To help you understand flaccid muscle tone in individuals with cerebral palsy, this article will discuss:

• Causes
• Signs and symptoms
• Management
• Tips for parents

What Causes Flaccid Muscle Tone in Individuals with Cerebral Palsy?

Cerebral palsy is a motor disability that affects a person’s movements. Our muscles create movement by contracting and relaxing. Individuals with flaccid muscle tone lack muscle tension at rest, which increases their risk of injury and makes it difficult to coordinate movements.

Abnormal (high or low) muscle tone is one of the most common effects of cerebral palsy. It is caused by damage to the areas of the developing brain responsible for regulating movement including the motor cortex, basal ganglia, thalamus, and cerebellum.

Depending on the location of brain damage, individuals may experience a wide range of secondary effects. Low muscle tone is most commonly associated with damage to the cerebellum that results in ataxic cerebral palsy. However, it can occur in individuals with spastic, dyskinetic, and mixed types of cerebral palsy as well.

Most children with flaccid muscle tone due to cerebral palsy will be diagnosed by the time they’re 6 months old. However, milder forms of hypotonia may go unnoticed until the child is older. The following section will discuss the various signs of flaccid muscle tone in individuals with cerebral palsy.

Signs of Flaccid Cerebral Palsy

Every case of cerebral palsy is unique. As a result, even individuals with the same type of CP may have completely different signs and symptoms.

Symptoms of flaccid cerebral palsy include:

• Limp or flaccid limbs
• Minimal or no neck control (head tilting to the side while sitting or inability to raise head when lying on stomach)
• Developmental delays
• Frequent falls and clumsiness
• Extreme flexibility
• Slow movements and reflexes
• A soft or weak voice
• Feeding difficulties
• Wide-based stance when walking, sitting, or standing
• Fatigue

While the brain damage that causes cerebral palsy will not worsen over time, secondary effects such as flaccidity can progress and significantly affect an individual’s quality of life. Therefore, proper management of abnormal muscle tone is essential for long-term functional independence.

Management of Flaccid Cerebral Palsy 

Early management of cerebral palsy and its secondary effects is crucial to maximizing your child’s mobility. In fact, many individuals with flaccid muscle tone are capable of building muscle tone and improving their overall mobility through repetitive, task-specific practice.

Improvements in muscle tone and mobility are possible because the brain is capable of utilizing neuroplasticity. Neuroplasticity refers to the central nervous system’s ability to make adaptive changes and reorganize its neural circuitry.

As a result, functions affected by brain damage, such as muscle tone, often have the potential to be rewired to unaffected regions of the brain and improved.  Below, we’ll discuss several therapeutic interventions that can help individuals with flaccid muscle tone improve their functional abilities.

Physical Therapy

Physical therapy for flaccid muscle tone often consists of targeted exercises that build muscle strength and improve coordination. 

Muscle tone refers to the amount of tension a muscle has at rest. In contrast, muscle strength helps you perform movements when the muscles aren’t at rest. By exercising to build strength, individuals with flaccid muscle tone may improve the speed and coordination of their movements.

The more you practice targeted exercises, the better the brain gets at perceiving demand for functions that utilize that muscle. Consequently, the repetitive stimulation will help promote adaptive changes in the brain and help strengthen the new connections. Continuing to practice physical therapy exercises at home can even further promote neuroplasticity and improvements.

Occupational Therapy

Occupational therapy for flaccid muscle tone generally focuses on improving an individual’s functional independence by practicing everyday activities such as eating, grooming, and dressing. Working on functional tasks teaches individuals with cerebral palsy how to be independent at home and promotes active movement.

Depending on the severity of the individual’s hypotonia, an occupational therapist may also teach your child how to use adaptive equipment or recommend positioning devices and strategies to increase functional independence.

Speech Therapy

Flaccidity can affect muscle tone throughout the entire body, including the muscles around the mouth. To manage speaking or feeding difficulties, individuals with hypotonia may benefit from treatments with a speech-language pathologist.

During speech therapy, individuals with flaccidity may practice activities focused on strengthening the oral motor muscles so that they can eat and/or communicate more effectively.

Additionally, those with severe oral motor impairments that are unable to produce speech may learn to use alternative forms of communication such as tablets or voice generators. Speech therapists may also recommend softer diet textures or thickened liquids if needed.

Orthotic Devices

Because children are constantly growing, poor posture caused by flaccid muscle tone in the trunk may affect the way the body develops. This can cause distorted growth, scoliosis, and pain.

Wearing orthotic devices such as braces or casts promotes proper body alignment and form. For example, a trunk brace can help prevent slouching caused by weak core muscles and promote better upright sitting balance. Similarly, if a child has more severe cerebral palsy and needs to use a wheelchair, lateral supports or a contoured backrest may also encourage better posture.

While orthotic devices won’t change flaccid muscle tone, they provide the structural support necessary to reduce injuries and promote proper musculoskeletal alignment.

Caring for a Child with Flaccid Cerebral Palsy

Now that you understand what flaccid muscle tone is and how to manage it, here are some tips to consider when caring for a child with hypotonia:

1. Before lifting your child, always make sure that one hand is supporting the back of their head to prevent neck injury.
2. Avoid lifting your child by their arms or legs because children with low muscle tone are more likely to dislocate a joint.
3. Select clothes that are comfortable, easy to put on, don’t restrict movement, and won’t get caught on nearby objects. 
4. Encourage your child to perform activities of daily living independently (or as independently as developmentally appropriate) and only assist them when they ask for it to promote active movement and body awareness.
5. Be patient. Because children with flaccid muscle tone struggle to coordinate their movements, they’ll likely need more time to carry out tasks and activities.

With the right care and enough practice, individuals with hypotonia can learn to significantly improve their mobility and overall quality of life.

Flaccid Cerebral Palsy: Key Points

Flaccid muscle tone can make it challenging for individuals with cerebral palsy to maintain their balance and coordinate movements. With a personalized management program that targets their specific weaknesses, individuals can improve their muscle tone. Additionally, there are effective ways to compensate for low muscle tone such as learning how to use adaptive tools and alternative forms of communication.

We hope this article helped you gain a better understanding of flaccidity in individuals with cerebral palsy and how to manage it.

The post Flaccid Cerebral Palsy: How to Identify, Manage, and Improve Low Muscle Tone appeared first on Flint Rehab.

To help you understand mild cerebral palsy, this article will discuss:

• Signs of mild cerebral palsy
• The importance of early intervention
• Treatment for mild cerebral palsy

Signs of Mild Cerebral Palsy

Various factors can affect how mild cerebral palsy affects movement. For many, symptoms may be so subtle that motor impairments are not outwardly noticeable until the child begins intentionally moving around.

The Gross Motor Function Classification System (GMFCS) is often used to classify how severe an individual’s cerebral palsy is. It consists of 5 levels, with level 1 being the mildest and level 5 the most severe.

Individuals with mild cerebral palsy are often classified as GMFCS level 1. These individuals are generally able to walk and perform everyday activities without assistance. Because they’re able to maintain their independence, mild CP can go unnoticed and consequently untreated for years. However, it is essential to know what the signs of mild CP look like in order to prevent complications from progressing.

Signs of mild cerebral palsy include:

• Abnormal walking: walking on the toes, walking on the heels, continuous bending of the knees, walking with toes pointing inwards or outward, slight limping, etc.
• Difficulty with fine motor skills: skills that require precision and dexterity such as writing
• Speech impairments: slurred speech, breathiness, or inability to speak (associated with non-verbal cerebral palsy)
• Slow movements/low muscle tone: children that lack muscle tone may demonstrate slow movements, low strength, and have poor head and trunk control
• Stiff movements/high muscle tone: children with too much muscle tone (a condition called spasticity) may demonstrate stiff, rigid movements
• Poor balance and coordination: especially if the cerebellum has sustained damage (associated with ataxic cerebral palsy)
• Poor posture: such as leaning/tilting towards one side, rounded shoulders, or bent knees when standing
• Tremors: involuntary, rhythmic, and oscillatory movements

Now that you understand what signs to look out for, let’s discuss the importance of early intervention.

The Importance of Early Intervention for Mild Cerebral Palsy

While the brain damage that causes cerebral palsy will not progress, secondary effects (such as abnormal muscle tone and chronic pain) can worsen over time. Therefore, early intervention is key for preventing the progression of secondary complications.

