Treatment

Therapy Goal: – to maximize the functional use of limbs and ambulation – to reduce the risk of contractures – to help the patient in attaining his greatest potential physically, mentally and socially

Rehabilitation Physical therapy – to develop muscle strength, flexibility and strength Occupational therapy – to help learn physical skills needed to function in everyday life Recreational therapy Orthotic devices such as ankle foot orthoses Speech therapy – to overcome speech problems Psychotherapy

Parent education Teach the parents how to work with their child in daily activities such as feeding, dressing, bathing, and playing in ways that limit the effects of abnormal muscle tone. Instruct the parents in the supervision of a series of exercises designed to prevent the development of contractures, especially a tight Achilles tendon.

For children with Spastic Diplegia Use walkers, poles, and standing frames Surgery may be considered to reduce muscle spasm around the hip girdle (adductor tenotomy or psoas transfer and release) Rhizotomy procedure – roots of the spinal nerves are divided, produces considerable improvement in some patients

For children with Spatic Hemiplegia A tight heel cord may be treated by tenotomy of the Achilles tendon Constraints can be applied to the unaffected side – this induces improved hand and arm functioning on the affected side. This is effective in patients of all ages.

For children with Spastic Quadriplegia Use motorized wheelchairs, special feeding devices, modified typewriters, and customized seating arrangements

Surgical To correct anatomical abnormalities or release tight muscles To help repair dislocated hips and scoliosis (curvature of the spine)

Surgery Dorsal rhizotomy (for severe spastic diplegia) – Cut specific nerves at their roots to reduce spasticity Stereotactic surgery – To improve rigidity, athetosis and tremors Reconstructive surgery to an arm – to restore muscle balance, release contractures, and stabilize joints

Medical Therapy Goal of pharmacotherapy is to reduce symptoms (e.g. spasticity) and prevent complications (e.g. contractures) 2 types of medications – For spasticity and abnormal movement – For seizures

Medications for spasticity Dopaminergic drugs – increase dopamine levels to decrease rigidity and abnormal movements – E.g. levodopa/carbidopa Botulinum toxin – Injected into specific muscle groups – Shows very positive response – May also be used to reduce the severity of drooling when injected into the salivary glands

Medications for spasticity Muscle relaxants – Baclofen: controls muscle contractions and relaxes tight muscles, but lowers seizure threshold – Botulinium toxin A: causes mild muscle paralysis and reduce contractions – Benzodiazepines (valium) – sedation is a side- effect – Oral dantrolene sodium – Need constant follow-up

Medications for seizures Anticonvulsants – Used to terminate clinical and electrical seizure activity as rapidly as possible – Prevent seizure recurrence Phenobarbital or phenytoin – Effective against partial seizures Benzodiazepines – Used in acute management of seizures

Other Problems Important to identify and manage behavioral problems early - work with a psychologist or psychiatrist Learning and attention deficit disorders, and mental retardation – assessed and managed by a psychologist and educator Strabismus, nystagmus, and optic atrophy are common – consult an ophthalmologist Promptly assess and treat lower urinary tract dysfunction Communication - Use Blissymbolics, talking typewriters, and specially adapted computers

Reference alsy alsy Nelson’s Textbook of Pediatrics 18 th ed.