A special issue on Cerebral palsy

This issue of PhysioTimes is dedicated to those little angels with cerebral palsy and the struggle of their families and to the relentless efforts of the therapists and the multidisciplinary team members involved in the rehabilitation of such children to the main stream of society. The fact that CP causes damage to a child’s brain that cannot be reversed or cured is very hard for everyone concerned to come to terms with. The doctors, therapists, community workers and others working with the child and her family have a narrow path to walk. They must help those closest to the child to find a balance between acceptance of the child as she is and hope that she can be helped to be more independent. The issue discusses at length the current approaches in the management of cerebral palsy, clinician’s view points on differential diagnosis, recent concepts in orthopedic interventions, role of Botox, as well as it touches upon the importance of early intervention and long term outcome in children with cerebral palsy.  

Apart from the regular sections like Ergonomics, Inside Imaging, we have guest columns on the role of speech therapist in CP, emerging topics like stem cells and interesting areas like play in palsy, role of assistive aids etc. An interesting feature is the interview of Esther De Ru, a veteran physiotherapist in Brazil, having worked in pediatric physiotherapy for more than three decades. I am indebted in particular to my revered Guru and guide, Dr.Nilima Patel, for having shared a very interesting real life case of Aayush and how Physio Yoga can help children with special needs. I thank Dr. Savjibhai Nakum and Dr. Asha Chitnis for their interest, guidance and help in putting this issue together. Without their help, it would have been impossible for us bring this issue to you. In the end, I would sum up by saying that as a therapist we must offer families of children with special needs, a kind of help and hope that may change their lives for the better. After all “Every child is special”. God bless those little wonders and those wonderful hands responsible for healing.


COVER STORY: Current Concepts In The Therapeutic Management Of Cerebral Palsy - DR.ASHA CHITNIS

The History of Cerebral Palsy - A Long Wait for Recognition of the Disease that Cripples

Cerebral palsy is not a new disorder. Even though history lacks written proof, there is no doubt that cerebral palsy has existed as long as women have been giving birth or as long as there have been children. The earliest documentation of cerebral palsy goes back to the ancient Egyptians. A tablet in the Temple in Memphis dating from the fifth century BC memorializes its adult male caretaker who... Read More

CLINICIAN SPEAKS: Recent Concepts In Orthopedic Interventions For Children With Cerebral Palsy - DR.ASHOK JOHARI

Cerebral Palsy is a major cause for disability in the younger population. Varied forms of disability result from damage to different regions of the growing brain. Whilst medical and surgical interventions aim to bring the patient to maximum normalcy, optimum 'cure' remains a far too distant goal and residual disabilities really do remain a problem. Key points in Orthopaedic Interventions for children with cerebral Palsy include:

1) Proper Evaluation  2) Orthopaedic Surg... Read More

SPECIAL ARTICLE: Botox for celebral palsy

Cerebral palsy (CP) is a non-progressive lifelong condition resulting from damage to the newborn brain. Most infants have spasms (spasticity) affecting at least one leg that prevents normal movement. It can cause muscle contractures and deformities and the affected muscles do not grow as rapidly as neighbouring bone and soft tissue. Treatment includes physiotherapy, oral anti-spasticity drugs, casts, splints and orthopaedic surgery. Injection of botulinum toxin (BTA) into muscle causes local ... Read More


It’s my pleasure to write first time for my therapist friends. As a Pediatric neurologist, I receive so many difficult to treat patients from therapist friends, in which despite of their extreme efforts they don’t get desirable results. So what are the reasons of these mishappenings? Why some children respond very well to therapy and others don’t?

I want to share some clinical hints by which you can diagnose major pitfalls in a child quickly and avoid disappointmen... Read More

REVIEW ARTICLE: Physiotherapy In High Risk Babies - DR.SHRADDHA DIWAN

Recent advances in the field of neonatology have significantly reduced the morbidity and mortality rates particularly among low-birth weight infants. Because premature birth is associated with an increased risk of neurological injury, the improved survival rates very small infants are associated with an increased prevalence of major and minor neuro-developmental disabilities. Hence challenge for early identification and prevention of neuro-developmental disabilities has greatly increased for ... Read More


