Recovery and Prognosis for Cerebral Palsy

Therapies Affect Prognosis

With regard to the gross motor skills recovery for patients with CP, most of the studies were evaluated before newer therapies became available such as selective dorsal rhizotomy, botulinum toxin, and intrathecal baclofen. There were modest improvements in functional scores for selective dorsal rhizotomy plus therapy and botulinum toxin injections. Intrathecal baclofen is more often being used to treat spasticity and pain, but increase functionality is harder to assess. It seems logical that if a child is not in pain, then therapy might yield better results. The subjective and often non-quantifiable improvements in motor functioning may be too subtle for measurement. This makes an assessment of long-term prognosis difficult. Furthermore, 90% of motor function skills are attained by age five which hardly extrapolates long-term and with continued therapies and newly developing technologies, which impacts the future profoundly.

Most of the information available is based on motor functioning without the aid of walkers or crutches and does not assess the quality of motor function which has important implications for which activities the child could or could not participate. It does not factor in how a child may change throughout the years regarding energy, stamina, increased balance, and increased strength. The study did appear to show an age-related increase in gross motor skill levels. The concept of prognosis is dynamic and is based on many factors, notwithstanding inherent psychological and cognitive functioning. It should never be assumed that further therapy is unhelpful. Up until age 12, it appears the prognosis for people with CP is stable and that CP is not a progressive disease. However, it should be assumed that discontinuation of therapy, especially for motor skills, will result in deterioration or regression of those skills. Muscle strength improves with repetition while inactivity causes muscle atrophy and weakness.

Confounding Variables Affect Prognosis

Motivation, parental encouragement, visual abilities, and the absence or presence of seizures will likewise impact the overall prognosis. The impact of puberty and secondary school requirements may impact prognosis as well.

CONCLUSIONS

In general, children with cerebral palsy, 50% have an intellectual impairment, 75% have chronic pain, 33% cannot walk, 25% cannot talk, 25% have behavioral problem, 25% have seizures, 25% have bladder issues, 20% have problems sleeping, 4% are deaf, 10% are blind, and 6% require a feeding tube.