What do you understand by physical therapy in CP:
Physical therapy is the mainstay of treatment in cerebral palsy? We cannot cure brain damage but we can limit the progress of musculoskeletal problems.
Physical therapy in cerebral palsy is kind of special exercise to deal with specific problem of these children and adult. It consists of traditional & advance physical therapy. Traditional physical therapy includes stretching, joint mobilization. This traditional therapy is not of much useful in children with cerebral palsy and some time it harm to children. Fast mobilization of joint create new problem of dyskinetic pattern. Muscle sore & fracture of bone can occur with vigorous stretching. Advance physical therapy include strength training, NDT, SI, CIMT, HAND THERAPY, GAIT TRAINING, mirror therapy, YOGA, TRP & MRP etc. In early age when child is too much behind his milestone, intensive therapy is needed followed by maintenance therapy for long duration. Intermittently with increase in height and weight child develop new set of problem that need small period of intensive therapy. As child matured they need more strength training, yoga and gym to maintain stamina.
CP Patients Physical Therapy
Physical therapy is required in children with cerebral palsy for whole life but type of physical therapy may differ according to problem, disability, age. In Early age physical therapy is needed to manage primary problem of balance, sensory issue, pelvic control and to get developmental milestone. But as age increases demands and type of physical therapy changes. We need to keep records of progress and need as per requirement.
How is Physical Therapy Performed?
It works on the principle of neuro plasticity of brain. We have to train the normal neurons of brain to perform the functions which a person otherwise learns naturally. Therefore we cannot jump to train a child for walk, who does not know to sit. We have to follow the natural development pattern. There are many types of specialized techniques for physiotherapy use in cerebral palsy. We have to decide a therapy program according to age of child, type of cerebral palsy and severity of problems after detail clinical assessment of a child.
Different options of physical therapy for children with Cerebral Palsy:
Physiotherapy & occupational therapy is main line of rehabilitation for children with cerebral palsy. We also take help of other types of treatment modalities to help the child.
Specialized Physiotherapy along with judicious use of light wt polypropylene brace & walking aid is the mainstay of treatment. General & traditional physiotherapy including stretching & joint mobilization does not help. It requires highly advance techniques of physiotherapy. The techniques must be used according to age, type of CP and condition of the child after full clinical assessment. some of the techniques used are NDT, SI, TRP, MRP, CIMT, Context therapy, Strength training, Mirror therapy, FES, Hydrotherapy, Horse riding different types of Yoga postures etc. Along with therapy, some children with cerebral palsy may need botulinum toxin and surgery to manage associated spasticity and contracture.
Goal of Physical Therapy:
Goal of physiotherapy in a CP child is to make him as much functionally independent as possible so he/she can lead a life of their own. But it is not always possible. A child above one year who cannot hold his neck it is very difficult that he can walk on his own. With early intervention more than 60% children can have fully independent ambulatory life, 20% need assistive devices and rest 20% need good nursing care and full support from family member.
How can we benefit with this Physical Therapy?
Physical therapy helps child to regain functional & developmental milestone. It helps the child in maintaining stamina. By physical therapy child can work in much better way. Physical therapy helps in maintaining bone and muscle health. Physical therapy can helps in ambulation. If child don’t have neck holding then different methods of exercise on back, shoulder and neck will help in regaining neck holding. It also helps child in sitting walking. Hand therapy will help the child in writing skill and catching the object in much better way. During therapy child should be calm and be involve in therapy program. Parents have to learn all exercises needed for child so that they can do at home.
Physiotherapy: Inspired by YOGA
Yogasana are ancient practice for healthy living which involve moving the body and training of brain to achieve balance & well being. The purpose of traditional yoga is to keep each individual healthy, both physically and mentally and also to be able to achieve his/her highest potential as an individual. The meditation and yoga help to relieve anxiety and relax the tense muscles & strengthen weakened muscle which helps in therapy.
What are the basic areas of Practice?
- Yogasana (body postures) : Particular posture of body which is steady and comfortable.
Active posture – Activate & strengthen musculoskeletal system.
Active assisted posture – Most of the individual with disability require some assistance for doing and maintain yoga posture.
Passive posture – Employed in meditation, relaxation, pranayam.
- Pranayama (breathing exercises) : Breathing exercise to increase vital capacity and breath holding capacity.
