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Medical Author:

Norberto Alvarez, MD

Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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While specific therapies help a child develop specific skills and abilities, the overall goal of treatment is to help the individual with cerebral palsy reach his or her greatest potential physically, mentally, and socially. This is accomplished with a variety of different approaches managed by a team of professionals. Care for people with cerebral palsy is complicated, requiring a number of different services and specialists. In some areas, care is available through a single multidisciplinary clinic that oversees all aspects of the child's therapy.

Rehabilitation: A comprehensive rehabilitation program may include physical therapy, use of special equipment, and spasticity treatment. This program is often overseen by a specialist in rehabilitation medicine (sometimes called a physiatrist).

• Physical therapy involves stretching, physical exercises, and other activities that develop muscle strength, flexibility, and control. The goal is to maximize function and minimize disabling contractures. The focus is on developing specific skills such as holding the head up, sitting unsupported, or walking. Braces, splints, and casts may be used to help reach these goals.
• Special equipment that may be helpful to people with CP includes walkers, positioning devices, customized wheelchairs, scooters, and tricycles.
• Spasticity may be treated by injections into the muscles or by medications. Reduction of spasticity can improve range of motion, reduce deformity, improve response to occupational and physical therapy, and delay the need for surgery.

Occupational therapy: The occupational therapist helps the individual learn physical skills he or she needs to function and become as independent as possible in everyday life. Examples are feeding, grooming, and dressing.

Speech/language therapy: This therapy helps the child overcome communication problems. Many children with cerebral palsy have problems speaking because of poor tone or uncontrolled movements in the muscles of the mouth and tongue. Speech therapy helps develop those muscles, improving speech. Speech therapy also benefits children with hearing loss. Children who cannot speak may be able to benefit from communication technologies such as a computerized voice synthesizer.

Vision problems: An ophthalmologist is consulted for children who have strabismus and visual problems.

Medical therapy: This encompasses treatment for all medical problems whether related to CP or not. Various specialists may be called upon to deal with specific problems.

• Seizures: Seizure disorders are common in people with cerebral palsy. These are not always well controlled with medication. A specialist in conditions of the nervous system (neurologist) may be consulted for help in selecting an appropriate regimen.
• Feeding and digestive problems: Individuals with cerebral palsy often have gastroesophageal reflux or GERD (severe heartburn and related symptoms caused by regurgitation of acid from the stomach) as well as swallowing and feeding problems. A team consisting of a doctor who specializes in digestive diseases (gastroenterologist), a nutritionist, and a feeding and swallowing therapist can assess nutritional status and treat problems. Swallowing therapy helps the child eat and drink independently and helps prevent aspiration. The child's diet must be customized to accommodate limitations in swallowing. Children with severe swallowing problems require feeding through a tube.
• Breathing problems: People with cerebral palsy may have breathing problems because the muscles that control expansion and contraction of the lungs are disabled. A specialist in lung disorders (pulmonologist) should be consulted for management of the resulting lung disease.

Educational services: Many children with cerebral palsy, even those of average or above-average intelligence, are challenged in cognitive processes such as thinking, learning, and memory. They can benefit from the services of a specialist in learning disabilities.

• Such specialists can identify the child's specific learning disabilities, direct early interventions and preparation for school, and monitor his or her progress.
• In the United States, these services are provided for children younger than 3 years by an established early intervention system. Representatives of the appropriate agencies will work with parents to develop an Individualized Family Services Plan, or IFSP. This plan describes the child's needs and the services the child will receive to address those needs.
• Educational services for school-aged children are provided by the public school system. The staff at the child's school will work with the parents to develop an Individualized Education Plan (IEP) for the child. This may include services besides classroom teaching.

Navigating all of these different services can be difficult for parents. The child's health care professional can refer parents to a medical social worker who can help them find and enroll in the services their child needs.

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