Cerebral Palsy and Mobility Issues

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Impaired mobility is the most common issue associated with cerebral palsy. Mobility issues range from a slightly abnormal gait to being unable to walk at all. Medications, surgery, physical therapy, and adaptive equipment can improve mobility and quality of life.

Why Cerebral Palsy Affects Mobility

Cerebral palsy is a group of neurological conditions caused by abnormal development or damage to the brain during pregnancy, birth, or early childhood. It causes impaired muscle tone and movement, leading to spastic or flaccid muscles, impaired reflexes, poor coordination, involuntary movements, poor posture, and impaired balance.

All of these issues impact how a person moves and can get from one place to another.

Mobility Issues by Type of Cerebral Palsy

Everyone with cerebral palsy is different, and the degree and type of disability vary widely. Most people with cerebral palsy have some degree of difficulty with mobility, moving around, or getting from one position or place to another. Although there are a lot of differences, there are some common mobility issues seen with various types of cerebral palsy.

Spastic Cerebral Palsy

The most common type of cerebral palsy is spastic, characterized by overly toned muscles and spastic, jerky movements. Tight, stiff, overly toned muscles make controlling movements difficult.

If it affects the muscles of the lower body, this type of cerebral palsy also makes walking difficult and causes a jerky, awkward gait.

Dyskinetic Cerebral Palsy

With dyskinetic cerebral palsy, a person struggles with involuntary movements in the muscles. Muscle tone fluctuates from overly to undertoned, so moving and controlling the limbs is challenging.

Ataxic Cerebral Palsy

Ataxic cerebral palsy causes shaky movements and difficulty balancing. When walking, a person with this type of cerebral palsy may need to spread the feet wide to maintain balance.

How mobility is affected also depends on which muscle groups are most affected and how severely. With symptoms mainly in the legs, mobility becomes more of an issue.

Gross Motor Function

A system of classifying the severity of cerebral palsy helps to describe a person’s limitations and abilities in terms of mobility. It is called the Gross Motor Function Classification System, or GMFCS, and describes five levels of mobility:[1]

• Level one describes someone who can walk with no limitations.
• Level two means a person can walk but with some limitations.
• Level three means a person can walk but needs an assistive device like a walker or cane.
• At level four, a person may be mobile with a self-operated wheelchair
• At level five, mobility is only possible in a wheelchair operated by another person.

Evaluating Mobility in Children with Cerebral Palsy

If you have a child with cerebral palsy, chances are they will have some degree of difficulty with mobility. To help them overcome those limitations, evaluating their current mobility is essential. This evaluation tells experts their abilities and limits and what kinds of treatment, therapy, or adaptive devices will improve mobility.

A gait assessment or analysis is the usual technique for evaluating how a child walks and their limitations. It is an extensive assessment that helps doctors determine how a patient walks and why. Understanding the underlying causes of an awkward gait allows professionals to come up with ways to make corrections.

The assessment looks at strength, muscle tone, reflexes, range of motion, balance, and more.

Surgery

Although not common, surgery may be an option to improve mobility in a patient with cerebral palsy. It all depends on the severity of the issue, the cause, if it can be easily corrected with a surgical procedure, and the child’s age.

Cerebral palsy is never curable, but surgery to repair a deformity in the legs, for instance, could help a child ambulate more easily and reach a higher level of independence. Surgery to lengthen contracted muscles and tendons can also help improve mobility while reducing spasticity and pain.

Some of the types of surgery a child with cerebral palsy might benefit from include:[2]

• Tendon surgery. In children who can walk, spastic muscles often cause tendons to tighten and shorten over time. A procedure to lengthen tight tendons in hips, legs, or feet can help children who can walk improve their gait.
• Osteotomy. This procedure reshapes and realigns bones to correct positioning and make walking easier.
• Spinal surgery. A child may benefit from a procedure called spinal fusion to stabilize or straighten the spine. It can also relieve painful pressure on nerves.
• Selective dorsal rhizotomy. This neurosurgery severs nerves that trigger spasms in the muscles of the legs or feet. This can reduce spasms that lead to tightness and make walking more difficult.

Physical Therapy to Improve Mobility

A standard treatment for mobility issues that anyone with cerebral palsy can benefit from is physical therapy. A physical therapist can help patients set mobility goals, like being able to walk with an assistive device, walking with less pain, or having better balance, and then work with them regularly to meet those goals.

Physical therapy helps with mobility by strengthening muscles, improving coordination, improving balance, and increasing flexibility. Exercises, adaptive equipment, stretching, and other activities are used in physical therapy to achieve these goals and give children greater independence, physical function, and, ultimately, more mobility.

Medication

Certain medications may also help relieve specific symptoms of cerebral palsy by targeting the underlying problems with muscles. Muscle relaxants are commonly used for cerebral palsy because they reduce muscle spasticity, one barrier to better mobility.[3]

Diazepam, baclofen, and others reduce stiffness and contracted muscles, allowing a person to move more smoothly and easily. Side effects may include drowsiness, weakness, diarrhea, and nausea.

Assistive Devices

In addition to therapy and other strategies for improving mobility, devices that assist people with walking can be helpful. Canes and walkers help children whose gait is awkward or lack good balance. For those who cannot walk at all or only with great pain or difficulty, a wheelchair can significantly increase the ability to get around and be mobile.

Mobility is one of the most common issues associated with cerebral palsy. A child with this condition should have the type and extent of mobility issues evaluated, and parents should be given options for improving their child’s mobility.

Although the condition cannot be cured, taking steps to make moving more accessible can help children reach their best possible outcomes for function and independence.