Other Options

With or without surgical reconstruction, The Cerebral Palsy and Neurological Upper Extremity Service advocates a traditional therapy program beginning with early intervention and progressing to maintenance of an active adult lifestyle for all of our patients. Some options you may hear about are listed below. These are brief descriptions of the services and do not reflect the full scope of service or philosophy. Additional contacts are provided where available. The benefits and limitations of any therapy program should be discussed with your pediatrician, orthopedist and therapy team.

---

 Types of traditional therapy

Neurodevelopmental Treatment (NDT):NDT treatment is based on the work of Dr. Karel and Berta Bobath. This approach primarily considers the neurological and developmental issues of the child and was largely based on their experience with children with cerebral palsy. The use of handling techniques (ie helping the child to move through facilitation and inhibition) in order to encourage more mature motor patterns and increase function is the primary goal. This type of treatment is widely used in pediatric facilities and is appropriate for most, if not all, baby and child aged patients with cerebral palsy. An eight week certification course in NDT is often a goal for therapists interested in NDT. For further information, contact www.ndta.org.

Also:Other less common treatments available include: Conductive Education, hyperbaric oxygen treatment, PNF patterning and a myriad of others. Also, after clearance from your health care professionals, swimming, dance, karate and any other age appropriate school aged activity that a child would be interested in is encouraged. Many local centers and instructors work with children of varying abilities. Contact local providers for availability. Your therapists may be able to guide you to centers more attuned to the needs of children with varied abilities.

---

Services Often Provided

Early Intervention (EI): EI began in 1986 as a federal law amendment (PL 99-457) to provide therapy and medical services to children without regard to financial status and with a focus on a family centered model. All states must provide early intervention to children with described delays from birth to three years. The programs in each area vary slightly. Your pediatrician or hospital social worker should be able to refer you to your local agency. (0-3yrs)

Committee on Preschool Special Education (CPSE): This agency is for the transition between early intervention and board of education services. Again, your pediatrician, EI case worker or hospital social worker should be able to refer you to your local agency and describe your local guidelines. (3-5 yrs)

Board of Education (BOE): This provision of services was the first of its kind in 1975 with the passing of PL 94-142, or the Education for All Handicapped Children Act. This public law entitled school aged children to therapy services in situations where their difficulties hampered their education. Because this law primarily considers concerns interfering with education, not all types of treatment are always provided. You local Board of Education will be able to define the standards of service provision for you. (6 years and up)

---

Other Interventions

Botox: Botox may be the most widely heard of chemical agent to interrupt spasticity. Botox is administered by an injection in the muscle. Botox effects how a signal is transmitted in the muscle, thus weakening it. Botox lasts only about three months in the body and then the pre-injection state returns. In the lower extremity, where the foot is often set on the ground or placed in an orthotic, longer effects are sometimes maintained. In the upper extremity, where motion is free in space, the pre-injection state usually returns in three months. In The Cerebral Palsy and Neurological Upper Extremity Service, Botox is used in a limited manner in a few patients. Sometimes, the muscles to be operated on are weakend with Botox in order to have a similar effect that the surgery will. This provides a surgical simulation for patients that have a complicated presentation. It also is useful in simulating surgery for patients with athetosis, as the patterns in athetosis are more difficult to predict. 

Rhizotomy: Selective dorsal rhizotomy is an operation at the spinal cord level that surgically interrupts selected rootlets (nerve roots thought to be causing spasticity). It is often performed by a neurosurgeon along with an orthopedic surgeon. It is performed at select centers throughout the country and is not without controversy as the criteria for patient selection is very strict.

Baclofen Pump: This treatment is also known as Intrathecal Baclofen, or ITB. ITB therapy administers the substance baclofen into the spinal fluid by a surgically implanted pump system. It has been approved for the treatment of cerebral palsy since 1996, but had been used since 1992 for other disorders causing spasticity.

Phenol Injections: Phenol injections are an older method of chemical interruption of the nerve signal to the muscle thus weakening it. Phenol injections are somewhat controversial due to early complications with administration and effects. Currently, in the treatment of spasticity due to cerebral palsy it is not typically recommended. It is, however, used in some settings with acquired spasticity in the early post injury state. Acquired spasticity includes diagnoses such as stroke and head injury.

Oral Muscle Relaxants: At times after surgery, valium may be used for spasticity reduction. It is not recommended for long term use in most cases.

Helpful Links

• Hospital for Special Surgery
• American Academy of Cerebral Palsy & Developmental Medicine
• Noah-Health (NOAH)
• United Cerebral Palsy
• We Media
• Exceptional Parent Magazine