massage, as their limbs have stiffness due to congenital disorder. Therefore, the massage will lead to more tightening which will lead to deformity in the limbs.
b. Avoid W-sitting - W-sitting makes their bodies stuck and limits the movement of the waist. W-Sitting can affect a child's gait and balance. W-sitting promotes inward rotation of the hips so that the spastic muscles tighten in that position and force walking on the toes.
c. Keep away from junk food – These babies mostly have constipation and digestive problems. So junk food can irritate their digestive system and add unwanted fat to their body which can result in poor health and prevent progress in them.
d. Check the child's health condition before doing therapy - Many children are affected by poor health condition like malnutrition, immature bone growth, respiratory problems, epilepsy and convulsions, excessive salivation etc. So before starting the treatment, the therapist should check every condition of the child so that the child does not face any injury or anomalies during the healing process.
e. Don't show aggressive behavior and don't yell at the child - Showing fear and anger can increase a child's physical and mental impairment, make them feel isolated and result in depression that can lead to a loss of their health and Life situation may deteriorate.
f. Do not keep the baby in isolation - Keeping the baby in isolation prevents the development of the brain from various energetic situations that can hinder the physical and mental development of the child.
g. Always keep the child's body in the correct position - A bad physical condition can increase the deformity, stiffness and physical deformity of the bone joints, resulting in muscle and bone pain, immobility which prevents proper physical development and growth.
h. Why post-operative therapy should be done after any surgery – When a child has developed contracture in the joints, it causes painful movements of the joint and restricts the mobility of that child. In that case it is not possible to do physiotherapy and occupational therapy to increase the range of motion of the joints. Therefore surgery to release the tendon or lengthen the hum muscle is recommended. Surgery can correct or improve movement and alignment in the feet, ankles, hips, wrists, and arms.
- Stretching therapy
- Strengthening therapy for weak limbs
- Positioning for distortion correction
- Multi Activity Therapy for Developmental Power
- Daily living activities
- Neuro-developmental therapy
- Sensory integration therapy
- Intensive activity-based training for weak limbs
- Gait based training
- Therapy with the help of assistive devices such as splints, calipers, braces etc.
- Prevent physical deformity
- Encourage mobility
- Implement therapeutic measures
- Demonstrate knowledge of the condition and treatment plan
- Get the child involved in maximum work
- Orientation of child to person, place, situation and time
- Enable the child to participate in specific or desired activities
- To create a personalized treatment plan
