Cerebral Palsy

Treatments for Cerebral Palsy (CP)

Although there is no known cure for cerebral palsy some conventional and alternative
treatments can help manage this condition. We have mentioned in this fact sheet several therapies. Please note this list is not exhaustive. For more information on some of the treatments or for information on disorders associated with cerebral palsy such as epilepsy contact the Henry Spink foundation.

Selective Dorsal Rhizotomy (SDR)

In medical terms rhizotomy means surgical resection of the dorsal root of a spinal nerve. In simpler terms, dorsal means backside and rhizotomy cutting of some nerves. SDR is a surgical procedure which involves cutting some nerve roots in the lower area of the back under general anaesthetic. The aim is to reduce contractures in the legs by reducing the amount of stimulation transmitted by the nerves to the muscles.

Signals received by muscles are regulated by nerve cells in the spinal cord. Sensory nerve fibres attached to muscles tell the spinal cord to tense or increase muscle tone, while the brain signals the spinal cord, through descending nerves, to reduce muscle tone. In individuals with cerebral palsy the communication pathways do not function properly, as a result the brain is not able to influence the amount of flexibility in the muscles. Cutting certain rootlets that come from the muscles and enter the spinal cord can reduce tightness.

The first step of the operation consists of dividing nerve roots into rootlets. The surgeon uses electrical stimulation (EMG) to select and cut rootlets that carry the defective message. Normal rootlets are left intact which allows the patient to keep moving.

Surgery is followed by an intensive period of physical therapy. Rehabilitation can take up to six weeks.

The main advantage of rhizotomy is that its effects are permanent. It can improve walking in those who can walk or sitting, standing, and balance control in those who do not walk.

The operation is long and complex and irreversible. The minimum age is 5 years. Long term side effects can include hip dislocation, sensory loss, loss of bowel and bladder control.

The decision to operate on a child comes after carefully assessing the child's mobility. A referral from the child's GP is necessary.

In the UK specialists have been more reluctant to perform rhizotomy compared to their American colleagues. Rhizotomy is now available on the NHS at the Robert Jones and Agnes Hunt Orthopaedic and District Hospital in Shropshire (see below).


- Galarza M, Fowler EG, Chipps L, Padden TM, Lazareff JA. Acta Neurochir. Functional assessment of children with cerebral palsy following limited (L4-s1) selective posterior rhizotomy - a preliminary report. (Wien) 2001 Sep;143(9):865-72 "The results of this study demonstrated improved function during walking as assessed using gait analysis techniques."

- Kim DS, Choi JU, Yang KH, Park CI. Selective posterior rhizotomy in children with cerebral palsy: a 10-year experience. Childs Nerv Syst 2001 Sep;17(9):556-62.
"SPR is an effective method of alleviating spasticity and provides lasting functional benefits at acceptable complication levels in spastic children with cerebral palsy."

For more research documents go to: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=&DB=PubMed

- Center for Cerebral Palsy Spasticity
- Connecticut Children's Medical Center


6 Market Road
N7 9PW
Helpline: 0808 800 3333

The Robert Jones and Agnes Hunt Orthopaedic and District Hospital
SY10 7AG
Tel: 01691 404236
Email: karen.edwards@rjah.nhs.uk

SDR Parents
c/o Ann Harrell
506 N. Washington St.
Bourbon IN 46504.
Tel: (001) 219 342 0618
Offers support to parents.


- Intrathecal Baclofen Therapy (IBT)

Baclofen is a muscle relaxant and antispasmodic that inhibits the transmission of messages between nerve cells. It is believed that Baclofen replaces the neurotransmitter gamma amino butyric acid (GABA) which is naturally found in the body.

When this chemical is released in the spinal cord the muscles start relaxing. Baclofen can be taken orally although it was found that high concentrations of the medication were needed which caused side effects such as lethargy and dizziness. An alternative way to dispense the drug was discovered with the Intrathecal Baclofen Therapy (IBT) or Continuous Intrathecal Baclofen Infusion (CIBI).

A pump implanted under the skin of the abdomen is connected to a tube (catheter) which is placed in the spinal canal. This system allows the medication to be directly delivered to the spinal fluid without circulating in the body. Thanks to a computer inside the pump, Baclofen can be delivered in minute doses continuously during the day. The pump is refilled every one to three months; a needle is used to inject the medication through the skin into the pump.

In 1994 the Food and Drug Administration, in America, granted a licence for this system to be used in children with cerebral palsy after researchers reported on its beneficial effects.

Baclofen is claimed to relax the muscles and help with swallowing and speech. The operation takes about one hour to implant. Doses can be monitored precisely and adjusted depending on the individuals' response.

The treatment can cause drowsiness and nausea. There is a small risk that the pump or the tissues surrounding may become infected and a very low risk of meningitis and seizures. The pump is generally used for children over the age of 5. Tests need to be carried out to decide whether the Baclofen pump is suitable.


- Scheinberg A, O'Flaherty S, Chaseling R, Dexter M. Continuous intrathecal baclofen infusion for children with cerebral palsy: a pilot study.J Paediatr Child Health 2001 Jun;37(3):283-8. "Children with spastic cerebral palsy can have their spasticity effectively reduced with CIBI."

- Stempien L, Tsai T. Intrathecal baclofen pump use for spasticity: a clinical survey. Am J Phys Med Rehabil 2000 Nov-Dec;79(6):536-41. "CIBI is an effective treatment for severe spasticity, with dramatic quality-of-life improvements and a small number of significant complications. Long-term benefits and complications need to be monitored in this complex population."

- Meythaler JM, Guin-Renfroe S, Law C, Grabb P, Hadley MN. Continuously infused intrathecal baclofen over 12 months for spastic hypertonia in adolescents and adults with cerebral palsy. Arch Phys Med Rehabil 2001 Feb;82(2):155-61. "Continuously infused ITB can reduce spastic hypertonia in the UEs and LEs associated with long-standing CP. This reduction in tone will allow more freedom of movement and the potential for improved function."