Children with severe neurological disabilities represent a challenging population for the PT or OT professional. The gap between what we know about neurological impairments and what we are able to do in terms of intervention to make lasting changes in functional ability, can be frustrating. One of the most fundamental goals in children with disabilities is increased independence to promote integration into life activities. Children with physical disabilities are often faced with the challenge... Read More

GUEST COLUMN: Positioning And Mobility Aids -The Role Of Assistive Technology In Well-Being Of Children With Neuro Disability - DR.DHRUV MEHTA

The quality of life and the well-being of the persons with cerebral palsy and that of parents and caregivers can be greatly enhanced by the judicious use of good, simple, user friendly positioning and mobility aids. A good team work between the child/adult who is going to use the devise, the parents and caregivers, the trans-disciplinary team of doctors, therapists, orthotic engineers and biomedical engineers and assistive technology experts goes a long way in assisting persons with disabilit... Read More

GUEST COLUMN: Audiologist's And Speech Language Pathologist'S Perspective Of Children With Cerebral Palsy - MRS.USHA DALVI

Cerebral Palsy is defined as a non-progressive disorder of movement and posture due to brain damage or injury occurring in the period of early brain growth, generally under 3 years of age (Lord 1984).  The resultant abnormalities remain relatively constant.  The severity of motor disturbances seen in these children is dependent on the site/s and the extent or size of the damaged area/s(lesion).  In most of the children, it is not limited to motor dysfunctions alone but there ar... Read More

SPECIAL ARTICLE: Play And Palsy- The Role Of Play Therapy In Cp - DR.SAVJI NAKUM

From the day they are born, children with CP are subject to many methods of intensive treatment. Children with disabilities like CP often visit doctors and specialists, and are in contact with many different faces.

They are also often hospitalized and separated from their parents. Apart from the type of disability, successful treatment and habilitation is dependent on the children’s will to collaborate.

Read More

PHYSIO YOGA: Yoga For Special Children - DR.NILIMA PATEL

Children are more intuitive, imitative and less conditional. Hence incorporating the core values and yogic practices from the early stages stimulate the creative abilities and strengthen the learning capabilities. In the case of special children, yoga is being practiced as a therapy, but is in fact a centuries old path of self-development and self- states that practicing yoga is a small sacrifice for something that can enrich one's life on any levels.

Read More

PHYSIO SPEAKS: Pediatric Physiotherapy- A Veteran's Perspective - ESTHER DE RU

1)  In your career spanning more than 3 decades, what has been the most satisfying thing about being a physical therapist?

The most satisfying aspects of being a physiotherapist are the responsibility and the factor time. We are one of the only professions that actually have time to spend with the patient. We have to do our job to the best of our ability and we are held responsible for our actions. Our profession requires a good mix of intelligence and practical handling and I ... Read More

HUMAN FACTOR: Handwriting Ergonomics In Children - DR. K.M.ANNAMALAI

Learning to read and write marks a significant transition in the lives of children. However, handwriting is a complex & demanding task we often take for granted. Schools depend on written work to measure what children are learning. Poor handwriting can have a significant effect on school performance and children who lack this skill may miss learning opportunities and lack self-esteem.

Handwriting ability can influence future academic success. Hence children need to develop compe... Read More

INSIDE IMAGING: Cp-Diagnosis- Neuroimaging Techniques - DR.CHHAYA.J.BHATT

Early signs of cerebral palsy may be present from birth.  Most children with cerebral palsy are diagnosed during the first 2 years of life.  But if a child’s symptoms are mild, it can be difficult for a doctor to make a reliable diagnosis before the age of 4 or 5.  Nevertheless, if a doctor suspects cerebral palsy, he or she will most likely schedule an appointment to observe the child and talk to the parents about their child’s physical and behavioral development.&... Read More

CURRENT AFFAIRS: Stem Cells For Cerebral Palsy - DR.ANAITA HEGDE

Stem cells are unique cells with the remarkable potential to develop into many different cell types in the body. These cells can divide without limit to replenish other cells, thus forming a sort of repair system for the body. Stem cells can be basically classified into two types based on their origin of derivation – Embryonic Stem Cells (ESCs) and Adult/Tissue Specific Stem Cells (TSSCs). The Embryonic stem cells (ESC) are derived from either the zygote or the blastocyst. (image 1) The... Read More




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