Tips for parents with Cerebral Palsy

Tips for Parents and Care givers of Children with Cerebral Palsy

ICD is a premier institute dedicated for children with developmental disorders. It has been working in the field since 2001. ICD’s training programs are well appreciated all over the world. Here is the latest support to parents with children with cerebral palsy for scientific parenting through proper handling and treating with the help of assistive technology.

Children with Cerebral Palsy Spastic Hemiplegia 

• There should be emphasis to stimulate the affected side as much as possible; the child should be encouraged to transit with the help of affected side. While carrying the child should be given opportunity to use the affected side as much as possible.
• Children with Hemiplegia should be helped with corner chair when the child has no neck control. Arm chair with tray cut out should be used to promote hand functions while sitting when the child is unable to sit independently. Australian Standing frame should be used to promote hand function of the affected side by promoting trunk control of the affected side. In general, very few cases require the help of standing frame as these children have good trunk.
• Children with Hemiplegia should be placed in AFO early as preventive care during night. When AFO is prescribed for the affected foot, the other foot is taken care with foot plate. Otherwise, the child will have leg length discrepancy in the long run. As the upper limb is more affected, Modified Cock up splint should be used to keep the wrist and thumb in neutral position as night splint. The hand splint if it is static should be used during day rather CIMT band should be used for the normal hand. A large proportion of this group has Genu recurvatum so modified angular AFO should be tried. In case of Genu recurvatum, gaiters have no role at all. 
• Mostly children with CP Spastic Hemiplegia do not require the support of mobility aids. In case of requirement, posterior Rollator is considered better than anterior Rollator

Children with Cerebral Palsy Spastic Diplegia 

• Children prefer to sit in ‘W Sitting” posture. This pattern should be avoided as much as possible. While carrying the child, it should be tried to keep the hips abducted if possible.
• Children with Diplegia should be encouraged to sit on arm chair with pommel so that the child does not start “w sitting”.
•  Children with Diplegia require AFO by the age of 6 months or so. Preventive AFO should be used while night as early as possible. The corset gaiters should be replaced with 3-points gaiters as the child becomes 3 years old if there is a need. If the child shows sign of tibial torsion, the gaiters should be modified to work as anti-torsion splint. A few children with hyper-extended knees may be helped with modified AFO where the AFO is kept in 5-7 degree flexion.  Always remember, there is no place for HKAFO / Calipers / KAFO in the current management technique so these splints should be discouraged as far as possible). In few cases GRFO can be tried although there is little data available to support the use of GRFO.
•  Most children with diplegia will require Posterior Rollator. Researchers have demonstrated the efficacy of the posterior Rollator higher than anterior Rollator. Parents / Professionals should follow the FMS (Functional Mobility Scale) guidelines as much as possible.

Children with Cerebral Palsy Spastic Quadriplegia 

•  Special handling technique should be used during infancy as these children have hypotonic trunk and hypertonic limbs. Postural alignment should be taken care properly to reduce the chance of hip subluxation scoliosis and other postural deformity.
•  Children with Quadriplegia should be provided corner chair with tray cut as they become 3-4 months old. These children take more time to achieve head control and prone development comparing to Spastic Diplegia. Arm chair with tray cut out and pommel should be used to get good trunk control and hand function. Standing frames are also being used in this group.
•   Children with Quadriplegia should be provided with Preventive Orthotic aids to reduce mal-alignment of ankle joints. The occurrence of hip subluxation is very high in this group so special splints should be made. These children may require splints for the upper limbs also as they have elbow flexors, mid arm Pronators and wrist flexors tightness. A few cases may require Thumb abduction splint also. Although, the use of HKAFO / Caliper has been outdated in the management of cerebral palsy, a few children can be benefited with these splints.
•  Children with quadriplegia should be given support to the trunk while making him mobile. The actual FMS has been developed for this group of children. Children who are more than 3 years old and not able to move from one place to other with any means should be provided with wheel chair.

Children with Cerebral Palsy Dyskinesia 

•  Due to dystonia, these children require guarded handling. While carrying, all possible care should be given to reduce fluctuation of tone and sudden fall. These children easily slip from lap.
•  In the initial stage, a modified corner chair can help the child to get midline orientation with trunk stability. The children with good head control can use the modified arm chair with tray cut out. In all chairs a pommel should be placed to prevent hip dislocation. Prone standers are better suited for these children.
•  Usage of Orthotic Aids
  Generally Solid AFO is prescribed for putting optimal weight bearing on feet. Anti-torsion splint may be used to prevent tibial torsion.  
•  Due to fluctuate tone of the child, Posterior and Anterior Rollator are not prescribed. Training walker should be used for these children.
•  Adaptive aids to promote hand function are being used according to the need of the children

Children with Cerebral Palsy Ataxia

•  These children require specific handling due to poor muscle tone or floppiness. Extra care should e given to have the head in midline while carrying and transfer  
•  Children with Ataxia should be provided corner chair with tray cut as they become 4 months old. These children take more time to achieve head control and prone development. An Arm chair with tray cut out should be used to get good trunk control and promote hand function. These children may need Standing frames also
•  Solid AFO or SMO should be prescribed to get good ankle and foot alignment as the child is ready to weight bear while sitting and standing
•  Most children with ataxia require the support of a walker initially but they switch over to walking cane or walking sticks very soon. Few children require the support of walking sticks for longer duration and sometimes life long

Children with Cerebral Palsy Hypotonia

•  The child should be handled with care till the child achieved head control. Spinal alignment should be observed while sitting and standing
  Transfer and carrying should be modified according the milestones achieved
•  Initially the child should be given corner chair to protect the spine and gain head control. As the child gets proper head control any arm chair with tray cut can be used. Few cases with hypotonic trunk can get help from a standing frame.
•  Initially a SMO can be given for aligned weight bearing.
•  The FMS approach should be practiced for better outcome in mobility skills