Specialties

Specialists

Cerebral Palsy Treatment

Cerebral palsy (CP) is a neuromuscular disorder that affects a child’s movement and coordination, causing issues like muscle contracture, low muscle tone, and problems with balance and coordination. Cerebral palsy is often present at birth or the early years of a child’s life, and is caused by damage or abnormalities in the parts of the brain that control movement and coordination.

Cerebral palsy treatment involves coordinated care with a team of specialists in different areas, including neurologists, physical and occupational therapists, speech and language pathologists, and orthopaedic surgeons. At Children’s Orthopaedic & Scoliosis Surgery Associates, our cerebral palsy specialists include Dr. Bland, Dr. Phillips, and Dr. Hahn. All of our specialists are fellowship-trained in pediatric orthopaedic surgery, including cerebral palsy treatment. Additionally, Dr. Bland trained with Dr. Henry Chambers, an internationally-recognized expert on cerebral palsy treatment. He also has an interest in medical mission trips involving the treatment of cerebral palsy.

What is Cerebral Palsy?

Cerebral palsy typically develops before birth, though the cause of the brain abnormalities often cannot be determined. The brain of an unborn child is susceptible to damage from factors like maternal infections, toxins, and exposure to drugs and alcohol. Lack of oxygen during or after birth, infection, or head injury can lead to the development of CP after birth. Premature babies also have a higher risk of developing CP. Early signs of CP typically begin to show in the early years of a child’s life, and may include missing milestones like rolling over, sitting, crawling, or walking.

Cerebral palsy typically causes physical disabilit, like muscle contractures, affecting the child’s mobility and coordination, though the extent of the disability can range from mild to severe. Children with mild cases can often walk without assistance, while children with more severe cases may need crutches, walkers, or wheelchairs for mobility.

Though there is no cure for CP, early detection and treatment can help children improve functional capabilities and delay the need for surgical procedures.

How Does Cerebral Palsy Affect Mobility & Coordination?

Cerebral palsy can cause several problems with the musculoskeletal system that affect a child’s mobility and coordination, including:

Muscle contracture – Increased muscle tone or tightness can cause the child’s back, legs, and arms to become stiff and contracted, making mobility difficult.
Low muscle tone / looseness – Low muscle tone or looseness can cause the child’s limbs to be weak and floppy, and may cause uncontrolled or involuntary movements. Children with low muscle tone may have difficulty with walking or sitting up straight.
Balance and depth perception issues – Balance and depth perception issues can lead to poor coordination, gait issues, and difficulty with precise movements, such as writing or buttoning a shirt.

Cerebral palsy may affect the entire body, or it may only affect one or more of the limbs. The severity of this condition, including issues with muscle tone, contracture, balance, and depth perception, also play a role in the child developing orthopaedic conditions, such as:

Orthopaedic Treatments for Cerebral Palsy

Early intervention and treatment for cerebral palsy is typically nonsurgical. Our cerebral palsy specialists work together with providers in other specialty areas at Johns Hopkins All Children’s (JHAC), including neurology and physical therapy, to provide comprehensive care to patients. Providers at JHACH include physiatrists (rehab medicine doctors), specifically Dr. Chinarian and Dr. Hart, who are instrumental in coordinating the non-surgical care and work closely with us to make sure patients get promptly referred to us if they see the need for surgical intervention.

Unfortunately, there is no cure for cerebral palsy, but regular treatments and check-ups ensure that your child maintains function and remains as comfortable as possible.

Nonsurgical Treatments

Physical therapy, in particular, plays a critical role in the patient’s treatment, and is often recommended on an ongoing basis. Physical therapists can help children with cerebral palsy improve muscle strength, balance, and coordination, and can also help prevent the muscles from becoming too tight and contracted. This can help patients delay or possibly avoid the need for surgery down the road.

Braces may help children compensate for muscle imbalance by providing additional support. Braces, splints, or casts may also be used to improve joint stability and prevent muscle contracture. Medications may be recommended to help prevent muscle spasms, relax muscle stiffness, or reduce uncontrolled movements. Botox injections may also be recommended to help relax muscle spasms.

If a child has an orthopaedic problem like hip subluxation or dislocation, foot deformity, or rotational or gait abnormality, our CP specialists coordinate with the child’s care teams to regularly check in on the progression of the condition. If an orthopaedic problem progresses to the point that nonsurgical treatments are no longer effective, surgery may be considered.

Surgical Treatments

Recommended surgical treatments for CP-related orthopaedic problems will vary based on the type and severity of the condition, but may include procedures to lengthen contracted muscles or correct limb positioning.

Patients with mild cases of cerebral palsy may never need surgery, while patients with more severe cases may need multiple procedures over the course of their lives to keep the muscles as flexible as possible and address abnormalities that are causing pain or mobility issues. Whenever possible, our surgeons try to wait until children are older to perform surgery, and will also try to complete multiple procedures at once if they are needed. This helps to minimize the use of anesthesia in young patients and may help with recovery times.