- United Cerebral Palsy
- American Academy for Cerebral Palsy and Developmental Medicine

· Phenol blocks

Phenol blocks were used prior to Botulinum Toxin A (see below). Their role is to block the message sent by the nerves to the muscles. Phenol is injected under local anaesthetic following two techniques:

- The motor nerve block, which consists of a perineural injection (to the nerves). This causes the destruction of a portion of the nerve.
- The motor point block, this procedure is more complicated to achieve than motor nerve block. It involves a series of injections of very small amount of phenol into the muscles.

Phenol blocks can be used in combination with Botulinum Toxin A. They are believed to work well with large muscles whereas Botulinum injections work better on small muscles. They also seem to last longer.

Phenol injections cause non selective tissue destruction, which means that a small amount of muscle may be permanently damaged. Other side effects include vascular complications, swelling and bleeding, Injections can cause a burning sensation in the muscles.

Today Botulinum Toxin A is preferred to phenol blocks as it has fewer side effects.

· Botulinum therapy

Botulinum Toxin type A (BTA) is a chemical poison which comes from the bacterium Clostridium Botulinum. When ingested in large amounts this bacterium causes a serious type of food poisoning called botulism.

BTA is known to interfere with muscle function, it temporarily paralyses muscles and has been used for the last twenty years to treat adult conditions resulting from muscle spasms such as torticolis, blepharospasm (involuntary contraction of eyelid muscles), dystonia (impairment of muscle tone), spasmodic dysphonia (a speech disorder), trismus (spasm of the jaw).

In America, the FDA (American Food and Drug Administration) has approved its use for these conditions. Recently its use in plastic surgery to smooth wrinkles has been much publicised.

Researchers found that when injected in minute amounts into the muscle, BTA could reduce spasticity, they explained that BTA prevents nerve endings from releasing the neurotransmitter Acetyl Choline which stimulates the muscle and causes it to contract. BTA is diluted and injected directly into the leg muscles. It only affects the muscles into which it is directly injected. The injection is generally given under local anaesthesia. It takes on average three days for the substance to start working and its action can last up to sixteen weeks, after which time another injection is needed.

BTA is said to improve toe-walking, balance and reduce spasticity thanks to a better stretching of contracted muscles.

Injections are relatively painful, they need to be repeated when BTA's action wears off. Side effects include a weakening of the nearby muscles, headaches or muscle aches after the injection. There is also a risk of developing antibodies. BTA injections are not suitable for all children with cerebral palsy. Proponents to BTA believe it is a very safe therapy and that when used in conjunction with physiotherapy its effects may last in the long term. There is no evidence to sustain these claims. The drug is available in the UK and US under the names of "Botox" and "Dysport".


Studies at the Musgrave Park hospital in Belfast and the Royal Belfast Hospital for Sick Children revealed that BTA may stop muscle spasms, reduce tightness, increase muscle and bone growth and may delay orthopaedic surgery.

- Corry IS, Cosgrove AP, Duffy CM, Taylor TC, Graham HK. Botulinum toxin A in hamstring spasticity Gait Posture 1999 Dec;10(3):206-10.

- Thompson NS, Baker RJ, Cosgrove AP, Corry IS, Graham HK. Musculoskeletal modelling in determining the effect of botulinum toxin on the hamstrings of patients with crouch gait. Dev Med Child Neurol 1998 Sep;40(9):622-5.

- Koman LA, Brashear A, Rosenfeld S. Botulinum toxin type a neuromuscular blockade in the treatment of equinus foot deformity in cerebral palsy: a multicenter, open-label clinical trial. Pediatrics 2001 Nov;108(5):1062-71 "BTX-A proved both safe and effective in the chronic management of focal muscle spasticity in children with equinus gait."

- Aguilar-Rebolledo F, Hernandez-Sanchez J, Rayo-Mares D, Soriano-Fonseca F, Garcia-Munoz L, Ruiz-Ponce J, Garrido-Ramirez E. Gac Med Mex 2001 Sep-Oct;137(5):403-11
"Botulinum toxin type A proved a highly useful adjuvant therapy and conservative management in CP."

- http://www.ipsen.ltd.uk/patients/cpparentguide Ipsen Limited
- http://www.hemikids.org/botox.htm
- http://www.aap.org/
- http://www.bham.ac.uk/arif/baclofen.htm

Alternative Remedies

· Homeopathy

Homeopathy comes from the Greek words "homios" which means similar and "pathos" which means suffering. The first homeopathic principles were defined by Hippocrates and Paracelsus and further developed in the 18th century by a German doctor, Samuel Hahnemann who hypothesised that if large doses of a remedy were to cause a disease in a healthy person then small doses might stimulate the body's healing properties in a person ill with the disease.

Homeopathy is based on three principles:

1. The principle of similars or that "like cures like".
Homeopathic remedies treat illnesses with a substance that produces, in a healthy person, similar symptoms to those displayed by the person who is ill. For example Allium Cepia, a remedy that comes from red onion, is used to treat disorders characterised by watery eyes and a runny nose.

2. The principle of infinitesimal dose.
Homeopathy works the opposite way of conventional medicine for which a minimum dose is required for effect. Hahnemann believed that the more a remedy is diluted the more potent it becomes, the more specific its effects are and the longer they would last.

It is believed that homeopathic remedies are diluted to such a degree that no atom of the original substance is left in the final remedy, how the remedies work is not well understood hence the scepticism of many physicians. Homeopaths believe the answer is to be found in the domain of quantum physics. Water holds a memory, or "imprint" of the active ingredient, it remembers that the substance was once there. Homeopaths claim that continued dilution and shaking or "succussion" can imprint the electromagnetic signal of a substance in water.

