INVASIVE OR TRANSCUTANEOUS TREATMENTS
CP treatments that pass through the skin or enter the body directly. Everything from oxygen to acupuncture or surgery for example. In alphabetical order.
Acupuncture reduces and relieves muscle spasticity, aches and pains. Acupuncture is an ancient Chinese medical technique developed more than two thousand years ago. Needles are inserted into strategic points along the body’s meridian lines. According to Chinese medicine, meridian lines are the channels through which our energy or ‘life force’ flows. This Life force is known as Qi (pronounced “chee’.)
According to western medicine, acupuncture involves stimulating sensory nerves under the skin and in the muscles. This stimulation results in the body producing pain-relieving endorphins.
Acupuncture is a well established and regulated medical procedure. A course of acupuncture results in long-lasting pain relief. Acupuncture can be used to alleviate: muscle spasticity, aches and pains, nausea, headaches and migraines.
One research study found that scalp acupuncture was more effective in improving motor function in children with cerebral palsy than habilitation with conventional methods. Another one indicates that limb motor function is significantly improved with acupuncture.
Drawbacks — not always easy to keep a young child still during the session and preventing them from flexing, which turns into pain, is even harder.
There are no side effects from acupuncture. It is a safe procedure in trained hands.
Julian was six years old when he underwent a several months course of acupuncture to release the spasticity in his legs. It was quite an unbelievable and beneficial experience. The spasticity in his legs had completely gone. Unfortunately, it was not possible to focus on just his left leg. And the reduction of his muscle tightness could not be regulated...so both legs were affected. But I would advise it to anyone with constant high tone. Not to mention that it is a more natural way to reduce muscle tightness than with baclofen for example.
CBD is the chemical found in marijuana. CBD is effective in reducing the pain from muscle spasms, as well as controlling convulsive seizures and epilepsy. CBD does not produce the ‘high’ associated with marijuana, because it does not contain the psychoactive ingredient called tetrahydrocannabinol (THC).
CBD is most often well tolerated, but can have the side-effects of dry mouth, diarrhoea, reduced appetite, drowsiness and fatigue for some people.
The main cause of concern with CBD is that it is an unregulated product. A recent study showed that more than 80 CBD products purchased online contained less CBD than labelled. In 18 of the products, THC was also found.
Craniosacral therapy for cranial osteopathy is a questionable treatment where massage is performed on the infants or child skull to reduce symptoms of cerebral palsy.
Deep Brain Stimulation
Deep brain stimulation is a surgical procedure used to treat symptoms of certain neurological disorders such as dystonia and epilepsy.
Deep brain stimulation surgery involves implanting electrodes into the brain. They stimulate the specific areas that control movement. The device, called an implantable pulse generator, regulates abnormal brain signals. The amount of stimulation is adjustable.
Deep brain stimulation is one of the most effective treatment options for dystonia.
Dry needling is a treatment that uses acupuncture needles which go directly into the muscle to be affected. It is used to to relax muscles as well as release myofascial trigger points. It is used to alleviate muscle pain, cramping and muscle tightness. Dry needling increases blood flow in the area and increases range of motion.
With trigger points, dry needling works by changing the way that the body recognises pain and thus ‘deactivates’ those trigger points. In CP dry needling mechanically elicits a response from the muscle by directly disrupting dysfunctional activity.
How it is done
Using acupuncture needles. The needle is inserted directly into the muscle to be affected.
Temporarily removes muscle pain and tightness and increases blood flow to region. It also improves range of motion. Dry needling can be used to help reduce: back pain, neck pain, knee pain, muscle spasms, muscle strains, joint problems, disk problems, tendinitis, migraine and tension type headaches, jaw and mouth problems, phantom pain and night cramps.
The needles used for dry needling are ultra-thin and are not felt when inserted into the body.
The only negative effect of dry needling is localised discomfort…This is usually due to flexion of the muscle after the needle’s insertion. The discomfort goes away when the muscle is relaxed again.
Other less common side effects of dry needling include: temporary soreness after treatment, bleeding where the needle was, fainting, fatigue and bruising.
More conventional methods may be considered for relieving muscle pain, such as stretching and massage therapy. But if stretching is already part of your daily routine, dry needling offers an excellent alternative.
Electroacupuncture is closely related to traditional acupuncture. It uses the identical needles to affect specific acupoints on a person’s meridians. The difference however is that in standard acupuncture only one needle is used in any given location. Whereas with electroacupuncture two needles are used.
