Cerebral Palsy

Renona Rehabilitation focuses on treatment and influencing congenital and acquired diseases and mental and physical problems.

The base of the treatment is rehabilitation. Renona Rehabilitation offers special rehabilitation approach based on complex treatment approach, using often used and successful procedures. Every patient goes through individual consultation and initial examination by our specialists in neurology, physiatry and children paediatrics. Based on this, a suitable rehabilitation procedure is selected.

Cerebral palsy of children is one of main focuses of Renona. It is a non-progressive disability with a possibility of change by developing and maturation of the central nervous system (CNS). It is caused by brain damage prior to its maturation. A characteristic feature of the cerebral palsy is motion disorder caused by disrupted muscular tension or disrupted muscular and neural coordination. Motion disruptions can be joined by mental disorders, behavioural disorders, communicative disorders, sensorial disabilities and epileptic seizures. Not all of these have to be present.

It needs to be said that cerebral palsy is not infectious. Children up to one year are vaccinated against cerebral palsy (poliomyelitis), what is an infectious type of palsy. The cerebral palsy rate at children is approximately 2 in 1,000 new-borns.

Brain damage is permanent and not insignificant indicator at motor activity disorders. Non-progressive, however, does not mean that the symptoms cannot be moderated.

Causes of cerebral palsy:

• During pregnancy (prenatal) – disease of the mother, X-rays, malnutrition, disruptions of placental circulation.
• During delivery (perinatal) – delivery with forceps, non-progressing delivery, late delivery, early delivery, all conditions leading to child having insufficient oxygen supply.
• After delivery (postnatal) – infection at new-borns with breathing failure, heart defects, cerebral infections up to six months of life, severe anaemia.

Symptoms of cerebral palsy:

The most frequent symptoms of cerebral palsy are:

• Late development of motion abilities (e.g. turning over, crawling, sitting, standing and walking)
• Stiffness of muscles or flabby muscles
• Bad body control
• Walking disorders
• Epileptic seizures
• Speech impediments, sputtering
• Eye muscle coordination disorders and strabismus
• Neurologic and affective disorders, increased salivation

Early and correct disease diagnosis is crucial, although new-borns might be asymptotic. Exercise is not only necessary, but also every-day and inseparable part of life of children and parents. Parents are a necessary element at reaching the target. Early diagnosis and indication of correct exercise can influence the total condition of a cerebral palsy affected child. Cooperation with specialists is also crucial. Cooperation and communication with them should represent one unit. An important part should be integrating the cerebral palsy patients into social life.

FORMS OF CEREBRAL PALSY

Spastic cerebral palsy

It is the most frequent form of cerebral palsy and is significant by muscular spasticity. The affected muscles are under permanent increased tension. They are stiff and tight when touched.

Spastic cerebral palsy can be divided into:

1. Spastic diplegia is another form of cerebral palsy, being the most frequent of all its spastic forms. Diplegia of children born at the right time is linked to prenatal factors. As a possible cause, there might be intraventricular bleeding with dilatation of cerebral chambers. During the growth, the lower half of the body remains undeveloped. There is increase in muscular tone – tension in lower extremities. When standing, the feet are twisted inwards and the standing position is typically on the toes. Legs are equinovarusely shaped.
2. Spastic hemiplegia is a condition to upper cerebral hemisphere. It is a disorder of the whole half of the body, accompanies by one-sided motion disorder, usually of spastic form. It is divided into congenital and acquired form. It affects more than a third of patients. Epilepsy is a sign of severe complication at infant hemiplegia. It is accompanied by mental retardation with link to epilepsy and 50% of hemiplegia patients suffer from it. This form of cerebral palsy is more typical for boys than girls and right-sided hemiplegia is more common. Hemiplegic extremities grow slower than the healthy upper ones. 
3. Spastic tetraparesis is a separate form of cerebral palsy. Only a third of the children with this disease develop normal intellect and half of them suffer under epilepsy. The disease is accompanies by severe impairment which can be treated therapeutically only very hardly. 
4. At bilateral spastic hemiplegia (quadriplegia), the scope of damage to both the hemispheres is important. Often this is the most severe and serious form of cerebral palsy. Usually, central disorder of cerebral nerves in the clinic form of pseudobulbar syndrome are visible. In various scopes, there are fatic disruptions and mental retardation.

Non-spastic cerebral palsy

This form is characteristic by weakened muscle tone. It can be represented in these types.

1. Hypotonic form it typical by weakened muscle tone. The child is weak with weakened muscles and joint structures in the form of hypermobility. It is also described by asynergy as a coordination disorder and unwillingness of muscle groups to coordinate. This way, consistency of movement is not present. The total psycho-motoric development is slowed down.
2. Dyskinetic cerebral palsy is characteristic by pathologic fast and uncontrolled tension change in the affected muscles. Children show involuntary movements, facial twitches, unintelligible and slow speech, hearing problems. Intellect is at a good level.