When a child grows up with unmanaged mild cerebral palsy, their motor impairments have had a long time to manifest. As a result, they may develop maladaptive movement patterns. Because children with cerebral palsy likely learn to walk and complete other daily activities with abnormal muscle tone, they don’t necessarily understand what it is like to go about daily life without it. As a result, it can be more challenging to replace these habits.

A leading CP neuroscientist, Dr. Karen Pape, explains in her book that when you ask a child with mild cerebral palsy to walk with correct form, they’ll typically be able to demonstrate their ability to do so. However, they quickly resort back to their previous gait pattern out of habit. The only way to replace this habit is to have your child consistently practice walking with good form.

This promotes the brain’s ability to make adaptive changes, neuroplasticity. Children’s brains have greater levels of neuroplasticity than those of adults. Therefore, it’s essential to take advantage of these increased amounts of neuroplasticity to help individuals with mild CP improve their motor functions before maladaptive movement patterns cause further complications.

The sooner motor impairments are addressed, the quicker and easier it is for children to learn new movement patterns that can replace the maladaptive ones. This stands true not only for walking, but also for other tasks that have been affected by a child’s cerebral palsy, such as running, speaking, or writing.

However, it’s also important to understand that the brain never runs out of neuroplasticity, so there is always potential to improve. Up next, we’ll discuss various interventions that may be involved in the management of mild cerebral palsy.

Mild Cerebral Palsy Treatment

Every case of mild cerebral palsy is unique and requires a personalized approach to management. The brain is always capable of adapting and with the right interventions put in place, individuals may be able to improve their motor functions.

One of the most common effects of mild cerebral palsy is spasticity. It is the underlying cause of many additional motor impairments including stiff movements, abnormal gait, and poor fine motor skills. By relieving spasticity, individuals can better participate in rehabilitative therapies and significantly improve their quality of life.

Below, we’ll discuss various treatments for spasticity in individuals with mild cerebral palsy.

Physical Therapy

Physical therapy focuses on helping individuals improve their mobility through targeted exercise. Continuously practicing the therapeutic exercises learned in physical therapy helps stimulate the brain and encourages it to make adaptive changes. As a result, movements affected by spasticity may be able to be reorganized to unaffected regions of the brain and improved.

Orthotics

If CP affects your child’s legs, it’s essential to correct their form before encouraging them to continue walking. Walking with an abnormal gait only reinforces poor walking habits, which may lead to chronic pain and increased difficulty with walking in the future. Wearing an orthotic device such as a brace can help hold the leg in place so it is positioned appropriately for walking.

This will help lengthen and support the affected muscles by gently stretching and preventing the leg from coiling up. It will also help strengthen your leg muscles as it passively resists against the contraction. It is important to practice walking with an appropriately fitted brace as needed in order to achieve a proper gait pattern.

On another note, when a child is having difficulties with spasticity in their hands or wrists, they may be recommended to use an orthotic called a splint. Similar to a brace, a splint will stretch the hand or wrist muscles for more functional positioning.

Botox

Physicians can inject Botox into spastic muscles to help individuals with cerebral palsy manage their spasticity. Botox works by blocking overactive nerve signals that cause muscles to involuntarily contract. The injection typically lasts for a few months before the muscles start to tighten again.

While not all individuals with mild cerebral palsy may need Botox to overcome spasticity, it allows those that do the opportunity to practice moving without the impact of spasticity. Even when the effects of Botox wear off, individuals can often maintain much of the progress they made while their spasticity was more controlled.

Baclofen

Baclofen is a muscle relaxant that can be taken orally or pumped directly to the spinal cord via a surgically implanted intrathecal baclofen pump. Generally, individuals with mild cerebral palsy will take baclofen in pill form as their spasticity is not severe enough to warrant surgery.

Similar to Botox, the effects of baclofen are temporary, and intensive physical therapy is recommended to promote better motor control.

Occupational Therapy

Children with mild cerebral palsy may also benefit from participating in occupational therapy. Occupational therapists can work with your child to enhance their participation in daily activities, including play, school, and self-care. They may include fine motor activities, sensory integration, and self-care training during their treatments.

Addressing spasticity in the hands and arms may help children more easily complete writing, manipulation of toys, and self-care activities. Again, repetitively practicing activities facilitates brain rewiring to make these activities easier in the future. Occupational therapists mainly use engaging activities, as opposed to exercises, to address the needs of a child with mild cerebral palsy.

Additionally, occupational therapists may suggest the use of compensatory strategies or adaptive equipment to increase a child’s ease of participation in certain activities, such as using a slanted surface for writing or using a utensil with a larger grip.

Speech Therapy

Speech therapists can address far more than just speech. Although not as common, some children with mild cerebral palsy have trouble with speaking, chewing, or swallowing due to spasticity affecting the facial muscles and neck muscles.

A speech therapist may be able to help with all of these areas. Speech therapists may use games or tongue and lip exercises to address the needs of children with cerebral palsy. They may also teach children alternative communication methods to use as needed.

Home Exercise

It’s essential to practice activities and exercises learned in physical, occupational, and speech therapy at home as well. Consistent practice helps reinforce demand in the brain, which promotes neuroplasticity and helps individuals improve their mobility quicker.

One way to help individuals with mild cerebral palsy stay motivated to practice at home is to use interactive neurorehabilitation devices. FitMi is a fun and engaging home rehabilitation program that encourages individuals to perform high repetitions of therapeutic exercises. It includes 40 of the top hand, arm, core, and leg exercises recommended by physical and occupational therapists.

Learn more about FitMi Home Therapy »

Understanding Mild Cerebral Palsy

Even mild forms of cerebral palsy have the potential to become more severe if its effects are not properly managed. Therefore, it’s important to learn how to effectively manage problems like spasticity to prevent future complications.

We hope this article helped you better understand the signs of mild cerebral palsy and what you can do to manage its effects. Early intervention is key, so make sure to see a doctor for an official diagnosis if you notice any signs.

The post Mild Cerebral Palsy: How to Identify the Signs & Why Early Intervention Matters appeared first on Flint Rehab.

Severe cerebral palsy often affects the entire body, which can significantly affect a variety of functions including motor control, posture, balance, and coordination. Fortunately, there are ways to effectively manage severe motor impairments and improve your quality of life.

To help you understand what to expect when an individual has severe CP, this article will discuss:

• When is cerebral palsy considered severe?
• Potential effects of severe CP
• Management techniques for severe CP

When is Cerebral Palsy Considered Severe?

One way to classify the severity of cerebral palsy is to refer to the Gross Motor Function Classification System (GMFCS). It consists of 5 different levels (1-5) that describe the extent of one’s functional abilities. The higher the level, the greater the severity of motor impairments.

Generally, individuals with a GMFCS level of 4 or 5 are considered to have severe cerebral palsy. These individuals are (for the most part) unable to walk, even with the assistance of mobility devices. As a result, individuals with severe CP typically have to rely on the use of a powered wheelchair to achieve self-mobility.

About 30% of individuals with cerebral palsy are wheelchair dependent. Of that population, 12.2% have a GMFCS level of 4 and 14.1% have a GMFCS level of 5. Because individuals with severe CP spend a significant amount of time in a wheelchair, it is essential to make sure they shift positions and move around (with the help of a caregiver) every few hours. This will help prevent the development of pressure sores and other complications associated with limited physical activity.

The following section will discuss how severe CP can affect an individual’s quality of life.

Potential Effects of Severe Cerebral Palsy

Generally, individuals with severe cerebral palsy experience motor impairments throughout their entire bodies, including the face. This occurs because greater amounts of brain damage typically affect more areas of the body.

Potential outcomes of severe cerebral palsy include:

• Feeding difficulties and poor nutrition
• Asymmetrical growth/ deformities
• Communication difficulties
• Increased caregiver dependence
• Increased risk of secondary complications (pressure sores, sleeping abnormalities, musculoskeletal pain, etc.)

Additionally, the more severe the cerebral palsy, the greater the chances of developing co-occurring complications such as epilepsy, intelligence impairments, and auditory/visual problems. These complications are not caused by the same source of brain damage that causes CP; however, they often co-occur as a result of extensive amounts of damage to the brain.

Below, we’ll discuss each of these potential outcomes in greater detail.

Oral Motor Impairments

Individuals with severe cerebral palsy often experience difficulties controlling the muscles that make up the mouth. These problems can affect an individual’s ability to feed themselves and communicate their needs.

