CEREBRAL PALSY Management

When you have a child with cerebral palsy that needs rehabilitation, you can be overwhelmed by the diverse and various types of therapies that are offered. You want to be sure that the type of rehabilitation,whether it is physiotherapy, occupational therapy,speech therapy and other vital therapies for your child,is the right one and that it will help your child improve and reach the goals that you and your family set. Our team has many years of experience in various forms of therapies.We always have the child’s benefit close to our hearts and always aim as a team to reach the goals set by the child and the close family. We offer tailored approaches to each child’s goals, always aiming for evidence based treatment with a measurement of outcomes. Our aim is that any intervention should strive for personal freedom and increased ability for your child. This is achieved by special assessment of all patients diagnosed with cerebral palsy; all members of the team are involved in the plan of rehabilitation and our main concern is the wellbeing of your child during the period of rehabilitation and achieving the best level of independence.

Our team that will take care of your child and guide you through a meaningful and caring rehabilitation is comprised of:

Paediatric Orthopedic surgeon

Physiotherapists specialized in children with cerebral palsy

Occupational therapists

Orthotists

1. PHYSIOTHERAPY

Working towards your goals, using an evidence based, modern and realistic approach our physiotherapists:

·         Attend multidisciplinary meetings with a surgeon and works alongside the team

·         Perform specialized assessments taking into account the whole patient (holistic approach).

·         Use specific muscle strengthening and stretching, as well as active strengthening programmes tailored to your child’s needs

·         Help the child reach its full potential and become a useful member of the community

·         Create a positive and creative atmosphere during sessions

·         Encourage and advise on outdoors activities

·         Achieve functional improvement both in home and in community

·         Address your child’s needs in school or day-care

·         Is the key person or mediator between the surgeon and the family

·         Give advice on exercise, therapy and equipment that contribute to the improvement of your child

·         Provide support in the development of new motor skills and in the improvement or maintenance of the child’s existing skills and abilities

·         Advice on how to re-learn postural and movement skills

·         Perform assessments and provide advice and support regarding mobility aids and equipment

·         Perform home visits


3. OCCUPATIONAL THERAPY

Working towards your goals, our occupational therapists:

 ·         Attend regular multidisciplinary clinics with the team

·         Organise home visits

·         Aim to improve the child’s performance and way of functioning at home or at school

·         Aim to improve the child’s upper limb coordination and function

·         Introduce useful aids for the home, school and work

·         Encourage fun and creative activities for your child

·         Address and facilitate your child’s participation in daily activities

·         Support the development of fine motor (hand) skills

·         Have innovative ideas to help make daily living easier for example, dressing or independent eating

·         Assess the need for  minor home modifications such as rails, entrances, pathways, ramps or steps

·         Provide sensory training


 

3. ORTHOTIC DEVICES

Orthotic devices have been used for many years in cerebral palsy,offering stability in walking for children and young adults. They are also used to correct poor skeletal alignment, provide an energy efficient gait, prevent deformities, provide a stable base of support,and maintain the results of surgical intervention.

Our orthotists will produce tailored-made orthotic devices according to your child’s needs and abilities. Our service provides:

·         Custom made orthotics that can be applied at the time of surgery

·         As many adaptation and modifications as required

·         Top quality products

Following application, the orthotics are clinically assessed in order to ensure:

·         Enhancement of the child’s ability to walk, as well as enhanced coordination

·         A reduction in the effects of spasticity in limbs

·         Enhancement of the child's balance in transfers

·         An energy efficient gait

·         An improvement in the transition between sitting and standing positions

·         A reduction or elimination of hip and knee hyperextension during gait

·         Reduced potential for accidents

·         An improvement in the child's ability to function physically and mentally

 5. GAIT ANALYSIS

In our centre, οur Doctor uses Qualicys, which is a highly sophisticated programme in order to detect and analyse human motion. He also uses this excellent tool for assessing abnormal movement, especially in children with cerebral palsy but also in other cases where a scientific undisputable assessment is called for.

The gait analysis detects how the joints perform and their range of motion. It also detects muscle function and coordination in each patient’s case. Gait analysis can detect problems in walking that are complex and unclear, which helps us gain a better understanding of each patient’s gait difficulties. 

Our Doctor is specialised in interpreting the results of the gait analysis, since he has been using it preoperatively for many years both in UK and in Cyprus. We as a team consider scientific and evidence based approaches invaluable, especially when it concerns children.

The results are then displayed in a full report by our Doctor both in text and in diagrams which is then given to the patients.

The gait analysis lasts for approximately 2 hours. Special detectors are attached on the pelvis and limb, which are detected by cameras and performance is registered.

This is a very precise and scientific assessment that requires the child to walk back and forth on a force plate until all movements have been registered.