THERAPY

Treatment of cerebral palsy:

The treatment of cerebral palsy patients in Renona Rehabilitation programme is complex. It requires permanent multi-discipline team work of several specialists and active participation of family members. An inseparable part of cerebral palsy treatment is rehabilitation. There are several rehabilitation methods which are different in effort and efficiency. The most crucial aspect is early start of efficient and intensive rehabilitation care which can moderate effects of cerebral damage in ability to move of the patient.

From the rehabilitation point of view, cerebral palsy is a motion and posture disorder. Rehabilitation therapy needs to be dynamic and react to clinical changes, needs of the child and its parents immediately. It also needs to be started early and performed regularly and individually. We are using rehabilitation to improve the quality of basic functions of the patient, broadening of the poorer repertoire of functional activities with the target to reach full or partial independence and make the life of the parents easier, as well.

The most important step at efficient and targeted rehabilitation is acquiring the right attitude. Cerebral palsy is a non-progressive condition. However, it is not unchangeable. The rehabilitation takes the whole life and progress depends directly on the every-day work of the child and its parent. Rehabilitation is based on the feature called plasticity – ability of the brain to learn new things and adjust. We teach the child new stereotypes, eliminate pathologic motion patterns and try provide prevention of spasticity and contractions. A child should pass several examinations at paediatric and neurologic specialists when born. The activity of a child is different at a healthy child and a child with a health condition. If a problem in terms of slower development is identified, a solution must be clearly stated and treatment procedure. In the early age of a child, locomotion should be a priority in exercises, i.e. training of right locomotion patterns. RRC focuses on a combination of therapies and methods which are combined together and are interconnected in the effect. The exercise is focused on targeted and strict following of locomotion sequence.

Spinal muscular atrophy – a genetic disorder affecting nerves and muscles. Its base is decrease in muscle cells, deterioration of the motion and not the cognitive side. The most frequent symptoms are hypotonia and muscular weakness.

The rehabilitation of this disorder depends on the diagnostics of this disease. Spinal muscular atrophy has four stages and each of them is specific in symptoms. The base or rehabilitation is the doctor’s indication for rehabilitation. The physiotherapists in RRC have experiences in spinal muscular atrophy at rehabilitation of children. The exercises are careful, maintaining and targeted. Passivity leads to weak and atrophic muscles. Over-activity leads to overload and damage of muscles. Therefore, an important factor remains the careful approach to the patient and his or her condition.

Plexus brachialis paresis – peripheral paresis caused by trauma. The damage is characteristic by limitation in the ability to move, sensitivity disorder, mobility disorder and many disease type characteristic symptoms. The rehabilitation is based in complete kinesiology analysis, mobility and motion stereotype analysis. By identifying pathologic motion patters, the exercise target and sequence of general rehabilitation is set. Oxygen therapy proved to be a very beneficial procedure in muscle nutrition and regeneration.

Cerebral vascular accident patients are also among the clients of RRC. The aim of their rehabilitation is return of independency, self-sufficiency and consciousness. Every therapy focuses on the return of lost or recreation or re-learning and perfection of remaining functions. The therapies are consistent and focus on the physical motion side, as well as psychic support, communication abilities and skills of a patient in ergotherapy. Training of gross motions influences fine motoric motions, which is usually very limited or non-existing after cerebral vascular accident. Besides the exercise in Renona rehabilitation suit, supporting therapies are additional and very important activities.

Post-traumatic conditions

Post-traumatic conditions are conditions which can fully limit the movability of parts of or the whole body. They result in severe loss of movability, coordination disorder, space orientation, self-sufficiency and independency limitation of the patient. This includes cerebral, spinal cord, muscular, tendon and other tissue damage. The health condition and result of rehabilitation of the patient depends from the damage and the set targets. The top target of the rehabilitation is recreate, restore or improve the remaining functions of the body. Renona Rehabilitation uses its experience and practice with the patients with post-traumatic problems to create a special rehabilitation programme, focused not only on rehabilitation in the centre, but also training of self-sufficiency of the patient when returning home. The plan is created by subsequent integration and mobilisation of the patient in the vertical position, starting with the training of walking with rehabilitation aids, going through to walking itself. Balance training is performed in the special Renona Climbing room. Supporting therapies are cognitive and communication skills, which are also often disrupted. Rehabilitation focuses on several age categories, from small children, through adults to elderly people. Among the contraindication for treatment in the Renona Rehabilitation centre are conditions accompanied by infectious diseases and tracheostomy.

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