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[Cerebral palsy in children--motor function and new treatment strategies]
Bjørn Lofterød1, Reidun Jahnsen, Terje Terjesen
1Barnenevrologisk seksjon, Barneklinikken, Rikshospitalet, 0027 Oslo, Norway. bjorn.lofterod@rikshospitalet.no
Insights
Recent advancements in managing children with cerebral palsy (CP) emphasize individualized, multidisciplinary approaches. Optimal treatment combines various methods, including medical interventions, physiotherapy, and orthotics, tailored to each child
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Developmental Pediatrics
Context:
- Cerebral palsy (CP) management has evolved significantly over the past decade.
- Treatment strategies are increasingly specialized and individualized.
- A shift towards evidence-based practices and interdisciplinary collaboration is evident.
Purpose:
- To describe recent changes in the management of motor function in children with cerebral palsy.
- To highlight new treatment modalities and evolving clinical practices.
- To emphasize the need for tailored, multidisciplinary care strategies.
Summary:
- Modern CP management integrates medical treatments (e.g., botulinum toxin A, intrathecal baclofen) and orthopaedic surgery, guided by preoperative gait analysis.
- Physiotherapy focuses on task-oriented, goal-directed training incorporating motor learning principles, strength, and fitness.
- Effective orthotic use and multidisciplinary evaluations are crucial for developing personalized management plans.
- Recognizing diverse CP subtypes necessitates tailored follow-up and intervention strategies, stressing parent collaboration.
Impact:
- Improved functional outcomes and quality of life for children with cerebral palsy.
- Enhanced decision-making in treatment planning through advanced diagnostics like gait analysis.
- The potential benefits of centralizing specialized care for this patient population.
Abstract:
Substantial changes have taken place in the management of motor function in children with cerebral palsy during the last decade. The objective of this article is to describe some of these changes. The article is based on search of databases and own clinical experiences. New treatment methods have been introduced and the management is more specialised and individualised. No single treatment method has proven to be sufficient alone and the challenge is to find the best combination of methods. This requires the ability to cooperate across disciplines. Medical treatment of spasticity (botulinum toxin A, intrathecal baclofen) may be an alternative or a supplement to orthopaedic surgery. For children who can walk, preoperative gait analysis has made it easier to find the right time for an operation and to choice the right type of intervention. Physiotherapy has become task oriented and specifically goal directed, based on documented principles of motor learning, strength and fitness training. Correct choose and use of orthosis is an essential part of the treatment. The different types of cerebral palsy have different natural progressions, risk factors and needs of follow-up. A multidisciplinary clinical evaluation is therefore needed as a basis for choosing the right management strategy. Given the complexity of this disorder, priority between various focus areas for different age groups is a challenge. A close collaboration with the parents is therefore essential. Children with cerebral palsy are a relatively small group, and the increased specialisation may indicate that parts of the treatment should be centralised.
