Cerebral Palsy (CP) and Physical Therapy

October 6 is World Cerebral Palsy Day.  In honor of this day, I want to highlight and discuss Cerebral Palsy (CP) and physical therapy.  Since October is also Physical Therapy month, what better way to celebrate than TWO blog posts this month??!  Stay tuned for round 2.

CP can result due to an injury to the developing brain.  This can happen in utero or soon after birth.  It is the most common physical disability in childhood.  While symptoms can vary, below is a list of symptoms that your infant may exhibit.

• Muscle stiffness
• Increased left/right preference
• Weakness
• Delayed milestones

If your child is under 5 months and had a premature birth, neonatal encephalopathy, birth defects, and/or admitted to the NICU, early standardized assessments should be completed.  Any infant who is unable to sit independently by 9 months, has hand function asymmetry, and inability to take weight through their feet, should also seek standardized assessments for CP.

Early diagnosis is key because this will help you advocate for services needed for your child, including financial assistance.  Most children are diagnosed between 1-2 years of age.  However, an earlier diagnosis can be made clinically.  In fact, there are outcome measures that can actually help predict CP.  At a younger age, we have a lot of brain plasticity.  This is a fancy way of saying that your nervous system can change based on the stimuli or exposure provided.  How cool is that?!  This means that with skilled exposure and intervention, it is easier to impact your child’s ability at a younger age.  We also know that children with CP are at risk for losing range of motion (contracture), developing scoliosis, and hip dislocation.  Because of these high-risk factors, your therapist will want to be proactive!  If you or your doctor have any concerns, a physical therapy evaluation is a great place to start.  Ultimately, your child will have a great team of providers (Neurology, social work, speech therapy, occupational therapy, etc) working together to ensure your child gets the best care possible.

Physical therapists often use standardized measures to help classify and track progress of a child with CP.  The Gross Motor Function Classification System (GMFCS) helps represent what a child can do and what they still have difficulty achieving.  It is important for your physical therapist to maintain consistency within their documentation and write the best goals for your family.  The Gross Motor Function Measure (GMFM) is a tool for your physical therapist to measure changes in gross motor abilities over time in children with CP.  This looks at 5 dimensions:

A. Lying and Rolling

B. Sitting

C. Crawling and Kneeling

D. Standing

E. Walking, Running, and jumping

Once the GMFM is completed, your therapist can use this score on the Motor Growth Curves.  The curves are based on each GMFCS levels.  Just like a “growth chart” that your pediatrician may use, this follows curves based on gross motor skills (GMFM score) and age.  An example for GMFCS level I is copied here:

                                                                                            

After completing an evaluation, your physical therapist will help set up a plan.  This can include stretching, strengthening, balance, and addressing equipment needs.  If your child is unable to walk, stand, or sit, there are multiple options to explore.  Below are a few common pieces of equipment that your physical therapist may recommend:

                                                                                           

Resources

“Early Detection of Cerebral Palsy: AACPDM.” American Academy for Cerebral Palsy and Developmental Medicine, www.aacpdm.org/publications/care-pathways/early-detection-of-cerebral-palsy#:~:text=The%20Test%20of%20Infant%20Motor,accurate%20diagnosis%20of%20cerebral%20palsy. Accessed 3 Oct. 2023.

Canchild, “Diagnoses” https://canchild.ca/en/diagnoses/cerebral-palsy.  Accessed 3 Oct. 2023

Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, Cioni G, Damiano D, Darrah J, Eliasson AC, de Vries LS, Einspieler C, Fahey M, Fehlings D, Ferriero DM, Fetters L, Fiori S, Forssberg H, Gordon AM, Greaves S, Guzzetta A, Hadders-Algra M, Harbourne R, Kakooza-Mwesige A, Karlsson P, Krumlinde-Sundholm L, Latal B, Loughran-Fowlds A, Maitre N, McIntyre S, Noritz G, Pennington L, Romeo DM, Shepherd R, Spittle AJ, Thornton M, Valentine J, Walker K, White R, Badawi N. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA Pediatr. 2017 Sep 1;171(9):897-907. doi: 10.1001/jamapediatrics.2017.1689. Erratum in: JAMA Pediatr. 2017 Sep 1;171(9):919. PMID: 28715518; PMCID: PMC9641643.