What is Cerebral Palsy?

Cerebral Palsy describes a group of chronic conditions affecting body movements and muscle coordination. It is caused by damage to one or more specific areas of the brain, usually occurring during fetal development or infancy. It also can occur before, during or shortly following birth.

“Cerebral” refers to the brain and “Palsy” to a disorder of movement or posture. Individuals are not able to use muscles in an optimal way (palsy) due to injury to their brain (cerebral). Children with cerebral palsy may not be able to walk, talk, eat or play in the same ways as most other children.

Cerebral palsy is neither progressive nor communicable. It is also not “curable” in the accepted sense, although education, therapy and applied technology can help persons with cerebral palsy lead productive lives. It is important to know that cerebral palsy is not a disease or illness. It isn’t contagious and it doesn’t get worse. Children who have cerebral palsy will have it all their lives.

Cerebral palsy may cause increased muscle tone, reduced muscle tone, or a combination of the two (fluctuating tone). Cerebral palsy is characterized by an inability to control motor functions, particularly muscle control and coordination.

Depending on which areas of the brain have been damaged, people with cerebral palsy may experience one or more of the following:

• Muscle tightness or spasm
• Involuntary movement
• Disturbance in gait and mobility
• Abnormal sensation and perception
• Impairment of sight, hearing or speech
• Seizures

There are three main types of cerebral palsy:
1. Spastic Cerebral Palsy – stiff and difficult movement
2. Athetoid Cerebral Palsy – involuntary and uncontrolled movement
3. Ataxic Cerebral Palsy – disturbed sense of balance and depth perception

There may be a combination of these types of cerebral palsy for any one person. This is referred to as Mixed Cerebral Palsy.

What can Keep Moving Forward Physical Therapy do for people with Cerebral Palsy?

At Keep Moving Forward, our physical therapists specialize in improving the development of the large muscles of the body, such as those in the legs, arms and abdomen (gross motor skills) which are typically affected by cerebral palsy. Our physical therapists help children with cerebral palsy learn better ways to move and balance. They will be able to help children learn to walk, use a wheelchair, stand by themselves or go up and down stairs safely. Our physical therapists will also work on developing skills such as running, kicking and throwing or learning to ride a bike.

We have seen an increased amount of success when our program is introduced to children in the first few years of life, or soon after the diagnosis of cerebral palsy is made. Our therapists use specific sets of exercises to work toward the prevention of musculoskeletal complications. The strenthening exercise aim to prevent the weakening or deterioration of muscles secondary to disuse. Our program will also help to avoid contractures, in which muscles become fixed in a rigid, abnormal position. Physical therapy will help prevent musculoskeletal impairments, as well as help your child perform common everyday activities with incorportation of the Therasuit ™.

Physical therapy is one of the most vital aspects of cerebral palsy therapy. The referral for physical therapy is often the first referral made in a child’s treatment plan. Our job is to help a child’s mobility to develop and to carry out and teach exercises designed to avoid contractures, bone deformity and unwanted movement.

A patient’s physical therapy treatment program will likely change quite a bit over the years, as one will probably not have the same physical limitations one had as an infant. At Keep Moving Forward, we are a progression based program, using milestones and other metrics to gauge achievements and then create new programs that will “re-goal” the patient.

Physical therapy can also help a child’s family through reducing stress caused by caring for the child. Much of what our physical therapist will do in their treatment program will be exercises that the parents are able to perform at home, making it a less daunting task to help the child’s development. Many parents attend their child’s physical therapy sessions. Parental attendance is helpful and encouraged by the entire Keep Moving Forward team for numerous reasons. Once comfortable, parents or caregivers can give the child much-needed positive reinforcement and a feeling of security.

Ultimately we will be responsible for improving all motor skills (and with a concentration on motor skills will be the development of gross motor skill), functional skills, pain management, gait analysis and training, balance, coordination, sensory integration, fitness, range of motion, and posture. We also will recommend adaptive equipment (mechanical aids) as well as orthotics, and assist with positioning and seating.

Traumatic brain injury (TBI), also known as intracranial injury, occurs when there is an injury to the brain. TBI can be classified based on severity, mechanism (closed or penetrating head injury), or other features (e.g., occurring in a specific location or over a widespread area). Head injury usually refers to TBI, but is a broader category because it can involve damage to structures other than the brain, such as the scalp and skull.