In 2001 two researchers, Kurt Geckeler and Shasadhar Samal confirmed this theory and proved that following to the process of succussion, molecules didn't not disappear clumped together.

3. The principle of specificity of the individual.
The treatments are individualised, each individual has a symptom profile and it is likely that two persons with the same condition will be given different medicines. Practitioners look at the whole person not just the condition. They usually ask a series of questions about the medical history, moods, likes and dislikes, diet, chronic disorders or traumas of the patient in order to draw a list of symptoms. They pay special attention to unusual symptoms. The choice of remedies depends more on the patient's individual reaction to illness, mentally and emotionally, than on the signs and symptoms characteristic of the disease, for instance if a patient has headaches, it is not the headaches that will be treated but the person with the symptoms. Depending on where the headache is located or when it occurs different remedies can be used. The remedy that fits all the symptoms of a person is called "similimum" for that person.

There are over 2000 homeopathic remedies, they are made from plants, minerals, metals or animals. Their Latin name indicates the substance they were created from. The remedies come in the form of lactose tablets, powder, granules, or as a liquid. Parts of the original substance are dissolved in alcohol to create the mother tincture (MT). This liquid is shaken ("succussed") several times, 1 drop is mixed with various ratios of distilled water: 1 in 10 (x dilutions), or 1 in 100 (c dilutions), for example 2C (2CH in Europe) dilution means that 1 part of mother tincture is mixed with 99 parts of water and alcohol then shaken (1C), then 1 part of this liquid is mixed with another 99 parts and shaken (2C).

Remedies should be taken at least half an hour before or after taking food or drinks, it is advised to avoid strong-tasting substances such as peppermint (health food stores sell toothpaste that doesn't contain mint), eucalyptus, camomile, camphor, coffee and tobacco. Granules or tablets should be dissolved under the tongue for best results and it is advised not to touch them with fingers as they will lose their properties. Long-standing complaints are believed to take longer to treat. Symptoms may often get worse before they begin to get
better, this reaction is called "the healing crisis".

In the UK homeopathy is becoming increasingly popular. Clinical trials proved its benefits in the treatment of disorders associated with cerebral palsy such as digestive system problems, allergies, immune dysfunction, emotional, skin and respiratory problems.

- http://homeopathyhome.com
- http://www.boiron.com (the world leading homeopathic institute)


British Homeopathic Association
15 Clerkenwell Close
Tel: 020 7566 7800
http:// www.trusthomeopathy.org

The Society of Homeopaths
4a Artizan Road
Tel: 01604 621400
http:// www.homeopathy-soh.org

Homeopathic Medical Association
6 Livingstone Road
DA12 5DZ
Tel: 01474 560336

· G-therapy

The complete name of this form of treatment is "Homeo-Biochemic Formulation Therapy". It was formulated by Dr Gunvant Oswal from the University of Pune in India. G-Therapy is part of the Ayurvedic medicine, it is essentially based on a remedy whose substance is extracted from plants. The remedy is diluted according to the homeopathic process which states that the higher a substance is diluted the greater its effects will be; it is then added to biochemical salts or body salts. The final product is available in form of tablets and like homeopathic remedies, the tablets have to be taken sublingually (under the tongue). Dr Oswal explains that "the body salts bring about the necessary changes in neuro transmission while the herbal extracts act as a catalyst", he believes G-therapy can improve speech, concentration, communication, sleep, motor co-ordination; it can reduce spasticity, involuntary movements, hyperactivity and tantrums.

G-therapy is a controversial treatment: since the beginning of the nineties numerous articles in the press have reported cases of children whose condition improved greatly thanks to the therapy; Dr Oswal claims that none of the 1700 children he treated with the G-therapy showed any signs of side effects, he also estimated a 70% rate of improvement in "reduced hyperactivity", "improved speech" and "improved motor control" and that the results were visible within twelve weeks. According to Cerebra (previously known as The Rescue Foundation, a charity which focuses on brain injuries), more and more parents in the UK are interested in this treatment. However it is still not known exactly how the therapy works and there have been no clinical trials so far to prove the benefits and safety of the therapy.

For further details you can contact the G-Therapy Support Group UK at:

G Therapy Parent Support Group UK
c/o Sunderland Street
DN11 9QH
Tel: 01302 742 650

Touch & Movement Therapies

A - Oriental Medicine

· Acupuncture

This is the most well known therapy in Traditional Chinese Medicine (TCM). It is based on the principle that disease or physical disharmony is caused when the energy flow or "chi" is obstructed. There are twelve meridians or pathways in the body and each one is associated with a specific organ (liver, kidney, etc.) or body function. Disruption on a meridian can create illness at other points along it; for example, a disorder of the stomach meridian could be manifested
as pain in the gums. Acupuncturists endeavour to rebalance the vital force so that it can circulate freely through the meridians.

Very fine sterilised needles are inserted through the skin into any of hundreds of points located over the 14 basic meridians and over a number of specialised meridians. The typical insertion is 3 to 10 mm (0.1 to 0.4 inch) in depth; in some procedures insertions may be up to almost 25 cm (10 inches). Needles are usually left for a short while which is believed to cause little discomfort. By slightly manipulating or twirling them, the therapist can either draw the energy to the meridians or away from them.

It is common to insert needles at a considerable distance from the point on which they are to act and similarly successive points on a specific meridian may affect different areas or conditions, for example, a needle inserted into the pad of the thumb is used to produce analgesia in the abdomen.

Acupuncture treatment has long been used in Asian countries to treat patients with motor disabilities. It is thought to relieve pain and spasms as well as improve muscle tone, it can also fight infections and have positive effects for children with learning difficulties.