Difficulties controlling the oral motor muscles make it challenging to chew and swallow. Feeding problems can consequently lead to malnourishment, which may affect a child’s growth and development.

Additionally, oral motor impairments can impair an individual’s speech. In fact, individuals with severe CP are more likely to be nonverbal than those with milder forms of CP. Difficulties communicating may cause frustration and lead to behavior problems such as temper tantrums.

Restricted Mobility

Abnormal muscle tone in individuals with cerebral palsy can significantly restrict one’s mobility and overall independence. As a result, individuals with severe CP may struggle to perform activities of daily living (toileting, dressing, etc.) on their own and generally need the assistance of a caregiver to help them perform everyday activities.

Increased Risk of Secondary Complications

The majority of individuals with severe cerebral palsy experience high muscle tone (spasticity). If not properly managed, spasticity can progress and lead to additional complications such as the development of pressure sores, chronic pain, sleep problems, musculoskeletal pain, and joint dislocation.

Now that you understand the potential effects of severe CP, let’s discuss the best interventions to manage them and promote better mobility.

Management Techniques for Severe Cerebral Palsy

Early intervention can play a significant role in preventing the effects of cerebral palsy from worsening and further restricting one’s functional abilities.

Although cerebral palsy is a lifelong disability, individuals can improve their functional abilities by promoting neuroplasticity, the central nervous system’s ability to make adaptive changes. The brains of children are more adaptive than those of adults. As a result, it is easier to develop new movement patterns that can replace abnormal ones by participating in management interventions as early as possible.

The most effective way to promote neuroplasticity is through highly repetitive practice of task-specific exercises. Consistent practice helps reinforce demand for the targeted function and encourages the brain to rewire its neural circuitry.

Below, we’ll discuss effective management interventions that can help individuals with severe cerebral palsy improve their quality of life.

Physical Therapy

Physical therapy focuses on maximizing an individual’s mobility through targeted exercises. This can involve stretching tight muscles, strengthening underused muscles, and moving the joints through their entire range of motion.

Physical therapy may also teach individuals how to use mobility aids to encourage self-mobility and orthotic devices to promote better musculoskeletal alignment.

Occupational Therapy

Working with an occupational therapist can help individuals with severe cerebral palsy learn the most effective ways to maximize their functional independence. This may involve learning how to use adaptive tools to perform activities they otherwise may not be able to and addressing employment and education rights.

Speech Therapy

Just because an individual has severe cerebral palsy does not mean that their intelligence will be affected. Many individuals with severe CP know exactly what they want to say, but struggle to control the muscles in their mouth enough to produce speech.

In such cases, working with a speech-language pathologist can help individuals with severe CP become more effective communicators. This can involve learning how to use augmentative and alternative communication (AAC) or strengthening the oral motor muscles.  

Caregivers

Caregivers are able to play an essential role in the management of the effects of severe cerebral palsy and, with proper education, can help minimize the risk of further complications.

Caregivers may also benefit from participating in rehabilitative therapy sessions. This way, they can be educated on how to best assist their clients using hands-on techniques. This education could include recommendations on appropriate positioning and transferring techniques and reviews of home programs for daily stretching, use of adaptive equipment, and AAC practice. They also can become a source of encouragement for their clients to practice the skills learned in therapy at home to promote neuroplasticity.

Surgery

Very severe forms of cerebral palsy may not respond well to non-invasive treatment options. Surgical intervention may help provide the spasticity relief necessary to help make rehabilitative therapies more effective.

Surgical procedures that may be recommended for individuals with severe cerebral palsy include:

• Muscle lengthening surgery involves manual lengthening of spastic muscles
• Single-event multilevel surgery involves a series of manual lengthening procedures to optimize musculoskeletal alignment and ambulation
• Selective dorsal rhizotomy involves making selective incisions at the spinal nerve roots to cut off hyperactive muscle contractions

Another surgery individuals with severe CP may require includes the insertion of a feeding tube called gastrostomy.

Feeding Tubes

Individuals who cannot control their oral motor muscles enough to chew are generally recommended to utilize a feeding tube. A feeding tube directly delivers nutrients to the individual’s stomach to bypass the need for chewing and swallowing. It helps make sure that children with severe CP receive adequate nutrients to support healthy growth and development.

Severe Cerebral Palsy: Key Points

Severe cerebral palsy often affects motor control throughout the entire body, which can significantly restrict an individual’s mobility. Fortunately, there is hope for individuals with severe motor impairments to improve their functional abilities by promoting neuroplasticity. Even if ambulation is never achieved, individuals can significantly improve their quality of life by learning to optimize their functional abilities and prevent complications from progressing.

featured images: iStock/GaryRadler/jarenwicklund/trumzz

The post Severe Cerebral Palsy: What to Expect and How to Manage appeared first on Flint Rehab.

Individuals with ataxic CP may experience difficulties coordinating their steps or performing tasks that require precision such as writing. Fortunately, there are ways to target these skills and improve them to optimize quality of life.

To help you understand what ataxic cerebral palsy is and how it affects the body, this article will discuss:

• What are the causes of ataxic cerebral palsy?
• What are the signs and symptoms of ataxic cerebral palsy?
• When should you see a doctor?
• How to treat ataxic CP

Causes of Ataxic Cerebral Palsy

Cerebral palsy is a developmental motor disability caused by damage to the brain before, during, or shortly after birth. Common causes of damage include premature birth, lack of oxygen in the brain, and infection.

Depending on which region of the brain is damaged, individuals will be diagnosed with different types of cerebral palsy. For example, ataxic cerebral palsy is caused by early damage to the cerebellum.  

The cerebellum is the region of the brain primarily responsible for regulating balance and coordination skills, as well as fine-tuning your movements. Depending on the extent of damage to the cerebellum, the effects of ataxic cerebral palsy can range from mild to severe.

In the following section, we’ll discuss some of the most common signs of ataxic cerebral palsy.

Signs and Symptoms of Ataxic Cerebral Palsy

Ataxic cerebral palsy impairs balance and coordination; however, it can manifest itself differently in each individual depending on the severity of damage to the brain.

Generally, ataxic CP affects the entire body, including the muscles around the mouth and eyes. As a result, individuals may find it challenging to speak, chew, swallow, or control their eye movements.

Other common symptoms of ataxic cerebral palsy include:

• Wide-based gait. Many children with ataxic CP walk with their legs spread apart as it creates a more stable base. This helps compensate for the lack of balance skills.
• Speech difficulties. One of the most common speech irregularities in individuals with ataxic cerebral palsy is scanning speech (speaking in a monotone, sometimes breathy voice with unnecessary pauses in between syllables or unusual emphasis on certain syllables)
• Shaky movements. Individuals with ataxic CP often experience intention tremors, which describe increased trembling when purposefully reaching for something.
• Poor fine motor skills. Individuals with ataxic CP may struggle to perform tasks that require precision such as writing, typing or picking up objects.
• Frequent falling. Due to poor balance, children with ataxic CP are prone to falling (especially when walking on uneven surfaces).
• Abnormal eye movements. Ataxic cerebral palsy can also affect vision and eye movements, which can contribute to difficulties with balance and coordination.
• Hypotonia. Some people with ataxic CP will experience low muscle tone, which can be observed through flaccid, relaxed body parts. Lack of muscle tone makes it difficult to coordinate movements and maintain unsupported positions, generally resulting in greater energy expenditure.
• Trunk instability. Individuals with hypotonia may experience trunk instability and struggle to sit or stand for extended periods.
• Eating difficulties. Some people with ataxic CP can develop dysphagia, or difficulty swallowing, due to difficulties coordinating the muscles of the mouth.

Many of the effects of ataxic cerebral palsy can be improved through rehabilitative therapies, which we will discuss soon. Before we get there, let’s discuss when to seek medical attention.

When to Seek Medical Attention

Generally, ataxic cerebral palsy is easy to overlook in infants. A wide-based gait, falling, lack of fine motor skills, and speech difficulties are all typical during the early stages of child development. It isn’t until the child gets a little older that lack of balance and coordination become worrisome.

As a result, it’s essential for parents to keep an eye out for delayed motor development. One way to do this is to familiarize yourself with developmental milestones.

For example, by 18 months, your child should be able to walk independently. Delayed developmental milestones are often the first signs of cerebral palsy. The sooner signs and symptoms of ataxic CP are identified, the sooner management can begin, generally resulting in more optimal improvements.

