Non Operative Treatment

Treatment for upper limb cerebral palsy in children is typically tailored to the individual child's needs and may involve a combination of approaches. Cerebral palsy (CP) is a neurological disorder that affects muscle control and movement, and upper limb involvement can vary in severity from very mild to severe. Common treatments for upper limb cerebral palsy may include:

• Physical Therapy: Therapists work with children with CP to improve muscle strength, range of motion, and overall mobility in the upper limbs. Specific types of therapy may include Constraint, Bimanual and sensory integration therapy. 

• Occupational therapy:They work on fine motor skills, hand-eye coordination, and adaptive strategies to enhance independence in activities such as dressing, feeding, and writing. They can also advise on assistive devices such as adapted utensils or writing aids can also be used to facilitate independent function.

• Orthotics & Casting: Orthotic devices like splints or braces may be prescribed to help stabilise the upper limbs, improve posture and prevent contracture. Serial casting can be used to gradually lengthen and stretch muscles and joints that have become tight over time. 

• Tone Management: Many children will have had an assessment by a neurologist. In some instances, oral medications such as muscle relaxants or antispasticity drugs like Baclofen may be prescribed to manage spasticity and improve muscle control. One of the main problems with this is that the effects are widespread. Often the doses required to relax the upper limb can sometimes have unwanted side effects. Other options include local tone management where Botulinum Toxin is injected directly into the affected muscles. This is  very effective at reducing muscle spasticity but it is typically temporary and is primarily used as an adjunct to other treatment. 

• Functional Electrical Stimulation (FES): FES uses electrical currents to stimulate specific muscles, helping to improve muscle strength and coordination in the upper limbs. There is some evidence to support its use as a valuable adjunct to the conventional treatment options but it is generally not routinely used. 

The specific treatment plan for upper limb cerebral palsy should be developed in consultation with a team of healthcare professionals, including pediatricians, neurologists, physical therapists, and occupational therapists. 

All children should have an early referral and assessment by a specialist team. The goal is to maximise the child's functional abilities, reduce pain and discomfort, and enhance their quality of life. Early intervention and ongoing therapy are often key components of successful management for children with upper limb cerebral palsy..