British Acupuncture Council
63 Jeddo Road
W12 9HQ

British Medical Acupuncture Society
12 Marbury House
Higher Whitley
Tel: 01925 730 727
http:// www.medical-acupuncture.co.uk

· Acupressure

Acupressure is also part of TCM, it is often described as "acupuncture without needles". Like its sister therapy, it is based on theories of life energy and meridians. It is perceived as less invasive since pressure is applied instead of using needles. In treatment it is not necessary to undress, pressure is applied to specific points on the surface of the skin or acupoints. The practitioner stimulates "acupoints" using his/her fingers, thumbs and even feet and knees to apply pressure for a period of three to ten seconds. Pressure applied to the acupoints clears energy blockages in the meridians, it increases blood flow and releases tension in the muscle fibres. The effect of acupressure also promotes the release of endorphins, neurochemicals that relieve pain.

There are several forms of acupressure which focus on different acupoints depending on whether the "Tuina", "Shen Tao", "Jin Shin Do" or "Anma" techniques are used. Some acupuncturists may also integrate acupressure in their treatment.

Acupressure is believed to release tension in the muscle fibres and is thought to be beneficial for musculo- skeletal problems.


- Lai_XP (1996) AP Therapy and Point-injection of Med for Treatment of 32 Cases of Infantile Cerebral Palsy. Dept of AP and Moxibustion, Fuyang Textile Mill Hospital, Anhui, "32 cases of infantile cerebral palsy were treated with AP and point-injection. 15/32 cases were cured basically, 7/32 markedly effective, 9/32 improved and 2/32 failed; the total effective rate was 94%. AP both could improve the microcirculation of the brain tissues in favour of recovery of cerebral functions."

- Zhou XJ, Chen T, Chen JT. 75 infantile palsy children treated with acupuncture, acupressure and functional training. Zhongguo Zhong Xi Yi Jie He Za Zhi 1993 Apr;13(4):220-2, 197. "the treatment yielded a very positive improvement in the children's physical capability and an increase of their intelligence." For more information contact the acupuncture organisations listed above.

· Point percussion (PPT)

Developed by Wang Zhao-Pu, a Chinese orthopaedic surgeon in the eighties, it combines acupressure, manipulations and orthopaedics. Fingers are applied on various points and stimulation lines of the body, which stimulates some receptors in the muscles, tendons and joints and sends beneficial messages to the brain. With repetition it is believed that the brain will in turn send the right signal to nerve endings. PPT is claimed to increase muscle tone of weak muscles; decrease high tone of spastic muscles and stimulate local blood supply as well as nerve endings.

The University of Exeter is currently conducting a research project, commissioned by The Rescue Foundation; the results should be published early 2002. Information and research papers on PPT are scarce; for more information contact Cerebra in Wales (see below) or visit the following website:
- http://homepages.ihug.com.au/~myppt/

PPT is very popular in Australia. Wang Zhao-Pu, wrote a book based on his experience of treating children with cerebral palsy in Australia: Acupressure Therapy: Point Percussion Treatment of Cerebral Birth Injury, Brain Injury, and Stroke (1991) published by Churchill Livingston.

You can also access Wang Zhao-Pu's website at: http://www.mypptcenter.com/index.html

SA44 6AF
Tel: 01239 652 100/ 0800 328 1159

B - Functional techniques

· The Alexander technique

The theory behind this form of treatment is that individuals create unnecessary tension in their body because of bad posture, this tension can reduce their mobility and make them ill. The Alexander technique is taught on a one-on-one basis, and each session is individually tailored according to the client's needs. There are no set exercises. It is a physical and mental form of therapy as a large part of the practitioners' work involves psychological re-education.

Therapists teach their clients to use their body in a more efficient way, they make them aware of the way they perform activities and what optimum posture feels like before beginning to make adjustments, the goal is to produce maximum efficiency with minimum effort.

During the first session the therapist assesses the movements of the client, he/she focuses on the use of the body exploring everyday functions such as sitting, standing or walking and applies gentle pressure on specific parts of the body. Practitioners guide their clients through a series of gentle movements, which involve a lengthening and widening of the body. The session is restful; at the end of the treatment movements are easier.

The Alexander technique is claimed to relieve pain, it can improve coordination and balance. It works better with individuals with mild cerebral palsy.

The Society of Teachers of the Alexander Technique (STAT)
129 Camden Mews
Tel: 020 7284 3338

· Feldenkrais method

Named after Dr Moshe Feldenkrais, this method is a system of physical re-education that explores body awareness. It aims to improve physical and mental health by 'reprogramming' patterns of movement. According to Feldenkrais practitioners, certain postures and movements reflect disruptions to the nervous system. Their role is to teach how to hold or move the body and seek to identify these bad movements so that they may be avoided. They believe that individuals can subconsciously answer to movement and touch.

Contrary to osteopathy, where a practitioner works with the structure of the body, Feldenkrais and Alexander technique practitioners work with the function of the body.

"Functional Integration" sessions take place on a one-on-one basis and are custom-tailored. The therapist uses slow and gentle touch on the client who lies on a padded table fully clothed. He/she feeds back information to the client who in turn is asked to make the changes.

Dr Feldenkrais was noted for his work with conditions of severe neuromuscular disturbance such as cerebral palsy, his technique is believed to help children to increase their mobility and gain greater control over limb movements.

The Feldenkrais technique is relatively recent, its benefits and long terms effects have not been researched in clinical trials.

- The Reese Movement Institute

Feldenkrais Guild
PO Box 370
N10 3XA
Tel: 07000 785 506

· Rolfing

Created by an American, Ida Rolf, this is a form of bodywork sometimes called "structural integration", for which the key element is gravity. Ida Rolf believes that the body has a natural symmetry which enables it to work in harmony with the effects of gravity.

