World Cerebral Palsy Day is Oct. 5, so now is a good time for massage therapists to learn about this condition and how healthy touch can boost quality of life for a cerebral palsy patient.
Cerebral palsy is an encompassing term representing a group of conditions characterized by various motor disorders: movement and postural dysfunction and/or muscle coordination challenges.
Typically, deficiencies of movement and muscle dysfunction do not worsen over time. United Cerebral Palsy estimates 760,000 Americans (children and adults) manifest one or more forms of CP. Between 9,000 and 10,000 babies born each year will develop a form of cerebral palsy. Between 1,200 and 1,500 preschool-age children will be recognized and diagnosed with cerebral palsy each year. Boys have a 40 percent greater chance of developing this condition than girls.
Types of Cerebral Palsy
There are three distinctive types of cerebral palsy.
- Spastic cerebral palsy features muscle rigidity and painful contractures.
- Dyskinetic cerebral palsy features controlled choreal (involuntary writing motions) and/or slowing of bodily movement.
- Ataxic cerebral palsy presents with poor coordination and balance.
No matter the CP variety, fetal brain damage to one or more areas of the brain is the likely cause. This damage may occur in utero, during the birthing process (congenital) or during infancy or early childhood (acquired).
If acquired after childbirth, the most likely causes in infancy are bacterial or viral infection such as meningitis, fall upon the head, trauma, child abuse or motor vehicle accident.
The most common manifestations include the following muscle spasticity, gait or mobility disturbance (often called a “crouch gait”), involuntary movements, abnormal sensory perception and breathing challenges. Other common manifestations witnessed include difficulty swallowing or feeding, speech impairment, idiopathic seizures, learning challenges, skin disorders due to sores and bowel and bladder challenges.
There are common functional markers in childhood development that can be witnessed to track the development of cerebral palsy:
At 2 months: Difficulty controlling head and/or stiff legs that cross when picked up
At 6 months: Reach with only one hand while other is in a fixed fist position
At 12 months: Not begin crawling or unable to stand with support
At 24 months: Unable to walk or push a toy with wheels
Several risk factors have been identified with cerebral palsy development. Premature birth and low birth weight have been directly attributed. Within utero, a lack of growth hormone proteins, placental abnormalities, bacterial or viral infections and RH blood factor not matching have been identified as risk factors. During the birthing process, prolonged loss of oxygen and/or head injury have also been identified.
Although incurable, there are treatment options available. Because cerebral palsy conditions manifest uniquely with each child, early detection and intervention is key to the aid of the child. Treatment options include surgery to correct physical abnormalities, braces and other walking aid devices, computer technology to aid in communication abilities and complementary therapies including physical, occupational, speech and massage.
Massage for the Cerebral Palsy Patient
Massage therapy is a legitimate therapy option for cerebral palsy patients. Once such patient, Mike Briede, mentions employing massage in his treatment regimen: “I focus on a balanced diet and plenty of rest. I don’t walk and spend my days in a motorized wheelchair. If I were a luckier guy I would get a massage every week. But so far, the few I have had were very relaxing.”
The major considerations when working with cerebral palsy patients depends upon the type of cerebral palsy present.
Spastic CP featuring muscle rigidity and contractures. Therefore, the emphasis of treatment shall be placed upon on relaxing tight muscles. Modalities which facilitate the relaxation of muscle tissue will greatly aid this patient.
Dyskinetic cerebral palsy features uncontrolled choreal and/or slowing of body movements. For these patients, emphasis on producing parasympathetic response is vital. Bodywork to calm the mind—body—soul connection will greatly aid the efforts to curtail the involuntary movements. Fascial unwinding techniques will also be applicable to free restrictions causing the slowing of body movements.
Ataxic cerebral palsy features poor coordination and balance. Emphasis on improving joint proprioception and mobility along with strengthening muscles around the joints to aid in stability will have great positive impact.
Addressing the cerebral palsy patient’s crouch gait can be challenging depending upon how much mobility and how pliable musculature tissue remains. The general game plan will be to free the hips and legs from chronic flexion position and restore normal movement within the upper body, specifically reducing lateral arm swing and trunk rotation.
Finally, stretching techniques to aid mobility of limbs will be an excellent augmentation to bodywork treatments. Remember to support joints especially well to avoid injury with moving limbs into a stretched position.
Jimmy Gialelis, L.M.T., B.C.T.M.B., is owner of Advanced Massage Arts & Education in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches “Working with Pathologies—Arthritis” and many other classes. He wrote “Fibromyalgia: Massage Therapy Considerations” for MASSAGE Magazine’s July 2015 print issue, as well as “Things to Consider When Choosing a Continuing Education Class,” and “For HIV/AIDS Patients, Massage Provides a Touch of Humanity” for massagemag.com.