Cerebral Palsy (CP)-what does it mean?

Cerebral Palsy (CP) is now a widely used diagnosis given to many children. It is a term that can cover a wide spectrum of varying degrees of disability-it may include a mild impairment that only minimally affects a child’s everyday function, or a child may present with full body involvement and use a wheelchair as their permanent mobility. Obviously a blog post couldn’t possibly cover such a complex subject, but I’ve written this basic guide as a start….:

So what does CP actually mean? It is widely accepted that CP refers to a non-progressive, neurological disorder that is caused by a brain injury or developmental malformation of the brain. It is primarily a motor function disorder that affects muscle movements, posture and co-ordination. This can obviously present in many different ways and each individual is unique.

So to simplify that further…CP affects the way an individual can move and control some of their muscles. This can be often due to fluctuations in the tone of their muscles. Tone (in a basic explanation) refers to the amount of resistance that occurs when you try to move a limb or muscle. For most people with normal muscle tone, when relaxed, someone could easily bend their elbow so that their hand is close to their shoulder. This is because in a relaxed state the main muscles around our joints are not rigid so can be passively moved (moved by someone else). For a child with CP this may be slightly different: they may have high tone (hypertonia or spasticity) which would mean there is excessive resistance to any movement of certain muscles. They could also have some muscles which are low tone (hypotonic) and appear more “floppy” than you would expect. This will then affect their ability to move and control any of these muscles groups.

Cerebral Palsy is often broken down and classified even further, depending on how or where a child is affected. For example, if CP only affects one side, it can be referred to as being hemiplegic CP. If only the lower limbs are affected, this is known as diplegic CP and if all 4 limbs are affected quadriplegic CP. These all involve some degree of high tone (spasticity). There are also children who have CP that have lots of unwanted movements. This can generally be classed as either athetoid CP, where the child has constant unwanted movements, even when trying to sit still, or ataxic CP, which involves poorly controlled and co-ordinated or awkward movements. However, like many disorders, it is not easily “labelled” and even within each classification, every child will present very differently.

From a physiotherapy perspective, a full assessment can provide us with vital information about which main muscle groups are most affected. Rigid, high tone muscles can often lead to joints becoming stiff and even having reduced range of movement, which then affects function further. Unwanted movements and/or low tone can make mobility and simple tasks such a sitting on a school chair very difficult. It is our job to try to help a child to fulfil their full potential and to minimise any limits to their everyday function. Plus the key is…to make therapy FUN for every child. That way they don’t even realise that they are working hard!

If you would like more information, or think that Therapy Stars can help your child, please contact me on info@therapystars.co.uk or 07813764938.

 

Toe Walking-can physiotherapy help?

You may never have noticed, but some children tend to walk up on their toes, rather than keeping their heels down. This is referred to as “toe walking”. But why do they adopt this position?

 
In many cases, the reasons are never known why a child may start to walk on their tip toes. Some walk like that from very early on-as soon as they are on their feet. Others develop their walk in this position as they get older. Many children choose to walk on their toes for some of the time, as a game or to avoid a cold floor for example. But toe walking refers to children who walk up on tip toes for most of the time and often struggle to correct their position by keeping their heels down.

A child in a toe walking position.

A child in a toe walking position.

Toe walking can be very common and many toddlers grow out of it. However it can be associated with other conditions, such as cerebral palsy (CP). Children with CP may have tight Achilles Tendons due to spasticity (rigidity) in their muscles and this causes them to have to walk up on their toes. Some children who seek sensory feedback (for example children on the Autistic Spectrum) may adopt a toe walking position as a sensory strategy.

 
But for many there can be no definite reason for toe walking-this is known as idiopathic toe walking. Most children who are idiopathic toe walkers end up with some degree of tightness in their Achilles Tendon and calf. This is because the calf does not get a full stretch when in a pointed position, as it is when toe walking. But part of toe walking can also be attributed to habit…and this is often the hardest part to rectify. Therefore early intervention can be extremely beneficial.

 
For children who toe walk there are several methods of physiotherapy treatment that may help. Firstly a full physiotherapy assessment would be carried out. The Therapist would look at muscle length, particularly around the calf and Achilles Tendon. They would also assess muscle strength, especially the muscles of the lower limb and core (back, hips and abdominals). They would then provide an exercise programme that targets muscle lengthening and strengthening. For younger children this may involve parents being shown how to stretch certain muscle groups and encourage activities that help to strengthen particular muscles. For older children, it may be more appropriate for them to be taught how to stretch and strengthen themselves. They may also use a stretching wedge to specifically stretch the calf muscles.

