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Physiotherapy for neurological disorders - adult and paediatric

Children with Cerebral Palsy (CP)

During my career, I have treated many children with cerebral palsy (CP). CP is the most common neurological disorder found in children. It is a term used to describe a group of disorders, affecting the development of movement and posture, which are believed to arise from non-progressive disturbances in the developing foetal or infant brain. The causes of such disturbances may, or may not, be apparent.

CP neurological disorders range from very mild to very severe and are varied in nature. Each case will be classified as one of:

• Spastic CP – stiff, permanently contracted muscles – 50–75% of cases. This may be further sub-classified into the following:
  1. Diplegia – affecting either both arms or both legs
  2. Hemiplegia – affects limbs on only one side of the body
  3. Quadriplegia – affects all four limbs
  4. Monoplegia – impacts on one limb (extremely rare)
  5. Triplegia – affects three limbs (extremely rare)
• Ataxic CP - poor co-ordination, balance, depth perception – 5-10%
• Athetoid (or Dyskinetic) CP – slow, uncontrolled writhing movements – 10-20% of cases
• Mixed CP – a combination of the above – 10% of cases

In addition to the motor disorders that characterise CP, children with CP may display epilepsy, secondary musculoskeletal problems, and disturbances of sensation, perception, cognition, communication, and behaviour.

Diagnosis is typically made by reference to motor skills and medical history. Symptoms are likely to include:

• unnaturally soft, relaxed, or floppy muscle tone - called hypotonia
• muscle tone that is stiff or rigid - hypertonia.
• unusual posture - asymmetric crawling, failure to crawl or favouring one side
• growth disturbance, especially failure to thrive.
• signs of hand preference before the age of 1 year - infants usually do not display a tendency to use either the right or left hand during the first 12 months of life. CP infants often develop hand preference early, indicating one side of their body is stronger than the other.

Other conditions that can be linked to CP include seizures, mental impairment, and vision or hearing problems. Intelligence tests are often administered to a child with CP but the results can be misleading – a risk of underestimating intelligence – as a child with movement, sensation, or speech problems will have difficulty performing well on such tests.

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The Birkdale Clinic - Physiotherapy for neurological disorders - 34 Birkdale Road, Ealing, W5 1JZ - tel: 020 8998 9403 - email: Farshideh@hotmail.com

Areas covered: closest to central and west London - Ealing, Chiswick, Richmond, Kew – within the M25 area - south and west England.

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