Up next, we’ll discuss how individuals with ataxic cerebral palsy can develop their balance and coordination skills to improve their overall quality of life.

Ataxic Cerebral Palsy Treatment

Treatment for ataxic cerebral palsy focuses on targeting each individual’s specific symptoms to minimize the impact of motor impairments on one’s quality of life.

While damaged regions of the brain are not capable of regeneration, healthy parts of the brain can utilize neuroplasticity to improve functions affected by ataxic CP. Neuroplasticity is the central nervous system’s ability to make adaptive changes and reorganize its neural circuitry.

The brain is constantly adapting based on the actions we repetitively perform. Therefore, by consistently practicing the functions we wish to improve, functions affected by brain damage could potentially be rewired to healthy, undamaged regions of the brain and improved.

Treatment for ataxic cerebral palsy may include:

• Physical therapy focuses on developing your child’s balance skills and correcting abnormal walking patterns through targeted exercise. They may also address core strength and stability, and may recommend specific equipment, such as crutches or a walker, to improve walking abilities. Oftentimes, they can use games and activities, such as an obstacle course, to improve a child’s motivation to participate in therapy.
• Occupational therapy can help individuals develop their fine motor skills by practicing practical, everyday activities like grooming and eating. For children, occupational therapists may also focus on coordinating motions needed for play and addressing school-related skills. Occupational therapists may also educate individuals on how to use adaptive tools and compensatory strategies to make daily tasks easier to perform.
• Orthotic devices such as braces and splints provide structural support to help individuals with low muscle tone achieve better control and positioning.
• Speech therapy can help individuals with speech difficulties strengthen their oral motor muscles and become better communicators. If needed, individuals may also learn alternative communication strategies. Furthermore, speech therapists can address oral motor difficulties affecting eating and swallowing skills as appropriate.

Management interventions will vary depending on each individual’s specific motor impairments. Regardless of the types of treatment pursued, continuing to work on rehabilitative exercises and activities at home, rather than just during therapy sessions, can optimize neuroplasticity for greater improvements.

Understanding Ataxic Cerebral Palsy: Key Points

Individuals with ataxic cerebral palsy generally experience difficulties with balance and coordination due to cerebellum damage. As a result, they may walk with a wide-based gait, tremble when reaching for objects, fall over often, or even have speech or eating difficulties.

Although it cannot be reversed, ataxic CP can be managed through a combination of various therapies that focus on developing body awareness, strength, and fine motor skills. We hope this article helped you understand what ataxic cerebral palsy is and the best practices for managing its effects.

The post Understanding Ataxic Cerebral Palsy: How to Spot the Symptoms & Treatment Methods appeared first on Flint Rehab.

To help you better understand how different types of cerebral palsy affect movement, this article will cover:

• What are the 4 different types of cerebral palsy?
  • Spastic Cerebral Palsy
  • Dyskinetic Cerebral Palsy
  • Ataxic Cerebral Palsy
  • Mixed Cerebral Palsy
• Treatment for different types of cerebral palsy

What are the 4 Different Types of Cerebral Palsy?

Generally, cerebral palsy can be classified into 4 main types: spastic, dyskinetic, ataxic, and mixed.

To understand how these types of cerebral palsy affect the body, it helps to understand a little brain anatomy. While various regions of the brain are involved in regulating movement, each region plays a different role. Therefore, the 4 types of cerebral palsy are primarily distinguished by which area of the brain is damaged.

Generally, cerebral palsy is the result of damage to the motor cortex, cerebellum, basal ganglia, or thalamus.

Below, we’ll discuss the major distinctions between each type of cerebral palsy. 

1. Spastic Cerebral Palsy

Spastic cerebral palsy is the most common type of cerebral palsy. In fact, it makes up about 80% of all cerebral palsy cases.

Spastic CP is caused by damage to the motor cortex, the part of the brain responsible for controlling and planning voluntary movements. This type of cerebral palsy is primarily characterized by high muscle tone, otherwise referred to as spasticity. Because constantly tight muscles make it difficult to move, individuals with spasticity typically exhibit stiff or exaggerated movements.

Another unique characteristic of this type of cerebral palsy is that it can affect specific areas of the body. All other types of CP generally affect the entire body. As a result, spastic CP can be further differentiated by which areas of the body are affected.

Categories of Spastic Cerebral Palsy

The different subcategories of spastic cerebral palsy include:

• Spastic diplegia describes motor impairments that predominantly affect the legs. While individuals with this type of CP may experience mild motor impairments in the arms, the impairments are most severe in the legs.
• Spastic hemiplegia refers to motor impairments on one side (left or right) of the body. Either the left or right portion of the brain’s motor cortex is damaged in this type of cerebral palsy, leading to motor impairments on the opposite side of the body. Individuals with this type of spastic CP generally experience more severe motor impairments in the affected upper body than the affected lower body.
• Spastic quadriplegia affects the entire body. This can include the facial muscles, which may complicate functions like chewing, swallowing, and speaking. Generally, spastic quadriplegia is associated with the most severe brain damage.  
• Spastic monoplegia occurs when a single limb (usually an arm rather than a leg) is affected.
• Spastic triplegia describes when 3 limbs are affected, generally two legs and one arm.

Learn more about spastic cerebral palsy »

2. Dyskinetic Cerebral Palsy

Dyskinetic cerebral palsy occurs in up to 15% of all cerebral palsy cases, making it the second most diagnosed type of cerebral palsy.

It’s caused by damage to the basal ganglia and/or thalamus. These regions of the brain play a role in controlling voluntary movements and inhibiting unwanted movements. When dyskinetic cerebral palsy occurs due to damage to one or both of these regions of the brain, individuals primarily experience uncontrollable movements.

There are two main types of disordered movement patterns people with dyskinetic cerebral palsy may experience: choreoathetosis and dystonia. Choreoathetosis is characterized by uncontrollable fluctuations in muscle tone and rapid, jerky movements. In contrast, dystonia is characterized by muscle contractions that cause repetitive, twisting movements. Both choreoathetosis and dystonia tend to worsen when an individual is emotional or stressed.

Learn more about dyskinetic cerebral palsy »

3. Ataxic Cerebral Palsy

Ataxic cerebral palsy makes up about 5-10% of CP cases, making it the least common type of cerebral palsy. It is caused by damage to the cerebellum, which is the region of the brain responsible for regulating balance and coordination.

As a result, individuals with ataxic cerebral palsy may demonstrate:

• Frequent falls
• A wide-based gait (walking with the legs spread apart for extra stability)
• Speech difficulties
• Intention tremors
• Trunk instability
• Difficulty performing tasks that require precision (i.e., writing)
• Low muscle tone (hypotonia)

Low muscle tone can make it challenging for individuals to control their movements. Consequently, the body must expend more energy to move or to maintain an unsupported posture. As a result, individuals with ataxic cerebral palsy may tire easily and have low activity tolerance.

Learn more about ataxic cerebral palsy »

4. Mixed Cerebral Palsy

The final type of cerebral palsy is called mixed cerebral palsy. Mixed cerebral palsy is caused by damage to multiple areas of the brain. As a result, individuals experience symptoms of two or more different types of cerebral palsy.

The most common type of mixed cerebral palsy is spastic-dyskinetic. Individuals may exhibit characteristics of spastic CP, such as stiff movements, and characteristics of dyskinetic CP, such as uncontrollable movements that worsen when emotional or stressed.

Learn more about mixed cerebral palsy »

Now that you understand the main distinctions between the 4 different types of cerebral palsy, the following section will discuss treatment goals.

Treatment for Different Types of Cerebral Palsy

Regardless of the type of cerebral palsy a person has, no two individuals experience the effects of CP exactly alike. Therefore, a personalized approach to treatment that targets each individual’s specific weaknesses is essential.

Many children see a wide variety of medical professionals from diverse specialties like physical therapy, occupational therapy, pediatrics, orthopedics, behavior therapy, and speech-language pathology to manage their CP.

Because cerebral palsy affects movement, most individuals will benefit from physical therapy. There, they will work on strengthening underused muscles, lengthening spastic muscles, correcting abnormal walking patterns, and improving overall movement and posture.

The goal of physical therapy is to focus on promoting the brain’s natural healing mechanism, neuroplasticity. Neuroplasticity enables the brain to rewire its neural circuitry. Therefore, functions affected by damage to the brain have the potential to be rewired to healthy, undamaged regions of the brain and improved.

