Introduction

Most people may have encountered people with cerebral palsy, but may not know the condition or how to provide support for them. Cerebral palsy is a disorder that affects movement and posture permanently. Cerebral palsy (CP)  happens when there are disturbances that affect the growing brain. This usually happens in the early stages of infancy or fetal development. It is associated with restrictions on muscles that have an influence on physical activity, and it frequently comes with difficulties with perception, cognition, conduct, and communication. About 1 to 4 in every 1,000  births in the world are affected by cerebral palsy (CP); surprisingly, this is the main cause of most disabilities seen in adolescents.^1,2

Definition of cerebral palsy

The words "cerebral,"  which relate to the brain, and "palsy," which means  weakness or issues with movement in the body, are joined to form the term "cerebral palsy." CP involves a variety of impairments that affect the movement of the muscles, which is a result of injuries to the brain.  Based on the kind of motor impairment and the body part affected, the disorder is categorised, with spastic cerebral palsy being the most abundant, having 82.9% of cases.^1,3

Brief history 

In the 19th century, in the 1800s, knowledge of cerebral palsy was built. Dr. John Little was the first to make his contributions to cerebral palsy. He defined it in 1853, but this time it was identified as a little disease. Dr. John associated it with oxygen deficiency and injuries during birth. His work gave birth to further research and findings. Sir William Osler, in his book titled "Cerebral Palsies of Children” in 1887, attributed cerebral palsy to the findings of Dr. John  Little, that is, Little's disease.  This marked an important phase in the identification of the disorder.⁴

Sigmund Freud, a neurologist and a psychiatrist, further researched possible causes of Cerebral palsy as only little percentage has a connection with birth asphyxia (A condition where a newborn does not receive enough oxygen immediately after birth, which can be a result of fetal distress, maternal bleeding, placenta disruption, etc). Hence, he classified the causes of cerebral palsy, which may be those that occurred before, during, and following birth.⁴

Meaning and character of spasticity

The most significant features observed in spastic cerebral palsy are Spasticity, and it affects a higher percentage of the population, that is, 78-88% of people living with cerebral palsy. Spasticity is defined as an unnatural increase in muscle tone that causes stiffness and heightened reflexes. The disorder is caused by a malfunction in the upper motor neurons and is typified by hyperreflexia and abnormal reflexes, such as the Babinski sign. Different forms of spasticity can appear, such those spasms affecting one side of the body, affecting the legs, or affecting all four limbs.^5,6 

Assessment and diagnosis of cerebral palsy 

To choose the best course of treatment and track improvement, it is essential to assess and diagnose spasticity in children with cerebral palsy. To evaluate spasticity in this group, there are a number of techniques that can be used. There are two types of techniques discussed below

1. Traditional clinical scales 
2. Innovative technology 

Traditional clinical scales

1. Modified Ashworth Scale (MAS): This scale uses a  6-point rating system, the scale helps measure resistance to passive movement in the child. The scale is simple to use, which is why it's commonly used, but its objectivity and trustworthiness are limited
2. Tardieu Scale: This scale provides more information than the Modified Ashworth Scale and can calculate the muscle reaction angle at a certain speed. This scale has certain limitations, which include taking a longer time and requiring specialist training

Innovative technology 

1. Sonoelastography in real time: This tool assesses how flexible the muscle is and also measures the variations in spasticity throughout time
2. Inertial sensors: it is a wearable device that provides objective information about spasticity by measuring joint angles and angular velocities during passive and dynamic movements
3. Dynamic Range of Motion (DROM) Scale Evaluation: This scale provides a more complicated assessment of spasticity by evaluating the range of motion at various velocities
4. Stiffness tool: This instrument provides a more accurate evaluation of spasticity by measuring the resistance to passive movement at various joint angles

Management strategies for muscle stiffness and spasms 

In the management of spasticity in cerebral palsy, a multidisciplinary approach is needed. There are several scientific studies that have highlighted several approaches that can efficiently tackle these difficulties.

Exercise and physical therapy

Physical exercises are important in treating muscular stiffness and spasms. This involves having exercise routines that are designed to enhance general function, strength, and flexibility. This consists of stretching, strength training, and aerobic activities. 

1. Stretching: Constant stretching minimises stiffness by preserving muscle length and flexibility⁸
2. Aerobic Activities: By boosting circulation and encouraging relaxation, low-impact aerobic activities like swimming or cycling can lower stiffness and enhance general muscular health⁸

Warm therapies

Muscle spasms and stiffness can be instantly relieved with thermal treatments.

1. Heat Therapy: Heating a muscle can help it become more flexible and relaxed. Warm baths, ultrasonic treatment, and heating pads are a few of the methods
2. Cold Therapy: A cooling spray or an ice pack applied after vigorous physical exercise can help prevent muscular spasms and decrease inflammation

Medications

Effective management of muscular stiffness and spasms frequently requires pharmacological therapies. Typical drugs include:⁸

1. Muscular Relaxants: These medications help in relaxing the muscles, thereby reducing rigidity and spasms. Examples are  Baclofen, Tizanidine, and Diazepam
2. Injections of Botulinum Toxin: In patients with cerebral palsy, injections of botulinum toxin into certain muscles can lessen stiffness and enhance function
3. NSAIDs (nonsteroidal anti-inflammatory drugs): These medications can help reduce discomfort and inflammation brought on by tight muscles

Dietary support 

Eating a well-balanced diet helps improve muscle health. There are various nutrients that, if present in foods, aid in the muscles ' function better. They include: calcium, magnesium, and vitamins B12 and D. It is good for one to always stay hydrated because staying hydrated can reduce muscular spasms and stiffness.⁹

Frequently asked questions

Is cerebral palsy contagious?

No, Cerebral palsy is not a communicable disease; it is a disorder, so people cannot contract it.

What are the causes of cerebral palsy?

There are several causes of this disorder, it may be as a result of genetic factors, infection or damage to the brain of the fetus, or lack of oxygen during the birth process of the baby.¹⁰ 

Is there a cure for cerebral palsy?

There is no cure for cerebral palsy, but there are inventions developed by experts to manage cerebral palsy. Additionally, research is constantly done to identify new treatments for the disorder.¹¹

Summary 

The main characteristic of cerebral palsy, which is a complex medical condition with a long history of research and changing definitions, is motor deficits brought on by early brain damage, with spasticity frequently appearing as a significant symptom.

In cerebral palsy, managing muscular stiffness and spasms requires using several strategies such as physical therapy, heat treatments, pharmaceuticals, and nutritional assistance.