 
Regular, daily stretching is important in order to gain some length in the muscles and therefore allow your child to be able to put their heels down more easily. However, for some children, stretching alone may not be enough. These children may require further intervention that can include serial casting (regular plaster casts being applied to the ankles over a period of 4-6 weeks to gain a consistent stretch), splints (made of plastic, they hold the ankle in a certain position, therefore preventing toe walking) or in very severe cases surgery.

 
If you have any concerns about your child toe walking or would like some advice, please contact Therapy Stars on info@therapystars.co.uk or 07813 764938.

 

Hypermobility and your child

Having recently been asked to assess and advise parents regarding their child with hypermobility, I thought it may be useful to look at hypermobility in general. Many parents are told that their child is hypermobile…but what does this mean for your child? Hypermobility is the term used when you have more than normal range of movement at some or all of your joints. Is if often referred to as being “double-jointed”. It is relatively common, particularly in children, as we get less mobile as we grow older. Like many conditions it encompasses a wide spectrum from mild to more severe symptoms.

A mild case of elbow hypermobility.

A mild case of elbow hypermobility.

In a lot of cases, being hypermobile may have absolutely no consequences for your child-they may just realise that they are slightly “bendier” or  more flexible than their friends. But for some children, where they have several hypermobile joints, it may first become noticeable when they aren’t quite as quick to reach their developmental milestones.

 
Delayed walking can sometimes be an indicator that a child may have hypermobility around their ankles. For these children, supportive, well fitting footwear is crucial. Shoes should have a good supportive heel and sturdy upper material to offer you child’s foot maximum support and stability. Occasionally a child may benefit from specialist orthopaedic boots which can be prescribed through a physiotherapist, orthotist or podiatrist (dependent on the service in your area).

 
Children with hypermobile joints may complain of tiredness and fatigue quicker than their friends or siblings. This is due to their muscles having to work harder to stabilise the joints and can also be due to muscle weakness. They may be more prone to injury as their joints allow the body to adopt positions with greater ranges than the norm, which can lead to the soft tissues becoming over stretched. In the most severe cases joints may even dislocate.

 
For some children though this can even become an advantage-gymnasts and dancers are well known for needing to be ultra flexible and many children with hypermobility will excel at these types of disciplines. However it is important for their coaches to always be aware of their hypermobility to minimise the risk of injury.

 
So…what do you suspect your child is hypermobile? Firstly be aware of which of your child’s joints seem to have excessive ranges of movement. This is so that you can monitor any injuries or aches and pains to see if they are related. Pain relief can be given as and when appropriate for your child. If there are ongoing problems with pain and/or injury, then trying to strengthen your child’s muscles can often help. Swimming is a great way of targeting lots of muscles, and children often find it less stressful on their joints because there is no impact. For younger children, soft play areas and using trikes can be good ways of trying to encourage muscle strengthening.

 
In a few cases, severe or widespread hypermobility or hypermobility alongside other specific symptoms, may be an indicator of another condition. If you have concerns that this may apply to your child, you should consult with your child’s GP. There is also lots of information and advice on the Hypermobility Syndrome Association website www.hypermobility.org There is also an information leaflet produced by the APCP (Association of Paediatric Chartered Physiotherapists) which can be found at www.apcp.csp.org.uk/publications/parent-leaflets

 
If your child has hypermobility and you would like an physiotherapy assessment and further advice, please contact Therapy Stars on info@therapystars.co.uk or 07813 764938.

What is Paediatric Physiotherapy?

Therapy-Stars-header-logoTherapy Stars offers Paediatric Physiotherapy…but what is it?

Paediatric physiotherapists are physiotherapists who have experience and training to specifically treat children and teenagers. All physiotherapists have general training during their degree, and can then specialise in different areas, dependent on their interests, experience and developing skills.

Physiotherapists who work with children can be found in hospitals, in the community and in private practice. They can help children with a variety of symptoms, injuries, conditions and illnesses.

Paediatric physiotherapists will have a solid understanding of child development and growth, as this is a major difference between treating adults and children. They will also have knowledge of treatment methods that aim to maximise a child’s function and potential, whilst appreciating that childhood is a time for fun and enjoyment.

If you are unsure if your child may benefit from paediatric physiotherapy, please contact us at info@therapystars.co.uk or Sian on 07813 764938.