Management for CP athetoid

Athetoid Cerebral Palsy:

About 10 percent of children with cerebral palsy have athetoid cerebral palsy. Athetoid cerebral
palsy is caused by damage to the cerebellum or basal ganglia. These areas of the brain are
responsible for processing the signals that enable smooth, co-ordinated movements as well as
maintaining body posture. Damage to these areas may cause a child to develop involuntary,
purposeless movements, especially in the face, arms, and trunk. These involuntary movements
often interfere with speaking, feeding, reaching, grasping, and other skills requiring co-ordinated
movements. For example, involuntary grimacing and tongue thrusting may lead to swallowing
problems, drooling and slurred speech. The movements often increase during periods of
emotional stress and disappear during sleep. In addition, children with athetoid cerebral palsy
often have low muscle tone and have problems maintaining posture for sitting and walking.

Managing athetoise.
In the literature there isn’t much known about the management of children with athetosis. And if
you study single case studies they are all different from each other.

Case study 1
My daughter Natalie is now 6 and half with athetoid cp. She was also ng fed up until she was
2 years old. She could not take fluids as a baby and around a year old started taking
thickened fluids from a cup and small amounts of solids which she found easier to take. As
time went on she got better with it although at the time that she came off the tube her
weight wasn't great and neither was her intake. Now she has absolutely no problem with
either. Her fluids haven't been thickened in years, (her favourite being coke) although she
still needs a bit of help with her feeding. Natalie attends a PMLD unit at a nearby
mainstream school, she started there at 2 and half as soon as her statement was finished
(which took about 6 months). The unit provides her with physio, speech, OT, hydro and
rebound and other activities needing extra help, she is then mainstreamed for maths,
stories, playtime and more. Does Sophia have a social worker? they will give you advice on
benefits and housing adaptions. There is so much to tell you Natalie gets sturdier by the
day she is so determined, communication has been the most frustrating. Natalie uses
makaton mainly learnt at school and is learning to use a computer hopefully leading to a more
constructive form of communicating.

Case study 2
My son Adam is 3.5 and has athetoid CP with distonia. He doesn't seem (yet) to have too
much in the way of unwanted movement but he is certainly never still!! He "throws" the
professionals a bit because they feel how supple and mobile he is and so think that he's not
as disabled as if he had some spasticity but in fact he has very low/fluctuating tone in his
trunk, poor arm and hand control and very poor mouth and tongue control, hence no speech
and poor prognosis. He can sit on the floor and sort of crawl but his main desire is to stand
and walk and he constantly climbs up to standing and then tries to launch - problem is he
can't walk unaided so falls lots. Hope he will eventually use a rollator. He is however a
bright, sociable and very outgoing boy who we hope will get good enough with his
communication aid and PC to get a decent education. He has a P&G joystick which he is just
beginning to use on some games. we have one at home and he will have one on the lap top
which the LEA have just bought him for nursery.
Managing athetoise is most of the time trail and error working. Each child with athetoid cp is
different and therefore needs it’s own management. Some children will be totally dependent of
parents or care takers. And some children with athetoid cp will walk around and need only minor
help from others.
Each child will have it’s own strategies to cope with limitation caused by the athetoise. Most
motoric problems are caused by the fluctuations in muscle tone and reflexes. Partly we can use
these reflexes and muscle tone to create functional skills such as walking or sitting.
It takes a lot of repetitions before a functional skill will be used in the daily living. Therefor it is
very important to train in functional setting with these children.

Speech.
Most of the children with athetose have problems with talking. Speech therapy should focus on
the possibilities for the child to communicate. Speech maps or speech computers can help a child
with athetose to communicate with its environment.

From infancy to adulthood.

A child with athetose should be able to explore and play to develop his skills such as cognitive
skills and social skills. From the first year the child should have assistance to create the possibility
to play and learn what it can do and how he can do it. This is a journey that will go on until
adulthood.
Possibilities can be created with special aids such as standing boards, walking aids etc. etc.
Most of the time it will depend on the creativity of the therapist what a child with athetosis can
achieve.
During growth a lot of factors can be of positive effect on the skills of the child with athetosis.
Length growth or weight growth can increase de skills such as standing or walking. But they can
also cause negative effects on joints and or other structures of the human body.

All sorts of therapy methods can help stimulate motoric skills. NDT, Voita, PNF etc., can be of
great success, for these children to help them co-ordinate movements and learn new functional
skills. But al de therapies should be given in a functional way:
What does the child wants to learn?
What is its strategy?
How can I help him to achieve its goal?