Recent advances in cerebral palsy

Abstract

The words unpreventable, incurable, and untreatable are still synonymous with cerebral palsy (CP). However, research and evidence coming from the fields of neuroplasticity, neuroregeneration, and neuroprotection provide considerable cause for optimism for children with CP. There are now at least 64 different interventions for CP seeking 131 outcomes. A search of the Cochrane Library, PubMed, and Google Scholar was made using the keywords: CP, static encephalopathy, birth asphyxia, perinatal insult, hypoxic-ischemic encephalopathy, and neonatal encephalopathy. We found evidence to suggest that following interventions: Anticonvulsant drugs, ankle casting, botulinum toxin for focal spasticity, bisphosphonates, diazepam, hip surveillance, and dorsal rhizotomy are effective. The following interventions improve function: Bimanual training, constraint-induced movement therapy, context focused therapy, goal-directed/functional training, home programs, and occupational therapy. These interventions are effective if started early in life. Therapies such as hyperbaric oxygen, hip bracing, and neurodevelopmental therapy when child contractures are already developed are ineffective. In the last decade, the evidence on CP has rapidly expanded, providing clinicians and families with the possibility of newer, safer, and more effective interventions. In this update, the author reviews the current evidence of the management of CP and provides a comprehensive evaluation and multidisciplinary management.