The main difference between traditional acupuncture electroacupuncture, is that with electroacupuncture, as the name implies, mild electric current is passed from one needle to the other. This current stimulates the points more effectively than the needle-twirling used in standard acupuncture techniques.
Benefits — The benefits of electroacupuncture are similar to those of standard acupuncture.
— it has been used effectively to relieve pain from muscle spasms, as well as the treatment of other neurological disorders.
— The main benefits of electroacupuncture is that the practitioner does not need to be as exact with the insertion of the needles because the electric current affects a larger area.
— no pain is felt during an electroacupuncture session. There is however a more pronounced sensation of tingling than standard acupuncture.
— WARNING if not done correctly, electroacupuncture can cause internal injuries and possibly even electric shock.
— WARNING should not be done on anyone with history of epilepsy or any other types of seizures.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy involves breathing pure oxygen while in a pressurised chamber. The air pressure in the chamber is increased by 2 to 3 times more than normal air pressure. In this condition the lungs take in substantially more oxygen than in normal air. Its main purpose is to increase the oxygen levels supplied to the body.
Because it increases the amount of oxygen carried in the blood to the organs, the oxygen levels help tissue repair more efficiently. One might postulate that this increase in oxygen to the brain of a baby could improve and facilitate increase levels of neuroplasticity, but considering the side-effects, taking this chance seems extreme.
Oxygen therapy is used successfully to treat severe anaemia, burns, carbon monoxide poisoning, sudden deafness, gangrene, infection of skin or bone (that causes tissue death), radiation injury.
• Eardrum ruptures, middle ear injuries, temporary nearsightedness, lung collapse, oxygen toxicity (which is a seizure resulting from too much oxygen in your central nervous system), lowered blood sugar.
Hyperbaric oxygen therapy is one of those treatments that has shown no results in treating cerebral palsy. On top of that, the side-effects are quite drastic.
Muscle relaxants — Medications are used to reduce muscle stiffness, as well as muscle spasms. Relaxants can be taken either orally, by injection, or by an implanted pump. (eg. Baclofen, Dantrolene, Tizanidine, Flexeril, Diazepam)
Botox — Botox is the brand name of a neurotoxin called Botulinum toxin A. It is a neuromuscular blocker injected directly into the muscle. Botox relaxes the muscle by reducing the amount of nerve signals improperly received by the muscles.
The effects of Botox take full effect several days after injection. These effects are temporary.
There are two main differences. between a muscle relaxant and Botox.
1) Botox interrupts the nerve impulses that are improperly activating the muscles. This indirectly allows the muscle to rest more. Muscle relaxants on the other hand relax the muscles directly.
2) Botox is injected directly into the muscle, allowing for a very localised action. Muscle relaxants affect the whole body.
In the case of muscle relaxants and neurotoxins. Their use should only be to address the effects of spasticity and they should NEVER be considered as the only means of alleviating that spasticity. The momentary effects of medication can never replace the long lasting benefits of stretching and strength building.
Anticholinergics — medications used to block nerve signals causing involuntary movements, muscle spasms, tremors or excessive drooling.
Benzodiazepines — A sedative medication which relaxes, reduces anxiety, and relaxes muscles.
Anti-inflammatories — Medication used to reduce pain due to inflammation.
Anticonvulsants — Medications that are prescribed for people with cerebral palsy experience seizures. They work by reducing brain stimulation. This reduction in brain stimulation helps better control severity and amount of seizures experienced.
Developed by the Swedish med-tech company Exoneural Network, the Exopulse Mollii Suit is an assistive device. It is a full body garment. The garment has 58 electrodes integrated into it. These electrodes can stimulate 40 groups of muscles.
Unlike functional electrical stimulation (FES) the stimulation of the electrodes in the Exopulse Mollii suit are not intended to create motor function. The stimulation of the electrodes is used however to decrease spasticity of muscles by activating antagonistic muscles.
The suit not only reduces muscle spasticity, but also improves blood circulation.
By wearing the suit for one hour every day it is said that the effects of the Exopulse Mollii suit can last up to 24 hours or more.
Neuromuscular electrical stimulation (NMES)
Neuromuscular electrical stimulation therapies use low-level electrical currents to trigger a muscle’s contraction. These electrical stimulation therapies are most often used to relieve joint stiffness and muscle tightness. Their effects are short lived.
