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Cerebral Palsy Clinic: Your Child’s Care and What To Expect

Cerebral Palsy Clinic: Your Child’s Care and What To Expect

by | Mar 17, 2023 | Neurology

At Scottish Rite for Children, our experts provide care to the whole child – body, mind and spirit. The Neurology and Rehabilitation Medicine department sees children with orthopedic issues who also have related neurological disorders and neuromuscular diseases. One of the most common conditions seen by this team is cerebral palsy (CP).

Like all conditions, the severity of cerebral palsy can vary depending on the child and requires a multidisciplinary team to determine the best treatment options. With several factors that play into this diagnosis, we understand that as a parent or caregiver it can be challenging to navigate through the care plan for a child with cerebral palsy. Below is what you need to know about our specialized cerebral palsy clinic at Scottish Rite.

Who is part of the CP team?

  • Orthopedic Surgery
    • A pediatric orthopedic surgeon focuses on evaluating and monitoring for operative interventions to address function and pain.
  • Pediatric Rehabilitation Medicine (PRM)
    • PRM focuses on evaluating and monitoring the child for nonoperative interventions, including bracing, casting, tone medications, botulinum injections, equipment and therapies with the goal of optimizing function and reducing pain.
  • Neurology
    • This team treats the active neurological conditions such as seizures.
  • Advanced practice providers (APP)
    • The APPs work with both the neurologists and pediatric rehabilitation specialists to provide holistic care.
  • Nursing
    • This team coordinates and organizes each of the multidisciplinary teams and ensures that education is tailored to the needs of each patient.
  • Orthotics
    • A team of orthotists work with the teams to evaluate, fit and fabricate braces used to help your child’s mobility.
  • Physical Therapy (PT)
    • PT works with the child to improve functional mobility, with or without their needed equipment.
  • Occupational Therapy (OT)
    • OT focuses on activities of daily living, upper extremity function and the use of equipment needed to help your child function.
  • Therapeutic Recreation (TR)
    • TR works with the patient to promote activities and participation through peer interactions and relationships, such as adaptive sports, games and more.
  • Psychology
    • Our team of pediatric psychologists manage the psychological well-being of the child and helps them with strategies to overcome barriers to the treatment plan.
  • Developmental and Behavioral Pediatrics
    • This team optimizes nutrition, feeding and medical comorbidities and manages behavioral differences.

What can a parent/child expect when come to the CP clinic?

  • The child will first be seen by our motor control nurse who will go over medications and safety questions.
  • One of the neurology/rehabilitation medicine APPs will continue the visit.
  • A video recording will be conducted of the child for their gait to be analyzed so the team can compare changes that occur throughout time.
  • The pediatric rehabilitation medicine specialist and the APPs will then complete the visit and explain the plan to the patient and parent/caregiver.
  • Depending on the clinic and specific needs, the patient may also be seen by a pediatric orthopedic surgeon, orthotist, physical and/or occupational therapist, pediatric psychologist or a recreational therapist. When appropriate, referrals are also made to the other cerebral palsy experts.

How often are clinic appointments?

  • Children younger than 5 are typically seen every three to four months. Since this is a period of rapid growth and development, our team of experts want to make sure that they are monitoring the patient’s growth closely and intervening in any way needed to promote healthy and happy development.
  • Children between ages 6 to 12 are seen about every six months but may require visits more often if they are in the middle of a growth spurt.
  • After a child has completed their growth spurt, the team typically sees them between every six months to a year.

Pediatric rehabilitation medicine physician Fabiola I. Reyes, M.D., works closely with this patient population. “I am honored to have the opportunity to provide care to these kids,” Reyes says. “In the CP clinic, we pride ourselves in making sure that both the child and parent/guardian understand and feel comfortable with every step of the treatment plan. Although your child may have several specialists caring for them, which can be overwhelming, our team is here to walk you through the process – making sure the patient remains our priority.”

Learn more about the Neurology and Rehabilitation Medicine department.

Cerebral Palsy: Defining the Common Terms

Cerebral Palsy: Defining the Common Terms

by | Mar 23, 2022 | Neurology

Cerebral palsy (CP) is a condition that affects posture, movement and balance associated with an injury to the developing brain. The injury is static (does not worsen) and occurs before or during infancy. Scottish Rite for Children provides a multidisciplinary approach to care for children diagnosed with CP. Below are the most common terms used when our team is talking with patients and families about the condition. 

Motor Difference

  • Hypertonia – Increased muscle tone or a tendency for muscle to be tight.
  • Hypotonia – Low muscle tone, or a tendency for muscles to be excessively relaxed.
  • Dyskinesia – Excessive muscle movements.
  • Spasticity – Muscle tightness that manifests as a catch and release when a limb is moved quickly about a joint. This type of muscle tightness is constant and consistent throughout the day.
  • Dystonia – Muscle tightness that occurs because of unintended muscle activation. This type of muscle tightness can occur when an individual is trying to move other body parts or with certain emotions.
  • Ataxia – Motor pattern that describes difficulties with balance and difficulty with performing smooth limb movements.

Anatomic Involvement

  • Diplegic cerebral palsy – This term describes a motor difference that involves both legs.
  • Hemiplegic cerebral palsy – This term describes a motor difference that involves one side of the body and including the leg and arm on the same side.
  • Quadriplegic cerebral palsy – This term describes a motor difference that involves all four limbs.
  • Triplegic cerebral palsy – This term describes a motor difference involves both legs, and one arm.

Motor Classification

  • Gross Motor Functional Classification System (GMFCS) – This is a system used by clinicians to categorize how a person with CP moves and functions in different environments. It helps clinicians come up with treatment plans and anticipate changes that can occur in the body as the individual ages.
  • GMFCS I – Individuals in this category of mobility are able to go walk around their environment with little to no help. They can go up and down stairs without holding on to a handrail.
  • GMFCS II – Individuals in this category of mobility may need more help when walking on uneven surfaces or inclines and can go up and down stairs by using a handrail.
  • GMFCS III – Individuals in this category of mobility use an assistive device to walk community distances, such as a walker or crutches. They may use a wheelchair for longer community distances
  • GMFCS IV – Individuals in this category of mobility use a wheelchair for most of their mobility. They may be able to propel manual wheelchairs without any help, and they require little to no head and trunk support when sitting.
  • GMFCS V – Individuals in this category of mobility use the wheelchair for all of their mobility. They may be able to drive a motorized wheelchair and typically need head and trunk support when sitting.

Related Neurologic Findings

  • Periventricular Leukomalacia – This is a pattern that is seen on brain imaging that indicates scarring around the ventricles (the area of the brain that hold spinal fluid). It is usually associated with injury to the vessels around the ventricles in premature infants and affects both sides of the brain.
  • Hydrocephalus – This is a finding on imaging that indicates that the ventricles are enlarged.
  • Porencephaly – This is a pattern on brain imaging that indicates a local injury to a specific area of the brain. It usually affects only one side of the brain.

Related Orthopedic Diagnoses

  • Contracture – This describes a limitation in range of motion at a joint. There are multiple factors that contribute to contractures.
  • Hip migration – Tendency for the femur bone to become uncovered by the hip bone. This can occur in individuals with weakness or increased tone.
  • Neuromuscular scoliosis – A curvature of the spine that is related to weak or spastic muscles.