Rolfing involves manipulation and movement education. Dr Rolf explained that by using manipulation techniques the body could be re-balanced in gravity. Rolfing differs from traditional massage in that it does not focus on the muscles but on the connective tissue which forms their protective layer. This net of fine, elastic tissues, also called fascia, surrounds the muscles, bones and organs and connects all other tissues together. If the body is in disharmony with gravity the fascia becomes shorter, it hardens and loses pliability.

During a session therapists evaluate their client's posture by looking at them, sometimes they also take photos in order to assess any improvement. Firm pressure is applied using knuckles, elbows and fingers. Rolfers believe that manipulating the tissues will lengthen and reposition the fascia which will soften the muscles and remould them.

Rolfing can have a profound psychological effect on individuals, it can help them release the tension in muscles caused by emotions. Rolfers' work can increase flexibility and mobility is patients with cerebral palsy.


- Results of a clinical trial carried out by Perry, Jones and Thomas indicate that the younger mild to moderately affected persons with cerebral palsy experienced significant changes in lower extremity passive range of motion, muscle strength, balance, and gait. (Dev Med Child Neurol 1981 Dec;23(6):717-29. Functional evaluation of Rolfing in cerebral palsy.)

Rolfing is not as well established in the UK as it is in America, for a list of practitioners in the UK contact the following organisations:

The Rolf Institute
205 Canyon Boulevard
CO 80302
Tel: (001) 303 449 5903
http://www.rolf.org (the Institute follows variations of Dr Rolf's techniques)

The Guild for Structural Integration
PO Box 1559
CO 80306
http://www.rolfguild.org (The Guild was founded by Dr Rolf )

European Rolfing Association
25 80337
Tel: (00 49) 89 543 709 40

C - Structural therapies

· Osteopathy

Osteopaths diagnose structural and mechanical distortions in the body. They believe that the body has a natural tendency to strive toward a state of health and homeostasis, which means that the body has the ability to heal itself. Osteopaths are trained to feel the body's "living anatomy" (i.e. flow of fluids, motion and texture of tissues, and structural makeup). They believe that if the bones, joints and muscles are not correctly aligned this will affect their mobility and the tissues of the body will not function properly. X-rays are sometimes used to detect problems. The techniques used to correct them involve manipulation, stretching, mobilisation and soft tissue massage.

When working with children, osteopaths use functional techniques, which involve very gentle manipulations.

Osteopathy focuses on the nervous system. It can relieve pain, promote blood circulation and is said to be beneficial in the treatment of constipation.

· Cranial Osteopathy

Cranial osteopathy was developed as an extension to the osteopathic approach. It is a popular form of therapy for children since it is very gentle and non-invasive. Unlike most physicians, cranial osteopaths believe that the skull is not a rigid structure, its bones move in a rhythmic manner throughout life.

Cranial osteopaths focus on the pulsing of the fluid which nourishes and protects the membranes surrounding the brain, spinal cord and sacrum, this pulsing is called the Cranial Rhythm (or Primary Respiratory or Involuntary Mechanism). It is a movement of expansion and contraction of all the tissues of the body. Any disturbances in the flow of this fluid will reflect pressures on the cranial bones or injuries or tensions in the body.

Practitioners assess the quality of the patients' Cranial Rhythm and compare it to what they consider to be a normal rhythm, they can then judge the state of the patient's body and how well it is functioning.

During a session the practitioner will use light touch, he/she will delicately manipulate the cranial and spinal bones in order to restore the cranial rhythm, boost blood circulation and drain lymph and sinus fluids in the head.

· Craniosacral osteopathy

Craniosacral therapy was developed from cranial osteopathy. The term craniosacral was coined by Dr John E Upledger in the 1970's, cranio refers to the head or cranium, and sacral to the tailbone or base of the spine. Craniosacral therapists, like cranial osteopaths, believe that the bones that make up the skull do not fuse together to protect the brain. The brain and the spinal cord are bathed in the cerebrospinal fluid which goes upwards and downwards. Practitioners focus on the membranes encasing the brain and spinal cord, in contrast to cranial osteopaths, who focus on the bones of the cranium. They believe that it is the membranes that generate the cranial rhythm and that this rhythm affects every cell in the body.

Treatment involves light touch on the various points of pulsation and cradling the head or sacrum. Craniosacral therapists have a refined sense of touch, they are said to be able to listen or "tune in" with their hands resting lightly mainly on the head or other parts of the body. Corrective pressure is applied to the cranium and spine to normalise the cranial rhythm, although it seems that nothing is happening, the patient can feel sensations of warmth, pulsations and release of tension.

Contrary to cranial osteopathy, sacrocranial osteopathy is not included in the general osteopathic curriculum; practitioners are generally body workers who wish to broaden their skills. Severe birth trauma may be a factor in cerebral palsy, restrictions within the head and body can be helped with cranial osteopathic treatment.


International Cranial Association
478 Baker Street
Tel: 020 8367 5561

Osteopathic Centre for Children (OCC)
109 Harley Street
Tel: 020 7486 6160

The Upledger Institute UK
2 Marshall Place
Tel: 01738 444404

Craniosacral Therapy Association of the UK
Monomark House
27 Old Gloucester Street
Tel: 0700 0784 735

The British Osteopathic Association
Langham House
West Luton
Tel: 01582 488455

General Council and Register of Osteopaths
56 London Street

· Chiropractic

Chiropractic which means "done by hand", is very similar to osteopathy, it is based on the theory that the state of the nervous system in a person affects their health. The key element of the body structure is the spine, it is the link that carries nerves to the whole body. The vertebrae encase the tail of the brain which has an effect on the main bodily functions such as digestion, blood flow, heartbeat, the immune system and breathing.

Chiropractors check that the complex mechanisms of the vertebrae are in good working order, through gentle manipulations they realign the vertebrae and thereby release the pressure on the spinal cord and nerves. For babies and older patients a rubber-tipped instrument may be used to deliver a very small, precise thrust.

