Infantile Hemiplegia | Exploring the Impact of Physiotherapy on Motor Function, Muscle Strength, and Flexibility | Blog by CB Physiotherapy, Active Healing for Pain Free Life.

 

Infantile hemiplegia, a form of cerebral palsy, is a neurological condition that affects muscle control on one side of the body. This condition typically manifests in early childhood, impacting an infant’s ability to move and develop motor skills. While the diagnosis may be daunting for parents, advancements in medical and therapeutic interventions, particularly physiotherapy, offer hope and promise for improved outcomes in the management of infantile hemiplegia.

Understanding Infantile Hemiplegia

Infantile hemiplegia results from damage to the developing brain, often occurring before, during, or shortly after birth. This damage can disrupt the communication between the brain and muscles, leading to challenges in controlling movement on one side of the body. Common signs of infantile hemiplegia include muscle stiffness, weakness, and coordination difficulties, which can affect a child’s ability to crawl, walk, and perform everyday activities.

The Role of Physiotherapy

Physiotherapy plays a pivotal role in the comprehensive management of infantile hemiplegia. The primary goals of physiotherapy in this context are to enhance motor function, improve muscle strength and flexibility, and promote overall physical development. Here are some key aspects of the role of physiotherapy in addressing infantile hemiplegia:

1: Early Intervention is Key:
Early diagnosis and intervention are crucial in optimizing outcomes for infants with hemiplegia. Physiotherapists work closely with healthcare teams to identify developmental delays and implement targeted interventions as early as possible.

2: Customized Treatment Plans:
Physiotherapists tailor treatment plans to the unique needs and abilities of each child. These plans may include a combination of exercises, stretches, and activities designed to improve strength, coordination, and range of motion on the affected side.

3: Neurodevelopmental Techniques:
Physiotherapists often employ neurodevelopmental techniques that focus on facilitating normal movement patterns. These techniques aim to retrain the brain and promote more efficient communication between the affected muscles and the central nervous system.

4: Functional Activities:
The emphasis of physiotherapy extends beyond isolated exercises to encompass functional activities that are meaningful to the child. This may involve practicing tasks such as reaching, grasping, and standing, promoting the integration of motor skills into daily life.

5: Family-Centered Approach:
Physiotherapy for infantile hemiplegia is a collaborative effort involving not only the child but also their family. Physiotherapists educate parents on strategies to support their child’s development at home, fostering a continuous and holistic approach to care.

6: Adaptive Equipment and Technology:
Physiotherapists may recommend the use of adaptive equipment and assistive technology to enhance a child’s independence and participation in activities. This could include braces, orthotics, or devices designed to support mobility and function.

While the journey of managing infantile hemiplegia may pose challenges, the role of physiotherapy shines as a beacon of hope for families. Early intervention, personalized treatment plans, and a family-centered approach contribute to the overall well-being and development of children affected by this condition. As research and therapeutic techniques continue to advance, the outlook for infants with hemiplegia becomes increasingly promising, highlighting the profound impact that physiotherapy can have on their lives.

 

Cerebral Palsy | Improving Functional Mobility by Physical Therapy

Cerebral Palsy is the most common cause of disability in children. It encompasses a wide range of neurological motor impairments and can be severely disabling. Cerebral palsy requires treatment for optimizing an individual's motor functions. Physiotherapy being a part of the rehabilitation program is found to be effective in promoting the brain's ability to make adaptive changes. The more the patient performs an action, the stronger the neural pathways in the brain for that action become. In the same way, neglecting an action may cause its neural pathways to weaken.  Physiotherapy helps to identify the functional disability of the patient that needs help. The physiotherapist improves and develops a personalized rehabilitation plan to help the patient. In this blog, we have discussed cerebral palsy and its physiotherapy management.

 

Cerebral Palsy

Cerebral palsy is a non-progressive, nonfatal, and non-curable, chronic motor disability that results from damage to the growing brain before or during birth, or in the postnatal period. It may be associated with brain damage responsible for some defects of vision and hearing, abnormalities of speech & language and perception, apraxias, (restricted movements such acts as writing, drawing, and construction or even dressing), behavioral problems such as distractibility and hyperkinesia, which are based on the organic brain damage.

 

Physiotherapy Management:

The physiotherapist conducts a detailed assessment to find out the functional capacity of the child and the nature and extent of the motor as well as associated deficits. Physiotherapy involves highly repetitive, task-specific exercises, promotes neuroplasticity and achieves their optimal functional potential.  The aim is to achieve the milestones, maximize the tone, maintain muscle length, correct the posture and teach activities of daily living. Physiotherapy improves the functional capacity of the patient and makes the patient independent as much as possible through a planned intervention program.