Types of Injury:

These mechanisms are the most common causes of brain injury:

Open Head Injury: largely focal damage from bullet wounds, penetration of the skull, etc. Effects can be just as serious as closed brain injury.

Closed Head Injury: focal damage and diffuse damage to axons. The effects tend to be broad and can result from a slip and fall, motor vehicle crashes, etc. no penetration to the skull.

Deceleration Injury: (Diffuse Axonal Injury) Different parts of the brain move at different speeds because of their relative lightness or heaviness. When the brain is slammed back and forth inside the skull it is alternately compressed and stretched because of the gelatinous consistency. The long, fragile axons of the neurons (single nerve cells in the brain and spinal cord) are also compressed and stretched. This is called axonal shearing. When this happens, the neuron dies. After a severe brain injury, there is massive axonal shearing, neuron death, and brain swelling.

Chemical/Toxic: also known as metabolic disorders. They occur when harmful chemicals damage the neurons. Chemicals and toxins can include insecticides, solvents, carbon monoxide poisoning, lead poisoning, etc.

Hypoxia and Anoxia: If the blood flow is depleted of oxygen, then irreversible brain injury can occur from anoxia or hypoxia. Anoxia is when there is no oxygen and hypoxia is when there is reduced oxygen. It may take only a few minutes for either of these to occur. They may be caused by heart attacks, respiratory failure, near drowning, neck injury, drops in blood pressure and a low oxygen environment. This type of brain injury can result in severe cognitive and memory deficits.

Tumors: Tumors can cause brain injury by invading the spaces of the brain and causing direct damage. They can also cause damage as a result of pressure effects around an enlarged tumor. Surgical procedures to remove the tumor may also contribute to brain injury.

Infections: When the blood-brain protective system is breached, the brain and surrounding membranes are very prone to infections. Viruses and bacteria can cause serious and life- threatening diseases of the brain, encephalitis, and meninges, meningitis.

Stroke: If blood flow is blocked through a cerebral vascular accident (stroke), it will result in cell death in the area deprived of blood. If there is bleeding in or over the brain (hemorrhage or hematoma) because of a tear in an artery or vein, loss of blood flow and injury to the brain tissue by the blood will also result in brain damage.

What Can Keep Moving Forward Do for People with TBI?

Keep Moving Forward understands that the long-term symptoms of TBI can be divided into several categories, including physical changes, cognitive effects, sensory effects, perceptual effects, social/emotional changes and others. A primary goal is to overcome or minimize any debilitating physical conditions. Our physical therapists specialize in the examination and treatment of musculoskeletal and neuromuscular problems that affect the patient’s ability to move and function in daily life.

As part of ourintensive physical therapy program process, our physical therapist will assess:

• • Balance
  • Strength
  • Range of motion
  • Adaptive equipment and orthotics
  • Quality of movement
  • Spontaneous movement
  • Coordination of movement
  • Sensation
  • Pain
  • Functional skills

Our physical therapists will design a therapy program to maximize the physical functioning of the patient. There has been great technological advances in recent years, allowing patients with disabilities to achieve a greater degree of independence than ever before.

Intensive Physical Therapy at Keep Moving Forward, Inc.

Intensive physical therapy at Keep Moving Forward Inc. can minimize motor delays and improve balance and coordination faster than traditional physical therapy. This is due to the increased duration and repetition of tasks, helping with brain muscle reinforcement. We are also able to isolate muscles needed to initiate a movement or task. Our advance state-of-the-art equipment allows patients to maintain positions, which allow a greater level of security in order for them to figure out how to achieve the movement independently. This stability and security promotes increased independence, faster growth in strength, and muscle memory. Our Universal Exercise Unit promotes weight assisted support which allows for sensory integration and motor coordination as well as ability to achieve higher level and multi-joint tasks such as jumping. The Therasuit® allows for sensory integration and proprioceptive feedback throughout the body. This helps with the incorporation of senses through muscle movements. Our weight training activities, as well as equipment, (such as our pediatric treadmill and elliptical) help to incorporate increased strength, coordination and endurance. This integration of multiple activities helps to establish a greater balance and fluidity within an individual allowing them to perform various tasks increasing independence in all environments.