The most effective way to promote neuroplasticity is to repetitively practice the specific skills you wish to improve. Consistent and task-specific repetition reinforces demand for those skills, which encourages the brain to adapt.

Early intervention and treatment tend to be the most effective, as poor habits have had limited time to form and the brain is able to change and adapt at a more rapid pace. However, the brain always has the ability to adapt, so improvements are possible at any age.

Different Types of Cerebral Palsy: Key Points

There are 4 primary types of cerebral palsy: spastic, dyskinetic, ataxic, and mixed. They are primarily differentiated by which regions of the brain have been damaged.

Depending on the severity and location of that damage, individuals can experience a wide range of secondary effects. As a result, everyone experiences cerebral palsy differently and will require personalized treatment.

While cerebral palsy is a lifelong condition, there is hope for improvements! By engaging neuroplasticity through repetitive, task-specific movement, individuals can potentially rewire functions affected by brain damage to healthy regions of the brain.

We hope this article helped you understand the distinctions between the various types of cerebral palsy and how to promote long-term improvements.

The post Different Types of Cerebral Palsy: Spastic, Dyskinetic, Ataxic, and Mixed appeared first on Flint Rehab.

To help you understand what spastic hemiplegia is, this article will discuss:

• What causes spastic hemiplegia?
• What are the effects of spastic hemiplegic cerebral palsy?
• How to manage spastic hemiplegia
  • Physical Therapy
  • Constraint-Induced Movement Therapy
  • Occupational Therapy
  • Medications
  • Orthotics
  • Surgery

Causes of Spastic Hemiplegia

When cerebral palsy affects only one side of the body, it is called spastic hemiplegia. To understand this condition, it helps to have a basic understanding of how the brain controls movement.

The brain consists of 2 hemispheres. The right hemisphere controls movement on the left side of the body, and the left hemisphere controls movement on the right. Therefore, when an individual with spastic hemiplegia struggles with movement on one side of the body, it stems from damage on the opposite side of the brain.

More specifically, spastic hemiplegia is caused by damage to the motor cortex. This region of the brain is primarily responsible for the execution of voluntary movements.

While spastic hemiplegia is one of the most common types of cerebral palsy, everyone experiences it differently. Individuals may experience a wide range of secondary effects at varying severities, depending on the extent of the damage to the brain.

One common characteristic among individuals with this type of cerebral palsy is that they often experience more severe motor impairments in the affected upper limbs than the affected lower limbs. In the following section, we’ll discuss other common effects of spastic hemiplegia.

Effects of Spastic Hemiplegic Cerebral Palsy

Spastic cerebral palsy is primarily characterized by high muscle tone (spasticity). Because the transmission of messages between the brain and muscles is damaged, spasticity occurs and the muscles remain involuntarily contracted.

When only one side of the body experiences spasticity, it can harm a child’s growth due to excess strain on the joints and muscles. In comparison to the nonaffected side, the affected side may not be able to grow or function optimally.

Spasticity can restrict range of motion and discourage children from using their affected side. For example, if a toy is on the child’s left side, they may turn their entire body to grab the toy with their right hand rather than pick it up with their left hand.  

When the affected side of the body is “neglected” and unused during daily activities, children may develop developmental disregard. While it is completely normal to have a dominant side, becoming overly dependent on one side of the body can result in poor bilateral coordination (the ability to use both hands at the same time) and make everyday tasks much more difficult to perform. Additionally, the affected side of the body may lose functional skills and abilities, which makes it more difficult to use in the future.

Other common effects of spastic hemiplegic cerebral palsy include:

• Stiff movements
• Abnormal gait (walking pattern)
• Asymmetric growth
• Distortions
• Unstable trunk control (leaning to one side)
• Poor fine motor skills in the affected hand

Because every individual experiences spastic hemiplegia differently, it’s essential to seek personalized care. In the following section, we’ll discuss interventions that may help effectively manage spastic hemiplegia.

How to Manage Spastic Hemiplegia

Spasticity can be referred to as a “reversible type of muscle stiffness” because it often can be temporarily reduced through the use of medications, therapies, and surgeries. However, to permanently reduce spasticity, individuals must stimulate the brain’s ability to reorganize itself (neuroplasticity).

The brain is extremely adaptive, and every action we perform stimulates it. The more you practice a function, the better the brain gets at perceiving a demand for it, which encourages it to rewire its neural circuitry. As a result, motor functions affected by spasticity may be rewired to healthy areas of the brain. By practicing highly repetitive and task-specific movements with their affected side, individuals with spastic hemiplegia can help promote permanent improvements.

Below, we’ll discuss some management interventions that can help individuals manage spastic hemiplegia.

Physical Therapy

The goal of physical therapy is to help improve a client’s motor control through targeted exercises. A physical therapist will assess the severity of an individual’s motor impairments and develop a customized exercise regimen to:

• stretch tight muscles
• strengthen underused muscles
• maintain or expand range of motion
• encourage appropriate postures and positioning
• practice new movement patterns

Physical therapists help guide clients through exercises and make sure that they’re targeting the correct muscles. They may also recommend assistive devices, such as a walker or crutches, to assist with movement.

Constraint-Induced Movement Therapy

To avoid developmental disregard, individuals with spastic hemiplegia must continuously practice using their affected side properly. Constraint-induced movement therapy focuses on promoting the use of the affected arm by discouraging use of the non-affected arm.

Typically, the therapist instructs the individual to wear a glove or mitt on their unaffected hand to discourage its use. Then, the affected arm undergoes intensive training. Therapists often encourage individuals to continue using the glove or mitt at home while in the period of intensive training to further promote use of the affected arm. The goal is to promote neuroplasticity through repetitive stimulation.

Although it has not been studied specifically in individuals with cerebral palsy, therapists may also utilize constraint-induced movement therapy in a similar fashion to focus on increasing use of the affected leg.

Occupational Therapy

Occupational therapy can help individuals with spastic hemiplegia become more independent by practicing activities of daily living such as using silverware, writing, dressing and brushing their teeth. Additionally, individuals may practice fine motor activities and using both sides of their body to develop bilateral coordination skills and perform tasks more efficiently.

Occupational therapists are also able to recommend adaptive equipment to increase independence and safety with activities of daily living, such as using built-up handles for utensils or installing grab bars in the shower. They may also encourage use of compensatory strategies, such as dressing the affected side first and undressing it last, to increase overall independence.

Medications

Medications like baclofen and Botox can help temporarily reduce spasticity by inhibiting signals that cause muscles to contract.

However, these medications won’t permanently reduce spasticity. Instead, individuals should take advantage of their reduced muscle tone and practice moving and using their affected side as much as possible to promote adaptive changes in the brain. Improvements made while using Botox or baclofen can carry over even once the medication wears off.

Orthotics

Orthotics like braces, casts, and splints help support proper musculoskeletal alignment.

Because the brain damage that causes cerebral palsy occurs in early childhood, spastic hemiplegia can significantly affect the way a child’s body develops. Wearing orthotics can help provide trunk support, stabilize the limbs in place, and provide prolonged gentle stretching of spastic muscles.

Surgery

Generally, surgery is only recommended when all other forms of spasticity management prove ineffective.

Surgery for spastic hemiplegia generally involves manually lengthening and realigning the muscles or selectively cutting the nerve roots for a specific muscle to reduce its excitability.

Spastic Hemiplegia: Key Points

When an individual with cerebral palsy experiences motor impairments on one side of the body, it is referred to as spastic hemiplegia. Motor impairments are caused by damage to the opposite hemisphere of the brain. Therefore, damage to the left hemisphere causes motor impairments on the right side of the body and vice versa.

Fortunately, the brain is capable of making neuroadaptive changes through highly repetitive, task-specific stimulation. By managing spasticity and consistently training the affected side of the body, individuals with spastic hemiplegia can stimulate neural adaptations in the brain and improve motor control on their affected side.

We hope this article helped you gain a better understanding of what spastic hemiplegia is and how to manage it.

The post Spastic Hemiplegia: When Cerebral Palsy Only Affects One Side of the Body appeared first on Flint Rehab.

To help you understand what spastic diplegia is, this article will discuss:

• What causes spastic diplegia?
• What are the signs and symptoms of spastic diplegia?
• Is spastic diplegia treatable?

Causes of Spastic Diplegia

Cerebral palsy is caused by damage to the developing brain before, during, or shortly after birth. Common causes of early brain damage include premature birth, infection, and lack of oxygen to the brain.

