TIRR Memorial Hermann is a nationally recognized rehabilitation hospital, currently ranked No. 2 in the nation and best in Texas by U.S. News and World Report. With our unique relationship with Children’s Memorial Hermann Hospital, you need look no further than TIRR Memorial Hermann for the best possible care for your child. We provide comprehensive outpatient rehabilitation for cerebral palsy (CP) patients of all ages, and we understand that each patient’s condition and needs are unique.
Whether your child has been recently diagnosed with CP, or if you are simply trying to stay abreast of the latest advances in research and treatments for CP, we want to be your resource for accurate, up-to-the-minute information.
What is cerebral palsy?
Affecting about one in 500 live births a year, cerebral palsy is a neurological disorder that affects movement, muscle tone or posture and is caused by damage to the motor control centers of the developing brain. This damage typically occurs during pregnancy, during childbirth or after birth, up to about 3 years of age but many factors are still unknown.
Some of the factors that may negatively affect brain development are:
- Genetic mutations
- Maternal or fetal infections
- Fetal stroke
- Traumatic head injury
- Oxygen deprivation during difficult labor or delivery
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What are the symptoms of cerebral palsy?
Cerebral palsy affects body movement and muscle coordination. Each case is unique based on the patient’s type of injury and the timing of the injury to the developing brain. CP may affect one limb or side of the body, or the whole body. Some patients may have total paralysis, requiring constant care, while others with partial paralysis might require minimal assistance.
Symptoms appear during infancy or preschool years and may include one or more of the following:
- Muscle contractions, too much or too little, or simultaneous contraction of all
- Limb shaking, trembling or writhing as a result of contractions
- Limb stiffness, possibly forcing limbs into painful, awkward positions
- Impairment of balance, posture and coordination
- Delays in reaching motor skills milestones
- Difficulty with tasks such as walking, sitting, tying shoes or grasping objects
- Delays in speech development or difficulty speaking
- Intellectual impairment, seizures and vision or hearing impairment
- Drooling or problems with swallowing, sucking or eating
What are the types of cerebral palsy?
There are four major types of CP, based on mobility limitations and the body part(s) being affected: spastic, athetoid, ataxic and mixed type.
Spastic CP is by far the most common type of CP, comprising about 70 to 80 percent of cases. People with spastic CP often experience exaggerated or jerky movements (hypertonia). Common symptoms include awkward reflexes, stiffness in one part of the body, contractures (permanently tightened muscles or joints) and abnormal gait.
Athetoid CP (“non-spastic CP”), affecting about 10 percent of children with CP, is characterized by a mix of hypotonia (low muscle tone, causing loss of strength and firmness) and hypertonia (high muscle tone, causing rigidity and spasmodic movement). The main symptom is involuntary movement of the face, torso and limbs, resulting in rigidity or floppiness of the limbs, problems with posture and feeding issues.
Ataxic CP is a rarer form of CP that typically affects voluntary movement, causing problems with balance and coordination. Additional symptoms include difficulty speaking, problems with depth perception, shakiness/tremors and spreading feet apart when walking.
Mixed CP occurs when damage to the developing brain is not confined to one location, causing a child to exhibit symptoms of more than one type of CP. Fewer than 10 percent of all CP cases are diagnosed as mixed.
Cerebral palsy is also categorized by the location and type of movement problem and whether the limb is weakened (paresis) or paralyzed (plegia/plegic):
- Monoplegia/monoparesis: only one limb affected
- Diplegia/diparesis: two limbs, usually legs, affected
- Hemiplegia/hemiparesis: one side of body affected
- Triplegia/triparesis: three limbs affected
- Quadriplegia/quadriparesis: all four limbs affected
How is cerebral palsy diagnosed?
Parents typically first notice a problem when their child fails to reach developmental milestones surrounding motor functions, such as holding his/her head up, rolling over, sitting, crawling, walking or picking up small objects. A physician suspecting CP will evaluate your child by direct observation, medical history and physical evaluation.
Your physician may also order tests to help make an accurate diagnosis, including a magnetic resonance imaging (MRI), a cranial ultrasound or an electroencephalogram (EEG).
If your child is diagnosed with CP, a multidisciplinary team of TIRR Memorial Hermann affiliated physicians and specialists will perform additional tests to identify vision and hearing impairment, speech delays or impairments, intellectual disabilities, movement disorders and other developmental delays.
How Is Cerebral Palsy Treated?
Although there is no cure for CP, a number of treatment options exist that can alleviate the symptoms and, in some cases, allow a patient to gain greater functioning in the affected limb. Treatments range from oral medications – the least invasive – to select dorsal rhizotomy, and depend on the child’s specific condition.
Oral baclofen or muscle relaxants relax stiff or contracted muscles but may not always be effective. Because they have side effects ranging from drowsiness and changes in blood pressure to the risk of liver damage, their use requires continuous monitoring. They’re appropriate for children who need only mild improvement in muscle tone or who have widespread spasticity.
Botulinum toxin (Botox®), administered by local injection, relaxes contracted muscles by keeping nerve cells from over-activating them. Muscle relaxation occurs within days and peaks after a month, with the effect of the injection lasting three to four months.
Intrathecal baclofen therapy (ITB) requires a surgically implanted programmable pump, which infuses baclofen directly into the patient’s spinal fluid via a catheter inserted into the spinal canal. Ongoing treatment requires refilling of the pump and frequent monitoring to ensure the appropriate dosage is given. ITB is usually used to help spastic quadriplegics with poor trunk control, who have had multiple orthopedic surgeries and are unable to walk unassisted.
Select dorsal rhizotomy (SDR) is most effective for patients 2 to 40 years of age with spastic diplegia or spastic hemiplegia, who have good trunk control and have not had multiple orthopedic procedures. A neurosurgeon locates and selectively severs overactivated nerves at the base of the spinal column. The procedure is most commonly used to relax muscles and decrease chronic rigidity in one or both of the lower or upper limbs. SDR provides an immediate permanent reduction in spasticity and the potential to walk independently within one to two years with intensive postoperative physical and occupational therapy. Outcomes are excellent in carefully selected patients.
What types of rehabilitation are used for cerebral palsy?
Physical therapy (PT) focuses on basic mobility, such as rolling, sitting, standing, walking, climbing stairs, reaching or operating a wheelchair, and can help individuals:
- Develop coordination
- Normalize muscle tone and build strength
- Improve posture and balance
- Maintain or increase flexibility
- Improve gait
- Optimize physical functioning levels
- Maximize independence
- Minimize pain and discomfort
Children with CP may also experience difficulty communicating, as CP often affects the language centers of the brain that control speech.
- Supports learning and education
- Improves literacy
- Increases confidence and independence
- Improves socialization
- Eliminates self-consciousness
- Reduces shyness
Occupational therapy (OT) is an integral part of a Cerebral Palsy patient’s overall treatment program. By applying the proven techniques and latest technologies, our occupational therapists enable individuals with a variety of challenges to achieve as much independence as possible in their daily lives.
Meet the Team
Meet our team of spasticity specialists.
In response to demand for Texas Medical Center-quality services closer to home, TIRR Memorial Hermann Pediatric Outpatient Rehabilitation now provides intensive and specialized services for children at five locations in the Greater Houston area:
To get started, use this form to become a patient or contact us by phone 1 (800) 44-REHAB (73422) , (713) 797-5942 or fax 713.797.5988
Three-year-old Samantha Shine came to TIRR Memorial Hermann unable to eat solid foods. Through VitalStem Therapy, she now eats breakfast, lunch and dinner. Read the full story.