CEREBRAL PALSY

• Cerebral Palsy is a non-progressive motor disorder affecting movement or posture caused by an insult to the developing brain during infantile development up to the age of 3 years
• Depending on the affected brain area, spastic, ataxic, or dyskinetic cerebral palsy develops. While, in many cases, there is no identifiable cause, risk factors for cerebral palsy are prematurity, perinatal complications such as chorioamnionitis, birth trauma with intracerebral haemorrhage, or postnatal infections such as meningitis

• Idiopathic /Multifactorial

Risk factors 

• Prematurity
• TORCH infection
• Jaundice
• Perinatal Asphyxia
• Intracranial haemorrhage
• Brain abnormality either inborn or acquired
• Neonatal seizures
• Postnatal infections – meningitis, encephalitis

Types

• Spastic CP: Spastic diplegia where there is predominant involvement of lower limbs, quadriplegia/ tetraplegia, Hemiplegia
• Extrapyramidal CP or Choreoathetotic CP: seen after kernicterus
• Cerebellar or Ataxic CP: seen in developmental malformations of the cerebellum
• Mixed CP: two common varieties- Ataxic diplegia, Dystonia/ Choreoathetosis associated with spastic CP

Hypotonic CP

• Patients may present with mixed types of cerebral palsy (e.g., combination of athetoid and spastic CP)

Spastic type:

• Increased Muscle tone in one or more limbs 
• ↑ Deep Tendon Reflexes
• Persistence of primitive reflexes (e.g., positive Babinski sign) 
• Hip dislocation
• Scoliosis
• Hearing or vision impairment
• Toe walking or equinus deformity
• Muscle weakness and/or atrophy
• Scissor gait (as a result of spastic paraplegia of the hip adductors) 

Non-spastic type:

• Dysarthria and dysphagia
• Abnormal involuntary movements that worsen with stress and disappear with sleep
• Chorea
• Athetosis 
• Dystonia 
• Ataxia

All types 

• Intellectual disability (50%) 
• Seizure disorder (35%–50%)
• Joint contractures
• Attention deficit hyperactivity disorder
• Patients do not reach certain milestones 

• Based on clinical picture
• CT or MRI can localize the lesion
• Cranial Ultrasonography – in early neonatal period

• Be frank with the parent and inform that CP cannot be cured
• Treatment would aim to address the associated deficits like seizure etc and improving the functional abilities
• Multidisciplinary approach
• Physical therapy
• Speech therapy – for dysarthria
• Special tution 
• Bracing – to prevent contractures
• Social and psychological support

Ayurvedic Treatment

Spastic CP

• Deepana, paachana. Vata anulomana, vata hara treatment, medhya, vaak suddhikara

Choorna

• Ashtachoorna

• Infant: 2-3 gm,
• Toddler- 5gm, 
• School going- 7-10gm 
• Anupana: honey or water or along with food

Arishta

• Abhayarishta

• Up to 2yrs- ½ tsp arishta diluted with 1 tsp water
• 2-5 years- 2.5ml-5ml diluted with 5 ml of boiled water
• 5-10 years- 10ml
• 10-15 years- 15ml

 Kashayas 

• Ashtavarga kashaya/ Gandharvahasthadi kashaya/ Rasna saptaka kashaya

• Up to 1 year: for mother: 2tsp sookshma choorna is boiled in 2 glass water, strained and given to mother. If agni bala permits give 1 tsp thrice to the child
• 1 year to 5 years: ½ tsp powder boiled in 1 glass water and given as divided doses mixed with sugar or jaggery
• 5 to 10 years: 1 tsp powder boiled in 1 glass water and given as divided doses mixed with sugar or jaggery
• 10-15 years: 1 ½ tsp powder boiled in 1 glass of water and given twice daily mixed with sugar or jaggery

 Vatanulomana

• Gandharva Eranda as anulomana and koshta sodhana: ½ tsp to 1 tsp depending on koshta

Snehana

• Indukantam/ Shatpala gritha/Rasna dashamoola gritha /Kalyanaka gritha

• Up to 1 years: given as drops: always one should have a proper assessment of agni before administering sneha kalpana
• 2drops to 5 drops depending on agni
• Above 1 year: always start with a minimum dose- even 2 drops will be sufficient to get the desired effect
• Properly monitor the status of agni and increase the dose

Symptomatic management 

• Use of Brahmi gritha for improving intellect
• Kalyanaka avaleha choorna for improving speech 
• Associated features like seizures should be controlled along with Anti Epileptic Drugs

Procedure

Rookshana therapy

• Udwarthana/ Utsadhana / Choorna Pinda Sweda - with Triphala choorna, Kolakulathadi choorna 

Abhyanga along with Ushma sveda 

• Dhanwanthara taila
• Vatashini taila 
• Rasa taila
• Always ensure koshta anulomana while doing the procedure either with Gandharvahastadi kashaya or Gandharva Eranda

Vasti

• usually done as Yoga vasthi- Dwipanchamooladi Vasti or Mustadi Rajayapana Vasti: 

• 1 year to 4 years: 50ml – 200ml
• 4 years to 6 years: 200ml – 300ml
• 6 years to 10 years: 300 – 500 ml
• 12 years– 16 years: 500-800 ml
• The dose of Sneha vasti is calculated as a quarter of Kashaya vasti
• If bala is very less one can select Ksheera Vasti also. The dose of Ksheera vasti should be ¼ less than the total Kahsaya vasti for the age

Shastika lepa or Shashtika Pinda Sweda/ Kaya seka 

• Based on the strength of the child

Sirodhara/ Siropichu

• Dhanwanthara taila/ Mahamasha taila

 Physiotherapy

• To prevent disuse atrophy, prevent tightening of tendons, prevent fixity of the joints