Cerebral Palsy and Mobility Issues
There are many associated and co-existing disorders that children with cerebral palsy may experience. One of the most common is mobility issues. Since the condition affects muscles and movement, issues with mobility are common and range from difficulty walking or walking only with pain to being unable to walk at all.
It isn’t just walking that can be limited for someone with cerebral palsy. A child may have difficulty rolling over in bed, getting from one part of a crowded room to another, navigating outdoors, or using a vehicle. How limited a person’s mobility depends on the type of cerebral palsy and the severity of the condition. Treatments, therapy, adaptive equipment, and other tools can help provide greater mobility, and therefore a better quality of life.
Why Cerebral Palsy Affects Mobility
Cerebral palsy is a neurological condition caused by brain damage. The damage to the brain that a child suffers during or soon after birth affects muscle tone and movement, which affects mobility over all. Cerebral palsy causes things like overly toned muscles, poor reflexes, under-toned or floppy muscles, poor coordination, poor posture, and poor balance. All of these issues impact how a person moves and is able to 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. What most people with cerebral palsy have in common is some level 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.
The most common type of cerebral palsy is spastic, which is characterized by overly toned muscles and spastic movements, 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.
With dyskinetic cerebral palsy a person will struggle with involuntary movements in the muscles. Muscle tone fluctuates between overly to undertoned, which means that moving and controlling the limbs is challenging. 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 out wide to maintain balance. How mobility is affected also depends on where in the body the cerebral palsy is and how severe it is. With symptoms mostly 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. Level one describes someone who can walk with no limitations. Level two means a person can walk, but with some limitations. Level three means that a person can walk, but has to use an assistive device like a walker or cane. At level four a person may be mobile with a self-operated wheelchair, and at level five, mobility is only possible in a wheelchair operated by another person.
If you have a child with cerebral palsy, chances are she will have some degree of difficulty with mobility. To help her overcome those limitations, an evaluation of her current mobility is important. This evaluation can tell the experts what her abilities and limits are, 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 what the limitations are. It is an extensive type of assessment that helps doctors determine how a patient walks and why. Understanding the underlying causes of an awkward gait allows for professionals to come up with ways to make corrections. The assessment looks at things like strength, muscle tone, reflexes, range of motion, balance and more.
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, what is causing it, and if it can be easily corrected with a surgical procedure. Cerebral palsy is never curable, but surgery to repair a deformity in the legs, for instance, could help a child walk better and be more mobile and independent. Surgery to lengthen contracted muscles and tendons can also help improve mobility while reducing pain too.
A more common treatment for mobility issues that anyone with cerebral palsy can benefit from is physical therapy. Unlike surgery, there are no risks or side effects as long as it is conducted by a trained professional. 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 help them 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.
Certain medications may also help to improve mobility issues in 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. Diazepam, baclofen, and others reduce stiffness and contracted muscles and allow a person to move more smoothly and easily. There may be side effects, including drowsiness, weakness, diarrhea, and nausea.
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 who lack good balance. For those who cannot walk at all or only with great pain or difficulty, a wheelchair can greatly 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 be evaluated for mobility limitations and gait and parents should be given options for improving their child’s mobility. Although the condition cannot be cured, taking steps to make moving easier can give a child with cerebral palsy a better chance at a normal life and independence.