I recently received a very good email from a parent asking about why I… and many others… seem to talk more about CP than about spasticity. She wants to know is there any hope for reducing spasticity? The short answer is yes. The problem is that reducing tone is an on-going problem that requires a coordinated approach. Unfortunately, this is rarely done.
In my view, the first issue is a confusion of terminology. Cerebral palsy and spasticity are not the same thing. Cerebral palsy is a disorder caused by brain damage in an immature brain. Spasticity is a part of the complex signs and symptoms caused by the brain damage. This distinction is important because some of the treatments that are available aim to treat the underlying brain problem by encouraging neuroplasticity…making new connections. Some examples are Constraint Induced Movement Therapy (CIMT), the Anat Baniel method, Neurodevelopmental Therapy (Bobath/NDT) and a wide variety of Sensorimotor Integration techniques. EMG Triggered Stimulation (ETS or EMG+Stim) is a newer technology that allows the child to “find” new brain pathways, often in minutes. Each of these therapies works from a different theoretical background, but all of them are working to reprogram the child’s learned abnormal movement pattern into a more normal movement pattern. The goal is to teach the child how to move in a more normal fashion. There are other methods of treatment that also have the goal of improving the brain and over the years, I have found that there are regional and personal preferences amongst physical and occupational therapists.
Whatever the method used, if the brain re-wires into a more normal circuitry with a how to therapy, it seems obvious that spasticity will reduce. If in fact, after a treatment session, many children will move more easily. But it rarely lasts for long. The effect wears off and the child tightens up again. The mother who wrote me had tried Botox injections several times and was able to report that her four-year-old child had a much better potential of walking under the effect of Botox. The injection temporarily decreased her child’s spasticity, which allowed easier movement. However, as soon as the Botox wore off, she was back to square one.
I believe parents need to learn how to differentiate between treatments that teach a child how to do an activity in a different way and techniques and therapies that allow the child to move differently. Both types of treatment are necessary, but most times parents and therapists tend to focus on the most recent therapies and often neglect the basic requirement to maintain alignment until the child stops growing. Treatments that maintain alignment are the treatments and techniques that allow more normal movement and growth. A key difference between an adult with a stroke and a child with hemiplegia is the child has a growing body and any tone change will distort growth. Here is a reality check…None of the how to therapies work as well as they could if we allow the body to distort. It is not an either/or situation.
I am going to write more on this important topic in the coming weeks. In the meantime, try making a list of your child’s therapies that allow better movements and therapies that teach how to move differently.