Functional electrical stimulation (FES)
FES is a type of electrical stimulation used to achieve the functional goal (eg. Dorsiflexion — flexing the foot upwards at the ankle). FES does this by using bursts of electrical impulses to cause muscle contraction. FES can also be used to increase muscle bulk.
Therapeutic electrical stimulation (TES)
Unlike FES, which has a functional purpose for activating muscles, TES is used solely for gentle muscle contraction. TES is used to increase muscle bulk.
Repetitive Transcranial Magnetic Stimulation
Repetitive Transcranial Magnetic Stimulation (rTMS) can be used for the treatment of CP as it facilitates motor memory formation and motor learning. rTMS is a promising noninvasive technique of stimulating the brain by the use of magnetic pulses. It has been shown that rTMS combined with physiotherapy shows a reduction in spasticity and increase in functional motor activity.
Selective Dorsal Rhizotomy (SDR)
Selective Dorsal Rhizotomy (SDR) is a complex neurological surgical procedure. It involves entering the spinal cord through one of the vertebrae and severing the nerves responsible for transmitting the brain’s erroneous signals to the muscle. When the brain’s signals to the muscle are halted…the muscle is no longer incorrectly activated into tightness. This reduction/removal of constant tightness is the goal.
SDR is the only operation for people with cerebral palsy, that permanently reduces the tightness in the muscles. After surgery the tightness does not return later in life.
A study has also shown that having the SDR reduces the amount of subsequent orthopaedic surgeries being needed.
Selective Percutaneous Myofascial Lengthening (SPML)
SPML is a minimally invasive surgical technique to lengthen muscles thus reducing spasticity. The procedure is performed under general anaesthetic and involves making small incisions through the skin to reach the muscles that are tight. The connective tissue on the surface of the muscle, called myofascia, is cut with small incisions. This then allows the muscle to be stretched and lengthened.
Because it is minimally invasive, it is an outpatient procedure. Unlike the conventional surgery there is no overnight stays or extended rehabilitation needed.
Stem cell therapy
Stem cells are unique from all other cells in the body. They can make copies of themselves over long periods of time and, under optimal conditions, their supply is theoretically limitless.They can also change into more specific cell types. The change is called differentiation which means that the stem cells can themselves turn into specific types of cells in the body.
Stem cells have an unbelievable potential in the future to cure cerebral palsy…but not yet.
Snake oil is cheaper.
Stem cell therapy is currently NOT a viable treatment for cerebral palsy. It is still in its infancy. It has great potential to cure many things, but not yet.
So why is it on this list? As a warning to those desperate to do anything in their mission to find normalcy.
Far too often on the various social media sites, people ask questions about the stem cell treatments offered in distant countries. These incredibly sophisticated sites all look so very medical indeed. They assure magical results and make far-fetched promises at exorbitant prices. Don’t be tempted to become a “Stem cell tourist”. Go to Las Vegas instead… you've got more chance of winning there.
Ultrasound waves are created through the vibration of crystals in the probe of the ultrasound device. The probe is moved against the skin. The ultrasound waves pass through the tissue and cause the molecules to vibrate. This vibration makes the area within the tissue warm. The warmth is not felt by the individual because it all happens below the dermis.
The warming action on the tissue is said to have the following benefits:
• It promotes tissue relaxation
• Warms muscles and tendons
• Increases local blood flow
• Helps with scar tissue breakdown—both internal and external.
The intensity of the frequency you set the device to determines the tissue depth affected. Lower frequencies are used for more superficial activation.
Boney areas must be avoided.
There are many contraindications to using ultrasound and is always recommended to get professional guidance when considering it. Discuss the use of therapeutic ultrasound with a physiotherapist or osteopath to see if it might benefit your needs.
NB: One study suggests that excessive use of ultrasound may exacerbate cancer.
Whole body vibration is a therapy where the person sits, stands or lies on a machine with a vibrating platform. The energy transmitted to your body, as the machine vibrates, causes the muscles to contract and release many times per second. This muscle exertion.
The vibration to the body improves flexibility, increases blood flow, reduces muscle soreness, builds strength and improves balance. It is also said to increase the level of cortisol (stress hormone) in your body.
For people without disability, going for a walk, biking, or swimming or just as beneficial as whole body vibration. But for individuals with CP, who may have difficulty with those activities, it is most certainly beneficial in activating muscles.