Chiropractic is thought to have a positive action on neuromusculoskeletal disorders.

There are two schools of chiropractors in the UK, McTimoney practitioners and regular chiropractors. The former focuses on the whole body in the belief that complete realignment is necessary each time while the latter concentrates on specific areas.

Chiropractic is now the most widely practised complementary therapy in Western countries. In winter 2000, the House of Lords Select Committee on Science and Technology published a report on alternative and complementary medicine in which it acknowledged that chiropractic's activity is well regulated and that it can benefit patients. Medical opinion is generally well disposed to chiropractic following scientific evidence of effectiveness.


- Gottlieb MS. Neglected spinal cord, brain stem and musculoskeletal injuries stemming from birth trauma. J Manipulative Physiol Ther 1993 Oct;16(8):537-43 "Manual treatment of birth trauma injuries to the neuromusculoskeletal system could be beneficial to many patients not now receiving such treatment, and it is well within the means of current practice in chiropractic and manual medicine."


The British Chiropractic Association
Blagrave House
17 Blagrave Street
Tel: 0118 950 5950

British Association of Applied Chiropractic
167a London Road
Tel: 01795 520 707


Massage relieves tension and spasms, it improves blood circulation and digestion. In a study published in Nursing Times. 96(1): 51. 2000. (Massage for Children with Cerebral Palsy.) Katharine Stewart noted an increase in circulation in paralysed limbs, with a change in colour and temperature.

· Aromatherapy

Aromatherapy combines healing massage with oils that have the medicinal properties of plants. While in France essential oils may be prescribed in the form of capsules as an alternative to conventional medicine, in the UK the oils are never administered internally.

Essential oils are extracted from the roots, flowers, fruits, leaves and stalks of plants and certain trees. They contain various chemical compounds such as alcohols, esters, ketones, aldehydes, and terpenes. Depending on the oils chemistry, they can be uplifting or have a relaxing and calming effect. They have anti pain, inflammation, antiseptic, antibacterial and antidepressant properties.

The scents released in aromatherapy stimulate the hypothalamus, the area of the brain influencing the body's hormone system. It is not well understood how the oil molecules actually enter the bloodstream, but the psychological effects have been well studied.

A range of oils is used during a session (some are not appropriate in pregnancy, for young children or for certain conditions). Trained aromatherapists use high-quality, natural oils diluted in a "'carrier" oil or blended into a cream. Lower dilutions are used for sensitive skin and in pregnancy. Practitioners should only use oils that are organic and bought from reputable companies.

Aromatherapy massage techniques are based on Swedish massage which aims to relieve tension in the body and to improve circulation as well as stimulating the lymphatic system to eliminate toxins from the body. Aromatherapists can recommend other ways of using the oils such as in inhalations by adding a few drops on a handkerchief or in a bowl of hot water, or by using compresses and baths. Light bulb, candle lit or electric diffusers are also popular and relatively safe.


Essential oils should not be used neat on the skin or applied near the eyes. Rosemary, hyssop, sweet fennel, sage and wormwood should be avoided by epileptics while peppermint and thyme must not be given to small children. Peppermint and camomile block the therapeutic effects of homeopathy, these oils should be used at least half an hour before taking homeopathy. A qualified practitioner is used to dealing with pregnant women, children and individuals with various conditions and will know which oils are suitable for each client.


Clinical research into essential oils in the treatment of medical conditions is limited.

- Wilkinson S, Aldridge J, Salmon I, Cain E, Wilson B.An evaluation of aromatherapy massage in palliative care. Palliat Med 1999 Sep;13(5):409-17 " Massage with or without essential oils appears to reduce levels of anxiety. The addition of an essential oil seems to enhance the effect of massage and to improve physical and psychological symptoms, as well as overall quality of life."

- Cannard G. The effect of aromatherapy in promoting relaxation and stress reduction in a general hospital. Complement Ther Nurs Midwifery 1996 Apr;2(2):38-40. "The use of aromatherapy has significantly improved the sleep patterns of the patients and at the same time, reduced the amount of night sedation required."

To find a practitioner contact the following organisations:

International Federation of Aromatherapists

182 Chiswick High Road


W4 1PP

Tel: 020 8742 2605


International Society of Professional Aromatherapists
ISPA House
82 Ashby Road
LE10 1SN
Tel: 01455 637987

The Register of Qualified Aromatherapists
PO Box 3431
Tel: 01245 227957

· Reflexology

Reflexology is based on the theory that the feet and hands are mirrors of the body and that pressure applied to specific points can be used to treat the corresponding areas of the body. The whole foot, or sometimes the hand, is massaged so that the whole body is treated. The practitioner stimulates reflex points watching for any reaction of pain or tenderness as evidence of an imbalance in the corresponding area of the body.

The theory of reflexology is based on 'zones', for instance zones of the left side of the body correspond to reflex points on the left foot and hand and those on the right side of the body to the right hand or foot. Reflexology maps have been developed to chart the pressure points that correspond to particular parts of the body. Practitioners believe that accumulations of waste matter concentrate around reflex points in the form of uric acid and calcium crystals. Massage
aims to break these down in order to release 'energy flow' along the zones, open blocked nerve pathways and improve circulation to flush away 'toxins'.

As well as parts of the body, states of mind are also said to be represented by certain areas of the feet. Thus emotional problems are thought to respond to this therapy.

Reflexology's theories of zones and energy channels are not supported by scientific research but there is much evidence that massage is relaxing. The foot has 7,200 nerve endings and many doctors believe that pressure upon them may promote the feelings of deep relaxation which reflexology produces. It is also acknowledged that the massage of tense foot muscles may allow blood to circulate more freely, aiding the distribution of nutrients and oxygen and removing waste products.

Like aromatherapy this therapy is non-invasive. Reflexology induces relaxation, it can therefore relieve spasms. It is also believed to increase muscle tone.


