Cerebral palsy is a permanent but changing impairment of posture and movements. It results from lesions or anomalies of the brain in the early stages of its development.

The most apparent problems are motor problems in cerebral palsy patients. But we can see a complex of associated issues mainly with perception.

If a child needs to perform good movements, they need to have a good intact perception. But the children with cerebral palsy haven’t this base.

Cerebral palsy is an umbrella term for a multitude of conditions. Cerebral palsy children demonstrate a variety of

Problem of tonus – hypertonus,hypotonus,fluctuating muscle tones.

Classification of muscle tone

• Spastic
• Athetoid
• Ataxic
• Hypotonic

These various types of muscle tones lead to several problems of coordination in posture and movement and sensory-motor problems.

Cerebral palsy also involves other body involvements

• Quadriplegia – All four limbs are paralyzed.
• Diplegia – both upper limbs paralyzed.
• Hemiplegia – One side of the body paralyzed

Degree of tonus abnormality

• severe muscle tone
• Moderate muscle tone
• Mild muscle tone

Age-different needs of cerebral palsy children are varied.

The basic needs are varied according to the age limits of the children.

What are the associated problems of cerebral palsy children?

There are various types of associated problems with cerebral palsy. So parents need to pay close attention to those and they need to seek proper medical attention at the correct time.

Most of these problems are not diagnosed properly with these kids as they are non-verbal and can’t express their ideas by gestures even.

So it needs to identify clinically with good clinical expertise. Each child has his or her own combination of problems. So doctors cannot treat all children with cerebral palsy in the same way.

Most of these kids are having problems with vision, hearing, breathing, eating, and drinking. So it needs to apply specific strategies for these kids while feeding.

So proper positioning techniques are the best option to minimize the complication while handling these kids.

They are having communication, speech, and language problems also. Marked sensory processing issues also can identify within these kids.

They are having other perception, cognition, and emotional and behavioral issues together with the other complications.

Baby needs to position correctly while sleeping and resting at home or at a special school. If not it creates contractures and deformities.

Hypertonia in cerebral palsy

Most cerebral palsy children have increased muscle tone ( Spasticity, hypertonus )

This increased muscle tone is the result. with a brain lesion and altered mechanical properties of the muscle.

Resistance is felt when moving the child or changing positions. The degree of spasticity is varied depending on the movement.

Little active movements are possible in cerebral palsy kids because the muscles are weak or stiff. Loss of coordination of the muscles can be seen.

So the movements are very slow. There is a lack of variety of movements and a lack of rotation. A small range of movements is present due to the high tone.

The muscles of cerebral palsy kids are highly prone to contractures and deformities. The child has difficulties relaxing and the supporting surface is not adequately taken up.

The balance reactions are reduced among cerebral palsy kids.

Mostly the spasticity features are stronger with emotions. The spasticity develops after 4 months of age.

So parents have to look until the child starts to move against gravity to assess the degree of spasticity.

The features of severely increased muscle tone- Hypertonia, severe spasticity

The hypertonia does not change much at rest on being moved. If the child is trying to move their limbs with emotions it is constantly very high.

The stereotyped movements with a lack of variety and lack of rotation can be seen.

Body asymmetry is very clear with these kids. Little or no movements are observed in the affected parts.

Those small ranges of movements are having a high risk of getting contractures.

The balance reactions of the affected parts are very little or absent.

Features of moderate spasticity.

The level of hypertonus is moderate while resting or during activities. During effort and excitation, noticeable changes in tone can be seen. Again stereotyped movements, lack of rotation, and lack of variety are present.

At this level, the child is able to move. But still, the danger of contractures and deformities of the limbs is present. Also, the balance reactions are reduced.

Children show a lot of associated reactions. These kids have insecure emotions and tend to be easily frustrated because their repertoire of skills changes with the changes in tone.

Features of mild spasticity.

This is more similar to moderate spasticity. Hypertonus is mild at rest or during activities. The muscle tone will be increased with effort and speed.

The child is able to move. The danger of contractures is present at the end positions of the joints.

The distribution of spasticity can be seen with quadriplegia, hemiplegia, and diplegia.

Decreased muscle tone (Hypotonia) in cerebral palsy.

Features of hypotonia

Most children with cerebral palsy begin as infants with hypotonia. Especially children born very preterm. ( Less than 28-30 weeks gestational age )

Hypotonia is the transient stage of spasticity, athetosis, ataxia, or a combination of any of these.

Alternatively, a child with cerebral palsy may retain hypotonia in the trunk but will have spasticity in the limbs.

Hypotonia is a tone abnormality that can be caused by damage to the central nervous system. or damage to the nerves or muscles.

The joints are hypermobile in these kids. They can be moved easily and in a wider range than you expect. There is no resistance to being moved.

There is a little active reaction to being moved. The movements are limited, slow, and labored.

The abnormal pattern of movement and posture is very common in hypotonic cerebral palsy kids. The children have difficulties moving against gravity.

The more severe the hypotonia, the higher the difficulties. The muscles feel spongy and mushy and the limbs feel heavy.

The child takes up much of the supporting surface as possible. The high danger of dislocations, contractures, and deformities. These children are mostly passive.

Un co-ordinated voluntary movements of cerebral palsy kids

Ataxia is the name for the disturbance of coordinated voluntary movements.

It is the result of a lesion on the cerebellum. It is causing dyssynergia in the muscles. Pure ataxia in cerebral palsy is extremely rare.

Ataxia is usually seen in combination with athetosis, spasticity, or both.

The postural tone is low with ataxic cerebral palsy kids. Postural control against gravity is very difficult.

These kids are inability to hold steady postures. The movements are jerky. The coordination of movements is disturbed.

The balance reactions are present but unreliable and often slow and excessive. These kids have associated problems such as speech, swallowing, and visual and motor planning.

These children are fearful and tend to move more slowly.

General guidelines for the treatments of children with cerebral palsy.

Normally therapists do not teach movements or correct postures. They may facilitate movements on an automatic or voluntary basis or a combination of those two.

The trained movements or activities must be meaningful for the child. It can achieve success during the treatment.

Occupational therapists are trying to achieve purposeful and goal-directed movements if possible.

The facilitated movements should be as correct and as effective as possible for movement sequences. Parents and caregivers can use appropriate equipment to support their treatments.

If the child is undergoing a proper therapy schedule, they can self-initiate, self-direct, and self-correct the movements up to some extent.

Treatment guidelines for hypotonia

Therapists try to plan their treatments to increase the postural tone. Also, they work for head and trunk control and alignment.

They do work with these kids for activities up against gravity by using the appropriate stimulation such as voice and time to respond.

Also therapist work on associated problems such as breathing, eating, and drinking. They guide the parents in positioning their kids and help with daily management.

Treatment guidelines for ataxia

Here, therapists are trying to improve postural control with meaningful activities. They work for a more controlled sequence of movement.

They work with balance reactions. They think about the changes in the environment or equipment.

Therapists are assisting with motor planning. They plan a single step of a task. They instruct parents and carers in daily management.