Therapies
Multidisciplinary treatment of children with Cerebral Palsy
Prof.Jules Becher, MD PhD.
Pediatric physiatrist. Department of rehabilitation medicine, VU university medical center Amsterdam, The Netherlands.
Cerebral Palsy is the most common cause of physical disability in children. In developed
countries, the prevalence is about 2 per 1000 living born babies (1). In less favorable
circumstances, the prevalence is much higher (2). In the past, treatment of children with
Cerebral palsy was focused on treatment of impairment of body functions, and especially on
the treatment of signs of abnormal muscle function, in order to “normalize” muscle function
and development (for instance the NDT or Bobath treatment, Voyta treatment, Doman-
Delacato treatment etc). Research in randomized controlled trials could never demonstrate
specific beneficial effects of such therapies (3). Using the ICF-CY as model for treatment of
the consequences of a disease, therapy should be focused on improvement of activities and
participation of the child and support of the family in raising their child (4). Within this
concept, therapy should be based on identification of the needs of the child and the family,
analysis of the level of functioning, identifying the abilities of a child and constraints for
learning the desired task and functional therapy, focused on learning and applying new
tasks. The present course is based on the above mentioned principles. As the treatment of a
child with Cerebral Palsy and the family is complex and in fact a life-span condition, a
multidisciplinary team approach is presented, with the focus on medical treatment and
training methods. The theory is presented in lectures, but also practiced in small groups in
workshops, partly multidisciplinary, partly monodisciplinary, by both Polish and Dutch
teachers. On this way, modern methods for education are introduced. In the parents session,
the parents are asked to their needs and wishes, and the team approach based on the ICF-
CY model will be discussed. In summary, most recent views on the treatment of CP children
will be presented and practiced by multidisciplinary teams in this course: an unique
opportunity!
Reference List (1) Himmelmann K, Beckung E, Hagberg G, Uvebrant P. Bilateral spastic cerebral palsy--prevalence through four decades, motor function and growth. Eur J Paediatr Neurol 2007 Jul;11(4):215-22. (2) Serdaroglu A, Cansu A, Ozkan S, Tezcan S. Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Dev Med Child Neurol 2006 Jun;48(6):413-6. (3) Damiano D. Pass the torch, please! Dev Med Child Neurol 2007 Oct;49(10):723. (4) Lowing K, Hamer EG, Bexelius A, Carlberg EB. Exploring the relationship of family goals and scores on standardized measures in children with cerebral palsy, using the ICF-CY. Dev Neurorehabil 2011;14(2):79-86. Jules Becher MD, PhD,
Diagnosis, prognosis and goals of treatment
Marek Jóźwiak, M.D., Ph.D.
Professor of Orthopaedic Surgery
Department of Pediatric Orthopaedics and Traumatology Motion Analysis Laboratory K. Marcinkowski University of Medical Sciences Poznan
A critical objective of a medical team, which objective integrates the processes of making and implementing treatment-related decisions and of defining long- and short-term goals of treatment, is understanding of medical and social needs of children with cerebral palsy and of their families.
The chief aim is to offer children, their families and their communities the best medical, educational, living and economic conditions for their development, growth and social functioning during their social life. The essential prerequisite to achieve this aim is the earliest possible functional diagnosis, including the prognosis of locomotive development and of self-reliance. It is the basis of realistic therapeutic programmes including neurodevelopmental rehabilitation methods, surgical treatment, education and social action. Defining an accurate functional diagnosis allows to calculate the risk of the most serious consequences and complications in children with cerebral palsy so-called lever- arm dependent deformities of limbs and trunk in children able to walk independently or with the help of orthothic equipment and dislocations of hip joints and/or scoliosis, typical for patients on a lower functional level. Early assessment of a risk of complications and cerebral pasly form classification to accurate risk groups allow to provide prophylactic care which in turn allows to diminish the effects and clinical consequences of cerebral palsy.
Conducted by a Polish-Dutch team, the course aims to familiarize its participants with issues mentioned above and with a variety of diagnostic tools used for assessment and functional prognosis. Its goal is also to help determine the goals of treatment, to take therapeutic decisions based on objective clinical factors. Participants completing the course should be able to identify feasible short- and long-term treatment goals of children with cerebral palsy.