Cerebral palsy is a disorder in which the motor control portions of the brain are damaged in utero, during birth or shortly after birth. Infection, radiation exposure, low oxygenation of the brain and poor nutrition seem to play roles. The underlying cause(s) are still being explored. The rate of CP is generally 2.1-2.4/1000 among western populations.
Among the treatments available to improve function and maintain some level of independence, physiotherapy care is used. Franki et al, 2012 completed a systematic review of physiotherapy interventions on children with CP in order to begin the development of a framework and protocols.
In an analysis of massage, a level 2 study reported improved AROM and decreased pain while a level 4 study demonstrated to change. Psychological questionnaires demonstrated that children enjoyed the massages but that alone does not imply an improvement in their condition. Interestingly, massage did seem to decrease parental anxiety.
Stretching techniques included passive stretching. It demonstrated a level 2 effect on AROM and controlling spasticity. Passive stretching was defined as a stretch done on to the limbs of the child by an adult and held for at least 30secs.
Looking at electrical modalities, only level 4 evidence was present for the use of TENS for pain, muscle control or AROM while NMES demonstrated level 2 evidence for strength and endurance! NMES has multiple level 2 studies showing improvement in gait quality and endurance. These studies varied from 3 to 12 weeks indicating that the benefits from NMES don’t take long to measure compared to TENS where even studies of 40 weeks demonstrated no major effect.
Strength training has dozens of level 2 studies demonstrating improved AROM, strength, endurance and gait. It also increases participation level in other activities and helps with overall confidence and well-being. Strength training provides a clear way one can help children with CP move forward and manage their condition.
Endurance training was also reviewed. Level 2 evidence was found for gross motor function, strength, endurance, gait function and participation in other activities. Again, exercise seems to be a great moderator, helping to maximize function and improve overall well-being.
Weight bearing activity presented level 4 evidence for bone mineral density. This would minimize complications from osteoporosis. It also improved daily activities, bowel function and participation rates. Being able to ambulate in a somewhat independent fashion would clearly improve one’s ability to participate in activities and keep osteoporosis at bay.
Balance training demonstrated level 2 and 3 evidence for gait improvement and every day activities. Lastly, treadmill training has demonstrated a level 2 effect on gait and a level 4 effect on overall gross motor function.
In summary; strength training, endurance training, treadmill walking, weight bearing activity and stretching seem to have the largest measurable effect on the quality of life and independence of children with CP. Using an exercise based approach where possible, with appropriate use of drugs, psychological counseling and surgery as needed would be an excellent place to start. The protocols reviewed can be found in the original study by Franki, et al 2012.