 

Assistive aids and modifications

The physiotherapist recommends modifications like two-handled cups, angled spoons, etc. can be made to help the patient, a stiff cloth collar can be used to help provide neck support, old stools and boxes can be adapted to provide support during sitting, parallel bars can be constructed with wood logs to help gait training. The patient can use air beds and continuous change in position for pressure relief through bed positioning and seating adaptations. Many such homemade modifications can be made to prevent deformities to develop in cerebral palsied children.

 

Supportive Aids

Supportive devices like lightweight splints may be required to maintain normal postures. Splinting and exercise programs help to achieve the near-normal posture. Casts and splints should not be used for prolonged periods because they may lead to disuse atrophy of the muscles. AFO and calipers may be required to provide stability to the joints in a child who is learning to stand and walk.

 

Braces

Braces are used to correct deformity, obtain an upright position, and control athetosis. Children with spasticity are provided with muscle braces. Athetoid patients are trained to control simple joint motion. Ataxic patients may be given strengthening exercises for weak muscle groups.

 

Progressive patterns

The patient is taught motion according to the development like head and trunk rotation from side to side, arm on the face side in abduction-external rotation, elbow semi-flexed, hand open, and thumb out towards the mouth.

 

Synergistic Movement Patterns

Reflex responses are used initially and voluntary control of these reflex patterns is used later. Head and trunk control is attempted with stimulation of attitudinal reflexes such as tonic neck reflexes, tonic lumbar reflexes, and tonic labyrinthine reflexes, followed by stimulation of righting reflexes and later balance training.

 

Proprioceptive Neuromuscular Facilitation

Movement patterns are based on patterns observed while functional activities. The movement patterns consist of flexion or extension, abduction or adduction, internal rotation or external rotation, sensory stimuli are skillfully applied to facilitate movement. Stimuli used are pressure, touch, stretch, traction, compression, the proprioceptive effect of muscle contracting against resistance, and visual and auditory stimuli. Resistance to motion is also used to facilitate the action of the muscles, and form the components of the movement patterns.

Techniques used are:

·  Relaxation techniques – Hold Relax & Contract Relax

·  Rhythmic Stabilization

·  Repeated Contractions

·  Stimulation of Reflexes

·  Reversals

 

Neuromotor Development

The child is not permitted to use motor skills beyond his/ her level of development. The child is placed in a normal posture to stimulate normal tone, once postural security is obtained, achievements are facilitated and developmental sequences are followed throughout the training.

 

Reflex Inhibition & Facilitation

Reflex inhibitory patterns are used to inhibit abnormal tone, abnormal movement patterns, and abnormal posture. The reversal or breakdown of the abnormalities gives the child the sensation of a more normal tone and movements. The physiotherapist attempts to change the patterns of spasticity making the child prepared for movement. Mature postural reactions use key points of control like head, neck, shoulder, and pelvic girdles, though work is also done from distal key- points.

 

Sensory Stimulation for Activation & Inhibition

Techniques of stimulation, like icing, heating, brushing, stroking, massage, pressure, slow & quick muscle stretch, joint retraction & approximation, and muscle contractions are used to activate, facilitate or inhibit the motor response.

 

Reflex Creeping & other Reflex Reactions

Creeping patterns involve the head, trunk, and limbs and are facilitated at various trigger points or reflex zones. Touch, pressure, stretch, and muscle action against resistance are used to trigger or facilitate creeping, also resistance is recommended for the action of muscles.

 

Balance Interventions

Patients with cerebral palsy have a disorder with multisystem impairments, that affect the visual, vestibular, and somatosensory, inappropriate sequencing of muscle activity, poor postural control, and postural stability that is frequently interrupted by destabilizing synergistic or antagonistic muscle activity in patients. The physiotherapists work with the patient to manage the balance issues.

 

Electrical Stimulation Techniques

Patients with cerebral palsy should receive neuromuscular electrical stimulation (NMES) or transcutaneous electrical stimulation (TENS) in cerebral palsy physiotherapy.

 

Hydrotherapy

Hydrotherapy helps to learn new movement skills, which leads to increased functional skills, and mobility. The body is immersed in warm water, causing muscle relaxation and reducing spasticity, thus resulting in increased joint range of motion and creating better postural alignment.

The physiotherapist provides advice, education, and supervision regarding cerebral palsy to the patient, his/her family, and caretakers.