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Cerebral Palsy (CP) is caused by an injury to the developing brain. The common set of symptoms in children who have CP are abnormal muscle tone and difficulty with muscle coordination and movement.
The term cerebral palsy reflects a wide range of different types of brain injury. As a result, cerebral palsy can look very different from child to child.
In some children, only the legs are involved (diplegia); in others, only the left or right side of the body (hemiplegia). In others, the entire body is affected (quadriplegia). Muscle tone may be high (spastic), or it may be low (hypotonia), resulting in difficulty with balance (ataxia). Involuntary or dyskinetic muscle movements may be present. Sometimes a child's arms or legs may feel rigid, which is called dystonia.
While the brain injury that causes pediatric cerebral palsy doesn't progress over time, the child’s symptoms may change as their bones grow and muscles stretch; therefore it is important that they continue close medical care until they are done growing.
Children with CP often have one or more associated medical conditions. The following is a list of commonly associated medical conditions:
• developmental delay
• seizure disorders
• feeding and swallowing disorders
• gastroesophageal reflux
• poor nutrition
• airway difficulties
• difficulty with urination
• visual impairment
• hearing loss
• communication impairment
Monitoring and managing these medical conditions requires specialists from various departments and a multidisciplinary approach to optimize care delivery. Here at Boston Children’s Hospital, in our Cerebral Palsy Program we have orthopedic surgeons, neurologist, neurosurgeons, physiatrists, complex care/developmental pediatricians, physical and occupational therapists all working together in one clinic to provide comprehensive care for your child. Depending on a child's need and in consultation with the child's family and primary physician, referrals may be generated to any number of subspecialists.
Families are also provided access to a full range of support services, including social work, educational materials and community resources. New patients seen at Boston Children’s Cerebral Palsy Program are initially evaluated by a physician to determine the range of medical issues and developmental, physiatric, orthopedic and neurologic abilities affecting the child.
Children with CP often have limited mobility and therefore cannot exercise or stretch their muscles through regular running, walking or playing. Therefore, CP can interfere with normal muscle development and bone growth. Weakened and unbalanced muscle do not adequately support the spine and lower limbs which can lead to secondary conditions including scoliosis, hip dislocation and foot and ankle deformities, such as clubfoot, calf contracture and flat foot.
These secondary conditions can be prevented or treated by managing your child’s spasticity. The goal of this treatment is to prevent bone and joint deformity by balancing muscles forces around the joint as your child grows and develops.
Treatment for managing spasticity and muscle contractures can be broken down into the following stages:
• Physical and Occupational Therapy
Physical therapy alone, or in combination with special braces (sometimes called orthotic), work to prevent muscle
contractures by stretching spastic or tight muscles.
• Braces and Orthotic Devices
Orthotics can help control dynamic deformities by maintaining a stable joint position during walking and substitute
for weak muscle groups associated with CP.
• Botulinum Toxin and Phenol
Botulinum toxin and phenol are medications that our physiatrists and orthopedic surgeons use to also help control
your child’s muscle spasticity. These medicines can be administered in the operating room as well as in the clinic
depending on the specific situation. Both medications are not permanent and provide a period of muscle relaxation
so that bracing and physical therapy can be optimized.
• Single Event Multilevel Surgery
While not always necessary, surgery may be recommended when muscle contractures and bone abnormalities are
severe enough to cause problems with your child's movement, balance and coordination.
Surgery can help to reduce spasticity in the legs by elongating or releasing the contracted muscles and tendons that are too short and improving the alignment of the bones in the lower extremity.
Orthopedic surgeons assume a major role in the care of your child. After careful examination and review of each child's developmental progress, they will outline a course of therapy on an individual basis.
The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”