Depending on the size and location of damage to the brain, different areas of the body can be affected at various severities. For example, damage to the cerebellum causes ataxic cerebral palsy while damage to the motor cortex causes spastic cerebral palsy.

Spastic diplegia is a type of spastic cerebral palsy that primarily affects motor control in the legs. Generally, this type of spastic CP is associated with milder damage to the brain, which is why motor impairments primarily affect the legs as opposed to the entire body.

However, it’s important to understand that lower body motor impairments can still have significant consequences. Fortunately, when properly managed through rehabilitative therapies and other treatment interventions, individuals with spastic diplegia can improve their quality of life. In the following section, we’ll discuss the potential effects of spastic diplegia.

Signs and Symptoms of Spastic Diplegia

Most individuals with spastic diplegia have normal cognitive abilities and can walk independently. However, some individuals may experience more severe motor impairments and may be dependent on an assistive mobility device such as a crutch, wheelchair, or walker.

It’s ideal to identify the signs of cerebral palsy as early as possible so that your child can get the treatment they need to minimize the impact of their motor impairments and avoid forming poor movement habits.

Common signs and symptoms of spastic diplegia include:

Spasticity

All individuals with spastic diplegia experience some form of involuntary muscle contractions called spasticity. Spasticity occurs because damage to the motor cortex disrupts the transmission of signals from the brain to the muscles. As a result, the muscles associated with the area of damage remain involuntarily contracted.

Spasticity is the underlying cause of many secondary complications of cerebral palsy including abnormal walking patterns, pain, and distorted growth.

While the brain damage that causes cerebral palsy does not worsen over time, spasticity can.  If left unmanaged, spasticity can severely restrict mobility and result in the inability to walk.

Abnormal Gait

Most people with spastic diplegia have an abnormal gait (walking pattern) because the muscles in their legs cannot fully relax due to spasticity. The continuous muscle contractions result in stiff movements that make it difficult for individuals to maintain balance when they walk.

Common abnormal gait patterns in individuals with spastic diplegia include:

• Scissor gait (walking with the knees turned inwards)
• Tiptoeing (walking on the toes)
• Crouch gait (walking with continuously bent knees, hips, and ankles)

Muscle Weakness

Severe spasticity in the legs can discourage individuals from participating in physical activity. Our bodies build strength through everyday movements that place pressure on the joints, bones, and muscles. Without regular physical activity, the muscles and bones start to weaken, which increases one’s risk of injury.

Delayed Developmental Milestones

A combination of spasticity and muscle weakness can contribute to delayed developmental milestones such as crawling, standing, and walking. This doesn’t mean that children with spastic diplegia will never be able to walk; rather, it may just take them longer to learn how to. In fact, nearly 50-60% of children with cerebral palsy walk independently.

Those with more severe motor impairments who are unable to walk without assistance are taught how to use mobility aids such as walkers and wheelchairs to maximize their independence.

Limited Growth and Development

Spasticity at an early age can significantly affect a child’s growth and development. Individuals with spastic diplegia may develop deformities or distortions due to disproportional amounts of pressure on various muscles, joints and bones in the legs. For example, one leg may be longer than the other due to increased muscle strain in the shorter leg.

Now that you understand the potential signs and symptoms of spastic diplegia, let’s discuss treatment and the importance of early intervention.

Spastic Diplegia Treatment

While cerebral palsy is a lifelong condition, individuals can learn to significantly improve their quality of life with the right treatment. Spastic diplegia can range from mild to severe and affect various muscles in the legs differently, so a personalized approach to treatment is essential.

Treatment for spastic diplegia primarily focuses on promoting the brain’s ability to make adaptive changes and rewire its neural circuitry called neuroplasticity. This mechanism is what allows for functions affected by brain damage to be rewired to healthy, unaffected areas of the brain.

The most effective way to promote neuroplasticity is to focus on task-specific repetition. The brain functions on demand, so the more you practice any skill, the stronger the neural pathways for it will become.

At young ages, the brain has a higher level of neuroplasticity, making early intervention ideal. However, the brain never loses its ability to adapt, so there is potential for improvement at any age.

Management interventions for spastic diplegia typically include:

1. Physical Therapy

Physical therapy is essential for minimizing the impact of spasticity in the legs. At physical therapy, individuals with spastic diplegia may work on stretching spastic muscles, strengthening underused muscles, and walking with improved form.

Gait training is a type of physical therapy that specifically concentrates on improving one’s ability to walk. It can involve practicing exercises in the pool or walking on a weight-bearing treadmill. These activities relieve pressure on the joints, which allows individuals to focus on improving their form. They also minimize the chances of falling and the likelihood of injury resulting from a fall, which often makes individuals feel more comfortable with practicing more challenging skills.

Many physical therapists will incorporate games and activities, such as obstacle courses and balancing challenges, into their treatments with pediatric patients. This is a great way to motivate children with spastic diplegia to be fully engaged in therapy and can allow parents to more easily encourage practicing the skills learned in physical therapy at home.

Physical therapy is an effective form of treatment for spastic diplegia because it focuses on repetitions, which consistently stimulates the brain. The more you practice, the more you’re activating neuroplasticity and strengthening those brain-to-muscle connections.

2. Occupational Therapy

Occupational therapy focuses on promoting independence through activities of daily living.

Individuals with spastic diplegia are generally capable of being very independent because their motor impairments mainly affect their lower limbs. Therefore, they can learn how to use their arms to assist with everyday activities such as performing transfers, dressing, and toileting.

If motor impairments are more severe, an occupational or physical therapist may teach patients how to use mobility aids like walkers, crutches, and/or wheelchairs. Occupational therapists may also educate patients on how to use adaptive equipment, such as a sock aid or leg lifter, to increase their functional independence.

3. Botox/ Muscle Relaxants

Botox and muscle relaxants block signals that cause spastic muscles to tighten. This helps delay the progression of contractures and provides temporary spasticity relief.

Because spastic diplegia primarily affects the muscles in the legs, oral medications that affect the entire body are generally not ideal. Instead, direct injections to the affected muscles are more effective.

Because the effects of Botox and muscle relaxants are not permanent, individuals should take advantage of the period of reduced spasticity and intensely pursue physical therapy to promote more long-term relief.

4. Orthotics

Orthotics such as braces, splints, and casts are wearable devices that help keep the body correctly aligned.

Spasticity pulls the body out of alignment and causes unnecessary strain on the joints. This pressure may interfere with a child’s growth and cause serious complications such as hip dislocations. Orthotic devices help mildly stretch spastic muscles and provide structural support to prevent the muscles from further tightening. They can also help with maintaining positioning and stability to increase independence with walking and completing transfers.

5. Surgery

Surgeries for spastic diplegia typically consist of manually lengthening and realigning the muscles or selective dorsal rhizotomy. A selective dorsal rhizotomy involves making incisions at specific nerve roots to permanently sever innervation and reduce the excitability of the spastic muscle.

Surgeries are typically only recommended for very severe cases of spasticity.

Living with Spastic Diplegia: Key Points

Spastic diplegia is a type of cerebral palsy that primarily affects the legs. If not properly managed, it can significantly affect one’s growth and ability to walk.

Fortunately, the impact of motor impairments caused by cerebral palsy can be managed by promoting neuroplasticity.

Intensively working toward recovery is the best way to make progress and become as independent as possible. Thousands of repetitions are required to promote neurological changes, so it’s essential to stay motivated, commit to your exercises, and trust in the process. The more you practice, the more you’re stimulating the brain and promoting its ability to adapt.

We hope this article helped you understand what spastic diplegia is and how to treat it.

The post Understanding Spastic Diplegia: Causes, Symptoms, and Treatment appeared first on Flint Rehab.

Moreover, hypotonia is considered a rare outcome of cerebral palsy because most individuals experience the opposite effect: hypertonia (high muscle tone). However, it is possible for people with cerebral palsy to experience a combination of hypotonia and hypertonia in different muscles of the body.

To help you understand what to expect when your loved one has hypotonic cerebral palsy, this article will discuss:

• Causes of hypotonic cerebral palsy
• Signs of hypotonic cerebral palsy
• Goals of treatment for hypotonic CP
• Hypotonia management

Causes of Hypotonic Cerebral Palsy

To understand what causes hypotonia in individuals with cerebral palsy, it’s critical to understand the relationship between the brain and muscles.

