Physiotherapy management of cerebral palsy

physiotherapy management in brief

1. Physiotherapy management of cerebral palsy SAYALI GUJJEWAR MPT II

2. GOALS OF REHABILITATION

3. THERAPY PROGRAM

4. Basic problems in the neuromotor development of children with CP are : Difficulty with flexing and extending the body against gravity Sitting Functional ambulation For functional ambulation a child needs: Motivation to move Enough muscle strength and control Able to shift his body weight (balance ) Awareness of body position and movement (deep sensation ) Sufficient visual and vestibular system No deformities interfering with joint function

5. THERAPY METHODS

6. FOR MAINTANENCE OF SOFT TISSUE LENGTH Active & passive ROM exercises Weight bearing exercises Positioning

7. POSITIONING

8. ELECTRICAL STIMULATION Vang et al, (1995) found electrical stimulation resulted in a measurable reduction in spasticity in upper limb. O’Daniel & Krapfl , 1989 reported that the use of ES increases the effectiveness of stretching spastic muscles by reciprocal inhibition. Shindo (1987), has reported a reduction of spasticity by clinical evaluation, lasting 8 to 72 hours after each session of FES. Stefanovska (1988) measured decreased tone and increased voluntary strength in ankle plantarflexors after peroneal nerve stimulation for 1 year.

9. CRYOTHERAPY Ice can be used as an adjunct to other treatment methods or as a means of controlling tone in a specific area. Muscle cooling reduces phasic stretch reflex activity and clonus ( Hartviksen . K, 1962; Giebler KB, 1990 ). Slow Icing reduces spasticity (Roods Approach) Ice can be used with static stretch to overcome hyperactive stretch reflexes ( Giebler KB, 1990 ).

10. HYDROTHERAPY

11. NEUROFACILITATION TECHNIQUES Vojta Method Of Therapy Vojta used the positions of reflex crawling and reflex rolling He proposed that placing the child in these positions and stimulation of the key points in the body would enhance CNS development. In this way the child is presumed to learn normal movement patterns in place of abnormal motion. Bobath Neurodevelopmental Therapy This is the most commonly used therapy method in CP worldwide . It aims to normalize muscle tone , inhibit abnormal primitive reflexes and stimulate normal movement. It uses the idea of reflex inhibitory positions to decrease spasticity and stimulation of key points of control to promote the development of advanced postural reactions.

12. HORSEBACK RIDING Hippotherapy , a form of Equine Assisted Therapy, is gaining ground as an effective way to increase the physical and emotional health of children with cerebral palsy (CP). It has the potential to help the child develop physical strength and endurance and increase balance.

13. BRACING Increase function Decrease spasticity Facilitate selective motor control Stabilize the trunk and extremities Keep joint in a functional position Prevent deformity

14. MOBILITY AIDS Types Standers Walkers Crutches Canes Advantages Develop balance Improve posture Decrease energy expenditure Decrease loads on joints

15. Standers

16. Walkers

17. Canes, Crutches And Gait Poles