- Deep relaxation/meditation : Chanting and relaxing in deep concentration give a soothing effect on whole body specially mental status.
How it works?
Yogasana: Yoga is a practice which works simultaneously on mind and body. Yoga decreases abnormal firing in already affected muscle so abnormal posture can be corrected in easier way. It improves balance, coordination, strength, flexibility of body and strengthen mind in turn. It focuses on slow controlled movement aimed at stretching & relaxing muscle. You stretch & relax tight muscle along with strengthening of weak muscle by holding certain posture for certain period.
Yoga Asanas significantly reduce high muscle tone. Holding an asana gives the muscles and tendons a relaxing stretch, releasing overall stress and tightness throughout the musculature and around the joints.
Yoga also provides enough resistance to low muscle tone areas of the body to strengthen muscles in children with hypotonic CP & weakened muscle.
Yoga stretches and counter-stretches paravertebral muscles and realign spine. It helps to create more space between the vertebrae and reduce pressure on the disks and nerves that radiate out of the spine. Reducing the pressure on these nerves facilitates the release of muscular tension throughout the body and enhances overall nerve function. As a result, the child is able to develop a greater range of movement and coordination, as well as greater independence. Usual problem in cerebral palsy is in cephalo-caudal direction and most of the time spinal & girdle muscle are affected more than distal muscle. Yoga helps a lot in strengthening spinal and girdle muscle so it helps in correcting gait pattern & sitting balance.
Yoga helps in digestion, breathing, stamina and trunk control and helps in improving immunity.
Pranayama: The average person uses only about one-seventh of his total lung capacity. By doing deep breathing exercise, we can increase our vital capacity and increase influx of vital energy to other part of body specially brain & digestive system. Pranayama also help us in increasing our immunity to disease. Pranayama has powerful stabilising effect on mind & emotion.
Meditation/Deep Relaxation: during this process, we try to concentrate our mind on our inner consciences.
Few yoga posture for cerebral palsy affected individual:
1. Paschimottanasana- this posture also being maintain length of mildly spastic hamstring muscle but should not be utilized in patient with contracture or sever spasticity.
2. Udarkarshashana—with this posture we can control ATNR and spasm of back & glutei muscle.
3 Tiryak Bhujangasana— in this posture we can control spasm of Para-vertebral muscle but children who have strong Shoulder & elbow muscle can only do this posture.
4. Parvatsna- This posture should not be managed in every child with cerebral palsy. This posture is being utilized in children who have good control of shoulder, hip and back muscle. It is excellent posture to stretch out hamstring muscle along with strengthen of quadriceps
6. Matsyendrasana – this step is very important step in athetoid cerebral palsy.
7. Bhunanamana vajarasana- this posture also helps in stretching out hamstring muscle & back muscle
8. Vakrasana- this posture helps in stretching of hip abductor & tensor fascia lata.
9. Pawan-muktasana- this posture also helps in breaking up spasm of back muscle as well soothen & calm the child but initial posture should not be practice in children with tight hamstring.
10. Setu-bandhasana: this posture is very helpful in stretching out hip flexor and also strength back & abdominal muscle
11 Bhujangasana: this posture helps a lot in regaining neck control and strengthening of para-vertible muscle of upper part of back.
12 Makarasana: this posture is initial posture for neck control.
13 Mayura-asana- this posture can be utilized in children with strong shoulder & elbow extensor muscle.
14 Supta Bhadrasana- this posture should only be practice when body is in relax posture .
15. Purna pawan muktasana- very help full in athetoid CP
16 Dakchshsasana (first step of surya namaskar)
17 Sukhasana – Sidhasana- Padmasana: with increasing grade of complexity nearly similar posture. sukhasana is easier to do but rarely person can do padmasana. this posture is an excellent way to control spasm of adductor muscle. It also helps in controlling spasm of para-vertebral muscle. This yoga posture should be managed in very gentle way. With rapid application of this posture in patient with weak bone it can cause fracture of femur and in cases with tight adductor it can cause sprain of adductor muscle.
18 Pranayaam: this Yogaasana helps in relaxing spasm of chest muscle as well relax the child.
19 Anulom vilom: this posture is excellent way to control chest muscle as well also helps in bowel movement, strengthen abdominal muscle.
20 Bhramari: this posture in relaxing the muscle and relaxing the mind so child will be calm & quite and will take active participation during exercise. We can also ask for chanting during this posture.