Muscle tone is primarily regulated by the transmission of signals from the brain. These signals travel down the spinal cord and through the nerves to the muscles where they are directed to contract or relax.

Cerebral palsy is a motor disability caused by damage to the brain before, during, or shortly after birth. As a result, individuals with cerebral palsy often experience abnormal muscle tone due to disrupted communication between the brain and muscles.

While individuals with any type of cerebral palsy may experience hypotonia, it is most commonly associated with ataxic CP. This type of CP is caused by damage to the cerebellum, which is the area of the brain mainly responsible for regulating balance, coordination, and fine motor skills.

Most individuals with hypotonic cerebral palsy are diagnosed by the time they reach 6 months old. However, hypotonia may go unnoticed for several years in individuals with mild CP.  In the following section, we’ll discuss signs of hypotonic cerebral palsy.

Signs of Hypotonic Cerebral Palsy

Every case of cerebral palsy is unique. Depending on a variety of factors such as the severity and location of brain damage and the onset of secondary complications, individuals with hypotonic cerebral palsy may experience a wide range of effects.

Signs of hypotonic cerebral palsy include:

• Floppy limbs
• Poor head control
• Developmental delays
• Clumsiness/ frequent falling
• Excessive flexibility
• Slow movements
• A soft or weak voice
• Poor trunk stability
• Difficulties chewing or swallowing
• Wide-based stance while standing or walking
• Low activity tolerance

Because infants develop motor skills over time, signs of low muscle tone are often overlooked until the child gets older and demonstrates developmental delays or motor impairments. By identifying signs of hypotonia and seeking early management as soon as possible, parents can proactively minimize the impact of low muscle tone on their child’s everyday life.

Hypotonic Cerebral Palsy Treatment Goals

Early management of hypotonia in individuals with cerebral palsy is crucial to maximizing your child’s mobility. 

Children’s brains have greater amounts of neuroplasticity than those of adults, which makes it easier for them to adapt and learn new skills. Neuroplasticity refers to the brain’s ability to reorganize its neural circuitry. It allows for functions affected by brain damage to be relearned and improved by healthy, undamaged regions of the brain.

The most effective way to promote neuroplasticity is through highly repetitive and task-specific training. Consistent practice stimulates the brain and encourages neurological adaptations.  

However, it’s important to understand that adaptive changes can be beneficial or harmful. The movement patterns your child continuously practices are the ones that become solidified pathways in their brains and develop into habits. Therefore, the earlier abnormal movement patterns caused by hypotonia are addressed, the better the long-term functional outcomes.

Hypotonia Management

Because hypotonia can range from mild to severe, a personalized approach that targets each individual’s specific motor impairments is ideal.

Management interventions for hypotonic cerebral palsy may include:

• Physical therapy. A physical therapist will assess the client’s motor skills and develop a personalized exercise regimen to strengthen underused muscles and improve form.   
• Occupational therapy. Occupational therapy can help individuals with hypotonia learn how to be as functional as possible by practicing everyday activities such as eating, dressing, and grooming. Depending on the severity of your child’s hypotonia, an occupational therapist may also teach your child how to use adaptive equipment. They can also focus on the development of skills needed for participation in school, such as fine motor precision skills for handwriting.
• Speech therapy. If hypotonia affects the muscles around the mouth, individuals may struggle with feeding or speech. By working with a speech-language pathologist, individuals with hypotonic cerebral palsy can practice exercises that help strengthen the oral motor muscles or learn alternative ways to be effective communicators.
• Orthotic devices. Orthotic devices like braces, splints, and casts can provide additional musculoskeletal support which promotes correct form and minimizes the risk of falling.

Ultimately, management of hypotonia in individuals with cerebral palsy focuses on promoting functional independence and preventing further muscle weakness. By consistently practicing targeted exercises and activities, individuals with hypotonia can reinforce demand in the brain for those functions and promote neuroplasticity.

Cerebral Palsy and Hypotonia: Key Points

Individuals with hypotonic cerebral palsy experience low muscle tone, which can affect their balance and coordination skills. As a result, they may be prone to falls or struggle with tasks that require precision.

Fortunately, individuals with hypotonia can train their brains to make neurological adaptations and rewire these skills to undamaged regions of the brain. By strengthening underused muscles and consistently practicing movements affected by low muscle tone, individuals can significantly improve their functional independence.

We hope this article helped you better understand what hypotonia is and how it can affect individuals with cerebral palsy.

The post Hypotonic Cerebral Palsy: Understanding the Causes, Symptoms and Treatment Options for Hypotonia in CP appeared first on Flint Rehab.

For instance, one individual with dyskinetic CP may struggle with inward-facing feet while another individual may experience poor posture due to involuntary fluctuations in muscle tone. The effects vary greatly, which makes it essential to work closely with a therapist for individualized rehabilitation.

To help you better understand dyskinetic cerebral palsy, this article will explain:

• Causes of Dyskinetic Cerebral Palsy
• Signs & Symptoms of Dyskinetic Cerebral Palsy
• How to Manage Dyskinetic CP

Causes of Dyskinetic Cerebral Palsy

Dyskinetic cerebral palsy is caused by damage to the basal ganglia or thalamus before, during, or shortly after birth. Damage to these areas of the brain often causes abnormal muscle tone regulation, resulting in uncontrollable movements (dyskinesia) and irregular postures.

The basal ganglia are primarily responsible for motor control; however, they also play a role in motor learning, executive functions and behavior, and emotions. As a result, involuntary movements tend to become more severe when individuals are stressed or emotional.

Likewise, parts of the thalamus are involved in a complex set of neural pathways that affect movement. Therefore, damage to these areas can also cause involuntary movements.

Common causes of dyskinetic cerebral palsy include:

• Premature birth
• Stroke
• Birth complications
• Inadequate blood supply in the brain
• Traumatic brain injury
• Untreated jaundice
• Infection

Depending on the severity of the brain damage, individuals may experience a wide range of motor impairments. In the following section, we’ll discuss some of the defining characteristics of dyskinetic CP.

Signs and Symptoms of Dyskinetic Cerebral Palsy

Dyskinetic cerebral palsy is mainly characterized by two types of movement disorders: dystonia and choreoathetosis. They both generally affect the entire body; however, symptoms tend to be more severe in the arms than legs.

Often, individuals with dyskinetic CP experience both dystonia and choreoathetosis; however, they can also occur independently of each other.

Below, we’ll discuss the differences between these two movement disorders.

Dystonia

Dystonia is the most common and most noticeable movement disorder among individuals with dyskinetic cerebral palsy. It’s characterized by repetitive, twisting movements and abnormal postures caused by involuntary muscle contractions.

Common postures observed in individuals with dystonia include the inward-facing of the feet, outwards shifting of the wrist (ulnar deviation), and the inward curving of the lower back. These postures may occur in short intervals or last for prolonged periods.

Generally, dystonia occurs when individuals actively try to move. For some, it will only be triggered by certain movements.  Moreover, signs of dystonia can worsen depending on stress levels and emotions.

Learn more about dystonic cerebral palsy »

Choreoathetosis

Choreoathetosis can be divided into chorea (which describes rapid, jerky movements) and athetosis (which is characterized by uncontrollable fluctuations in muscle tone).

Because the muscles may continuously shift between stiff and floppy, individuals often appear as if they are constantly moving. This can make it challenging to sustain a stable posture, grip objects, and perform tasks that require precision such as writing.  

Generally, involuntary movements heighten when the individual is excited, upset, or anxious. These uncontrollable movements typically only cease when the individual is fully relaxed, distracted, or asleep.

Now that you understand the signs and symptoms of dyskinetic cerebral palsy, the next section will explore management interventions.

Dyskinetic Cerebral Palsy Management

As with all types of cerebral palsy, the brain damage that causes dyskinetic cerebral palsy is irreversible. However, there are ways to reduce uncontrollable movements and associated conditions like pain.

Below, we’ll discuss some of the most commonly used management interventions for dyskinetic CP.

Rehabilitative Therapies

Participating in rehabilitative therapies like physical therapy, occupational therapy, and speech therapy can help individuals with dyskinetic cerebral palsy manage their symptoms.

• Physical therapy promotes overall mobility and posture through strengthening exercises and stretches.
• Occupational therapy focuses on developing fine motor skills through activities of daily living. At occupational therapy, your child will learn how to use adaptive tools to expand their functional abilities.
• Speech therapy will strengthen the oral motor muscles to help individuals improve their chewing, swallowing, and speaking skills. They may also explore alternative forms of communication if needed.

