Cerebral Palsy.
The neurorehabilitation program for cerebral palsy changes over time. During the first 2 years of life, an infant stimulation program with an emphasis on more than just improving motor deficits is emphasized. The importance of involvement of a knowledgeable therapist cannot be overemphasized. Realistic expectations must be articulated firmly. Rather then cautiously attempting to correct a dysfunction that cannot be corrected, the therapist should help the patient develop compensation techniques; the severity of the disability frequently militates against the development of "normal" motor control. Educating the parents about cerebral palsy, showing how positioning can be an effective way of helping the child be mobile, and encouraging parent-child interaction are aspects of an infant stimulation program. The therapist should serve as a coach to the parents, who implement much of the actual treatment on a daily basis at home. From 2 to 5 years of age, rapid growth occurs, and muscle tone will either develop or worsen--the latter leading not only to the development of contracture but also to a decrease in mobility. In developing a program to control this muscle tone, the most important question to be answered is, Can I improve the patient's function and decrease the patient's disability by altering muscle tone? It is not uncommon for the real problem preventing the patient from performing certain functions to be lack of motor control or lack of sensation and not the abnormal muscle tone. Between 5 and 10 years of age, the child begins to approach adult height. At this time, definitive orthopedic intervention can be considered; as already noted, contracture development occurs as a result of abnormal muscle tone in combination with growth. Finally, as the child approaches the teen years, issues of sitting and hygiene are important considerations, especially in the nonambulatory patient. The problem of pain secondary to spasticity or dystonia must be addressed.
Russman
BS
Pediatric Neurology, Shriners Hospitals for Children, 3101 SW Sam Jackson Park Road, Portland, OR 97201, USA.