Association of Reflexologists
27 Old Gloucester Street
Tel: 0870 5673 320

The British Reflexology Association
Monks Orchard
Tel: 01886 821207

· Shiatsu

Shiatsu means "finger pressure" in Japanese. The therapeutic effects of massage were rediscovered in the early 20th century and developed into shiatsu by combining traditional techniques with a knowledge of physiognomy and anatomy derived from Western medicine. It is similar to acupressure, although an acupressure therapist will concentrate on a specific area during a session, whereas a shiatsu practitioner will cover the whole body.

Following the principles of energy and meridians in acupressure and acupuncture, pressure is applied in a combination of massage techniques to influence and stimulate the energy flow in the body. 'Hara' diagnosis may also be used in which the abdomen is gently felt to detect problems elsewhere in the body. Shiatsu promotes blood circulation and muscle tone.

The Shiatsu Society
Eastlands Court
St Peters Road
CV21 3QP
Tel: 01788 555051

Physical & Occupational Therapies

· The Adeli suit

This is a traction system, which aims at stretching specific muscles. It consists of interconnecting elastic bands placed in selected areas across the joints. The Adeli suit was originally created by Russian space researchers to help the Mir cosmonauts' muscles recover from months in zero gravity, they believed that by rubbing the body against the suit, muscles would strengthen. Russian doctors discovered afterwards that the same principle could be applied to children with cerebral palsy.

Each suit is individually created depending on which muscles the therapist wants to work on. Children have to wear the suit for one hour every day on average while the rest of the day they undergo intensive physical therapy. The treatment lasts one month.

Euromed clinic in Poland was the first treatment centre set up. At the end of 1999, a similar programme was started at North Oakland Medical Centers, in America, by Richard and Izabela Koscielny, two Polish therapists.

Positive results have been reported but they are often word of mouth. Due to a lack of research it is not known whether the Adeli suit is beneficial in the long term and how often the treatment should be repeated. This programme is not suitable for all CP patients as there is a long list of contraindications, it is also believed to be more effective on young children.

The cost of the treatment is around £6,000.


Research into the effects of the Adeli suit was carried out in Russia. Shvarkov, Davydov and Kuuz, in Neurosci Behav Physiol 1997 (Nov-Dec;27(6):644-7) reported positive results, and Semenova in Neurosci Behav Physiol 1997 (Nov-Dec;27(6):639-43) stated that positive clinical effects were obtained in 70% of patients, with improvements in walking and self-care ability.

- Shvarkov SB, Davydov OS, Kuuz RA, Aipova TR, Vein AM. New approaches to the rehabilitation of patients with neurological movement defects. Neurosci Behav Physiol 1997 Nov-Dec;27(6):644-7 "Results were obtained using a new method, based on the "Adeli-92" therapeutic space suit, for the rehabilitation of patients with movement disorders due to acute lesions of the cerebral circulation, head trauma, and other causes. The results obtained demonstrate the high efficacy of this new method."

- Semenova KA. Basis for a method of dynamic proprioceptive correction in the restorative treatment of patients with residual-stage infantile cerebral palsy. Neurosci Behav Physiol 1997 Nov-Dec;27(6):639-43 "The positive effects of this method were demonstrated objectively using electroencephalography, electroneuromyography, studies of somatosensory evoked potentials, and studies of the vestibular system."


Euromed Rehabilitation Center
Aleja Piastow 10
76032 Mielno
Tel: (00 48) 94 318 92 13

North Oakland mecial Centers
Izabela and Richard Koscielny
NOMC EuroPeds
461 West Hutton
Suite 406
Pontiac MI 48341
Tel: (001) 248 857-6776

· Bobath method

By developing this method sixty years ago in England, Berta and Karel Bobath intended to improve the posture and movement of CP patients. The Bobath method is said to work for all. The technique also called Neuro-Development Treatment (NDT), includes a widespread programme of individualised physical and play activities such as physiotherapy, occupational therapy, speech and language therapy.

The first stage of the treatment consists of observing and assessing the child's ability to move as well as its posture. The main aim is to encourage and increase the child's ability to move and function in as normal a way as possible The Bobath method focuses on two aspects: inhibition and facilitation. The former aims at counteracting some of the bad reflexes retained by children by correcting their posture and movement thus preventing further handicap caused by using
abnormal movement, while the latter enables them "to interact with their environment to develop more normal, functional movement patterns".

Parents also play an important role, they are taught how to apply the Bobath principles at home.

There are three specialised centres in England located in London, Cardiff and Glasgow. The Centre in London trains therapists and works closely with the Royal Free Hospital on research. The Bobath principles are widely used throughout the world by many orthodox physiotherapists.

A letter of referral must be obtained from the child's doctor.


The Bobath Centre
250 East End Road
East Finchley
N2 8AU
Tel: 020 8444 3355

Bobath Children's Therapy Centre, Wales
19 Park Road
CF14 7BP
Tel: 029 2052 2600
http://www bobath.org.uk/wales

Bobath Scotland
Bradbury House
2028 Great Western Road
G13 2HA
Tel: 0141 950 2922

· Conductive Education (CE)

Devised by Andras Peto, in Hungary fifty years ago, CE is not a therapy but an educational system with a holistic approach designed to help children and adults with motor disorders. The principle behind CE is learning how to learn. The aim is to enable the physical, intellectual, social and personal development of the children.

CE does not claim to be a cure but to promote the orthofunctioning of the personality - by improving motor skills CE strives to overcome problems of movement and make individuals independent in their daily living without relying too much on artificial aids. Specialist educators called "conductors" help implement a programme of rehabilitation for each child. This programme includes an education curriculum as well as physiotherapy and focuses on body control, mobility and communication. It is appropriate to the learners' age, their ability and needs. It is intensive as it lasts on average five hours a day and five days a week.