Medications

Oral baclofen and anticholinergic drugs like trihexyphenidyl are most commonly used to manage dyskinetic cerebral palsy. However, they generally have low effectiveness because they cannot efficiently pass through the blood-brain barrier.  Consequently, they need to be administered in greater doses, which increases the risk of adverse side effects.

Another option involves getting baclofen injected directly into the spinal canal through an intrathecal pump. It allows for a lower dose of the muscle relaxant to enter the body and decreases the risk of side effects.

This review found that intrathecal baclofen administration resulted in “significant decreases in dystonia and subjective improvements in mobility, speech and communication, swallowing, head control, sleep, pain and mood, comfort,  and ease of care.”

Orthotics

Orthotic devices like compression garments and braces can help stabilize the body to prevent growth deformities caused by uneven muscle pull and reduce the effects of fluctuating muscle tone.

Against spasticity, orthotics will resist against the contraction. Against hypotonia, orthotics will provide stability to keep you upright and promote proper musculoskeletal alignment.

Dyskinetic CP: Key Points

Dyskinetic cerebral palsy is a type of cerebral palsy characterized by uncontrollable movements due to abnormal muscle tone regulation. Individuals with dyskinetic CP may demonstrate various movement disorders resulting in repetitive, twisting movements, poor posture, or jerky movements.

With the help of rehabilitative therapies, medications, and orthotics, individuals with dyskinetic CP can learn to manage their symptoms and significantly improve their quality of life. Now that you have a better understanding of what dyskinetic cerebral palsy is, we hope you take the appropriate steps to properly manage it and improve your quality of life.

The post Dyskinetic Cerebral Palsy: Causes, Signs, Symptoms, & Management Techniques appeared first on Flint Rehab.

To help you understand what to expect if your child has spastic cerebral palsy, this article will cover the different types, causes, signs and symptoms, as well as management – let’s dive in!

Jump to a section

• Causes of Spastic Cerebral Palsy
• Signs and Symptoms
• Types of Spastic Cerebral Palsy
• Management of Spastic Cerebral Palsy

Causes of Spastic Cerebral Palsy

As with all forms of cerebral palsy, spastic cerebral palsy is caused by damage to the developing brain before, during, or shortly after birth. Specifically, it’s caused by damage to the motor cortex, which is the part of the brain primarily responsible for controlling voluntary movement.

Common causes of spastic CP include:

• Premature birth
• Infection
• Lack of oxygen in the brain
• Stroke
• Genetic factors
• Head injuries
• Cerebrovascular accidents

Depending on the severity of the damage to the brain, motor impairments may range from mild to severe. In the following section, we’ll explain common symptoms of spastic cerebral palsy.

Signs and Symptoms of Spastic Cerebral Palsy

As its name suggests, spastic cerebral palsy is mostly characterized by spasticity (involuntary muscle contractions). Spasticity occurs because damage to the brain disrupts the transmission of signals to the muscles.

The sensory and motor fibers within the central nervous system work together to regulate the tightening and relaxing of muscles. Damage to the brain or spinal cord can disrupt this system and cause muscles to involuntarily contract.

Spasticity is the underlying cause of many secondary complications of spastic CP, including:

• Abnormal gait
• Stiff movements
• Difficulties with balance
• Slow movements
• Chronic pain
• Clenching of the fingers or toes
• Spasms or jerky movements
• Chewing, swallowing, or speaking difficulties
• Developmental delays

Additionally, spastic cerebral palsy may only affect certain areas of the body. For example, depending on the severity of damage to the brain, individuals with spastic CP may only be affected on one side of the body or a single limb. Up next, we’ll review the various types of spastic CP and how they affect the body.

Types of Spastic Cerebral Palsy

While spastic cerebral palsy is the most common type of CP, it can be further categorized by which areas of the body it affects. Generally, the more severe the brain damage is, the more areas of the body will be affected.

The various types of spastic CP are:

• Spastic hemiplegia: motor impairments in one side of the body
• Spastic monoplegia: motor impairments in one limb (usually an arm)
• Spastic diplegia: motor impairments in both legs (may also mildly affect the arms)
• Spastic triplegia: motor impairments in 3 limbs (typically both legs and an arm)
• Spastic quadriplegia: motor impairments that affect all four limbs (may also affect the muscles around the mouth)

Spastic hemiplegia, diplegia, and quadriplegia are most common, while spastic monoplegia and triplegia are more rare.

Regardless, management for any type of spastic CP involves minimizing the progression of spasticity to optimize overall mobility and quality of life. Now that you understand the cause, symptoms, and types of spastic CP, let’s explore effective ways to manage the condition.

Management of Spastic Cerebral Palsy

To effectively manage spastic cerebral palsy and improve motor functions, individuals should focus on promoting neuroplasticity. Neuroplasticity is the brain’s ability to rewire itself. While damaged parts of the brain cannot heal, affected functions may be reassigned to healthy areas of the brain through consistent stimulation.

The more repetitions a person performs, the stronger the neural pathways for that function become.

It is ideal to start management as early as possible because children’s brains have higher levels of plasticity than those of adults. As a result, it is usually easier for children to acquire new skills to replace abnormal movement patterns.

Below, we’ll provide some of the most effective ways to manage spastic cerebral palsy.

1. Physical Therapy

Physical therapy for spastic cerebral palsy focuses on improving an individual’s mobility through targeted exercises.

By continuously stimulating the muscles and moving the joints, individuals with spastic CP may expand their range of motion, improve circulation, and promote neuroplasticity to reduce spasticity.

2. Occupational Therapy

Occupational therapy involves improves one’s functional abilities, primarily through practicing activities of daily living such as brushing one’s teeth or getting dressed.

By practicing everyday activities, individuals with spastic CP develop the skills necessary to optimize their independence.

3. Orthotic Devices

Orthotic devices like braces, splints, and casts can be extremely helpful for managing spastic cerebral palsy.

While the brain damage that caused cerebral palsy will not progress, symptoms such as spasticity may increase. The more severe one’s spasticity becomes, the more difficult it becomes to move. Some individuals with cerebral palsy lose the ability to walk as they get older due to increasing spasticity.

Orthotic devices promote proper form and musculoskeletal alignment. They’ll also mildly stretch spastic muscles and support underused muscles.

4. Botox

Botox is a nerve blocker that is directly injected into spastic muscles to relieve high muscle tone.

However, it’s important to understand that Botox is only a temporary spasticity treatment and its effects typically last between 3-6 months. To promote long-term spasticity relief, individuals should take advantage of the effects of Botox and pursue intensive physical therapy to promote neuroplasticity.

5. Muscle Relaxants

Baclofen is a muscle relaxant that reduces spasticity by regulating the release of neurotransmitters that cause muscle contractions.

Like Botox, the effects of muscle relaxants are temporary and may not be ideal for long-term use. Generally, muscle relaxants do not last very long and will need to be administered more regularly than Botox.

6. Speech Therapy

Individuals with motor impairments involving the mouth will benefit from speech therapy. A speech-language pathologist guides your child through exercises to strengthen their oral motor muscles and improve their ability to eat and speak.

Speech therapy may also help children who are non-verbal learn how to use augmentative and alternative communication devices such as communication boards or voice generators to improve communication with others.

7. Surgery

Surgery for spastic CP is generally only recommended if other methods of management prove ineffective. The most common surgery for spastic cerebral palsy is selective dorsal rhizotomy. It involves severing nerve roots at the spinal cord to relieve severely spastic muscles.

Other commonly performed surgeries for spastic CP include muscle and tendon lengthening surgeries as well as baclofen pump implantation.

Understanding Spastic Cerebral Palsy: Key Points

Although spastic cerebral palsy makes up approximately 80% of all cerebral palsy cases, everyone experiences it differently. As a result, management for cerebral palsy should be personalized to each individual’s unique symptoms.

While cerebral palsy is a life-long condition, individuals with spastic CP may enhance their mobility by promoting neuroplasticity. With continuous practice and spasticity management, movement patterns may be improved.

We hope this article helped you better understand what spastic CP is and how to manage it.

The post Spastic Cerebral Palsy Explained: Types, Symptoms, and 7 Proven Ways to Effectively Manage Spastic CP appeared first on Flint Rehab.