Gait analysis is indicated in patients with:

·         Neuromuscular pathology

·         Orthopaedic pathology

·         Movement disorders

·         Artificial limbs

The advantages of gait analysis are:

·         The dynamic and three-dimensional assessment of gait

·         The simultaneous measurement of all joint motion during gait

·         The assessment of rotational mal-alignement

·         The measurement of the direction of the ground reaction force at the time the foot hits the force plate

The clinical usefulness of gait analysis is:

·         Documentation of gait prior to any surgical intervention

·         Specific targeting for surgical intervention or botox injections

·         Help with orthotics

·         Targeted physiotherapy

·         Assessment of complex and multiple problems often escaping the eye

·         A signed report for the parents establishing the main problems in their child’s movement or walking 


6. BOTOX INJECTIONS

Spasticity, or muscle stiffness, is a common problem for children with cerebral palsy. Spastic muscles are tight and make movement difficult. Consequently, spasticity can interfere with many motor activities including sitting, walking, feeding, talking and play. Botox injections to tight muscles help reduce the spasticity and allow their antagonist muscles to strengthen and improve their performance.

The benefits of botox are:

·         Muscle relaxation giving the physiotherapist the opportunity to work with other muscles held back because of the illness

·         Significant improvement of gait and enhancement of other motor skills.

·         Can delay surgery till the child is older, reduce the frequency or even prevent the need for surgical interventions

·         Decreased pain in stiff muscles

·         Improvement in positioning and range of motion

·         It is a low risk procedure

·         Reduction of spasticity and greater ease in stretching.

·         Improved tolerance of braces.

·         Improved independent use of the upper extremities for ADL completion

Quite often we are being asked by parents ‘why should I put my child through a process of botox injection considering this is not going to last for ever?’ The answer to this question is that even though the effects of botox can wear off with good physiotherapy the benefits can be long lasting. We also have evidence to suggest that botox can reduce the frequency of surgical interventions.

We now have excellent results to demonstrate following botox intervention which are also shown in this website. In order to achieve the best possible outcome for your child the following need to be ensured:

1.      The correct dose of botox is accurately placed to the correct muscle

2.      An intensive physiotherapy programme is followed

3.      Support by good custom made orthotics

When it is decided that Botox injections will help your child to improve his/her abilities to function either in walking or in other areas, you will probably be concerned about the circumstances under which your child will be injected and the accuracy of the injection in the intended muscle. It is also common that parents be worried that their child will suffer or be afraid during the injection. Our team and our approach towards our children is one of trust and comfort during all procedures whether it is botox, surgery or therapies. We aim for positive experiences, calm and stress-free situations. The reason our doctor has his own protocol for Botox injections, in children, is exactly to avoid uncomfortable situations and unnecessary stress and anxiety for both the child and parents.To get the best effect of botox injection to a spastic muscle our doctor usually uses light sedation so the child can sleep through the process without stress or anxiety.

Our doctor always takes into consideration parents’ worries or uncertainties and always has a thorough discussion with the parents about the procedure.

Having the child under sedation gives the doctor the opportunity to thoroughly examine the muscles and use an ultrasound scan to detect exactly where the injection should be. After the botox injection the doctor usually uses casting up to the knees to further promote the stretching of injected muscles.

7. SURGERY-SPECIALIZED PROCEDURES

When your child needs surgical treatment, you want him or her to have the very best care available. So it stands to reason that if your child needs an operation, you will want to consult with a surgeon who is qualified and experienced in operating on children.

Children are not just small adults. They cannot always express what is wrong. Many times they do not understand the doctors’ medical questions or cannot always answer, and are not always able to be calm and cooperative during a medical examination. Paediatric orthopaedic surgeons know how to examine and treat children in a way that makes them relaxed and cooperative. In addition, paediatric orthopaedic surgeons often use equipment that is specifically designed for children.

Our paediatric orthopaedic surgeon is well-trained and has a vast experience as a doctor to properly evaluate and treat musculoskeletal (bone, joint, or muscle) problems in a child who is still growing. Children with complicated neurological problems or musculoskeletal deficiencies are best helped by a specialized pediatric orthopedic surgeon. Our Paediatric Orthopaedic surgeon has years of experience behind him both in UK and in Cyprus with many accomplishments in orthopedic pediatric interventions. Caring about your child and being available at all times, not just after surgery, is what defines him alongside with his excellent skills and experience as a team leader with your childs’ well-being close to heart, in order to help your child reach its outmost potential.

As far as cerebral palsy is concerned our paediatric orthopaedic surgeon:

·         Performs a thorough assessment using gait analysis and clinical assessment

·         Gives you a written report of what needs to be done and the exact post-operative physiotherapy regime that is required

·         Hands a pre-operative assessment and agreement protocol to the parents and physiotherapists letting them know what to expect and the plan of action

·         Is always available for the patient

·         Is able to safely guide the patient through the surgery and post-operative rehabilitation

·         Uses small incisions, corrects all deformities at one go reducing the need for multiple surgeries, and aims for immediate mobilisation

·         Uses a specific protocol for post-operative analgesia to ensure that your child has no or minimal pain after surgery

·         Uses surgical skills acquired from his general and paediatric orthopaedic training to address the needs of your child, such as limb lengthening, correction of deformities using the ilizarov technique, pelvic and long bone osteotomies, fixation of fractures, and reduction of hip dislocations.