Parents are involved as much as possible. The emphasis is put on group activities, as it is believed that children will learn from each other. This system is goal oriented and does not focus on the causes of disabilities. The equipment used is a plinth (slatted chair) and a ladder chair.

CE is not suitable to all children with cerebral palsy, a "dynamic assessment" usually takes place to find out whether it can be beneficial; during the assessment the therapist notes how the child responds to the approach.


The National Institute of Conductive Education
Cannon Hill House
Russell Road
B13 8RD
Tel: 0121 449 1569
The Institute was created in 1986 following a BBC documentary. It has a list of centres in the UK.

The Welsh Initiative for Conductive Education
PO Box 203 EDO
Mount Pleasant Lane
Tel: 02920 706 206

International Peto Institute
Kútvölgyi út 6
1125 Budapest
Tel: (0036) 1 224 1521

6 Market Road
N7 9PW
Helpline: 0808 800 3333
Scope has developed a number of schools and organises courses at the Keele University.

· Mobility Opportunities Via Education (MOVE)

Developed in America by Linda Bidabe, MOVE is not a therapy, it is an activity-based program designed to teach children basic, functional motor skills needed for adult life within the home and community. Move rejects the idea that if a child has never walked by the age of seven, he will never be able to do so. Unlike other therapies, Move educators don't teach the students to crawl before sitting, standing or walking, each child is seen as a "vertical individual". They believe
that it takes too long for children with neuro-motor disorders to learn to crawl. The students are taught to sit, stand, and walk first. Move educators also believe that with other therapies "the skills that students learn are not relevant to the needs of daily life and often emphasise the student's handicap because the skills are meant for children much younger." MOVE aims at increasing individuals' independence in their training. Goals are set and sixteen specific physical skills have been isolated as necessary for independent mobility, each of which
has been divided into four levels of success.

MOVE advocates the Bobath's theory whereby abnormal reflexes should be inhibited. Each programme is tailored according to individuals and includes a series of intensive exercises. Parents learn the techniques in order to apply them at home. There is an emphasis on speech and communication. Special equipment is used such as a wheel frame with straps or gait trailer, which allows children to stand or even walk.

MOVE is not appropriate for children who can already sit, stand and walk and those with medical contraindication.


MOVE Europe
Wooden Spoon House
5 Dugard Way
London SE11 4TH
e-mail: move@move-europe.org.uk

MOVE International
1300 17th Street
Bakersfield CA 93301-4533
Tel: (001) 800-397 6683

· The Institutes for the Achievement of Human Potential (IHAP)

The goals of this educational organization founded by Glenn Doman in 1955 is to achieve physical, intellectual, and social growth of all children. Doman claims that brain growth is not static and unchangeable but an ever changing process. By reprogramming brain cells, damage can be reversed. Learning repetitive simple exercises or patterns will stimulate the healthy cells of the brain so that they can take over the role of the damaged cells. According to Doman cerebral palsy is not diagnosis but a description of the results of brain injury. The Institutes use the term "brain-injured" which refers to the entire spectrum of brain injury. A neurological evaluation of the child will establish the degree of severity of the brain injury, at the end of this evaluation a profile is drawn which gives the child's neurological age, a series of passive exercises is then designed accordingly. Based on the belief that children love to learn,
exercises are taught in a joyful way to promote mobility, intellectual and physiological growth.

The Programme consists of visual, auditory and tactile stimulation with topics such as crawling (unlike the MOVE principles, Dolman and Delacato believe that children should learn to crawl or creep before learning to walk), creeping, patterning, early reading and language development.. There is also an oxygen enrichment program, nutritional program, respiratory patterning (several persons including a parent use simple repetitive movements to manipulate the child's
head and extremities to simulate prenatal and postnatal), pro-gravitational and anti- gravitational environments and facilitated communication. Diet plays a key role and a program of supplements is also recommended.

The child's progress is monitored and re-evaluated by specialists two or three times a year. Exercises take place at home and involve parents, friends or volunteers. Parents are regarded as the best teachers that their children and at least one of the parents is expected to attend courses run by the IHAP. The course focuses on the development of the brain in children and all aspects of brain injuries.

At present courses are given in America, Italy, Japan, and Mexico and they have been translated in several languages.

The Doman method is controversial, criticisms were raised about the promotional attitude of the Institutes and the demands placed on parents are also said to be too high and unrealistic.


The Institutes for the Achievement of Human Potential
8801 Stenton Avenue
Wyndmoor PA 19038

Istituti per il Raggiungimento del Potenziale Umano, Europa
Via delle Colline di Lari
6 56043 Fauglia
Tel: (0039) 050-650 237

The British Institute for Brain Injured Children (BIBIC):
Knowle Hall
Tel: 01278 684060

· Portage

This educational system originated from America following the observation that parents of children with special needs lacked guidance when it came to teach their children before they reached school age.

Portage focuses on the family environment and states that a child should not be separated from its family. Trained advisors, occupational therapists, social workers, nurses and teachers visit parents at home on a weekly basis to provide training and technical assistance. Although these advisors act as supervisors, parents are the key figures of the programme as they have the greatest influence on their child's learning.

The first visit consists of assessing the child's development in order to design a specific program which includes physical/motor development, speech and language, self help skills, cognitive development and socialisation skills. The programme focuses on behaviour modification and three or four behaviours are addressed every week. Teaching is integrated during the child's play routine.

Parents record their child's improvement and progress is regularly re-evaluated. New teaching targets are written down every week on an activity chart. Parents can express their view and ask that a specific skill should be developed. This form of teaching can continue even after the child has joined a school. Each programme is tailor made according to the child's requirements.

Portage was introduced to the UK in 1976.

National Portage Association
127 Monks Dale
BA 21 3JF
Tel: 01935 471 641.

· The Sunflower Method

The Sunflower Method has been developed over the past 20 years by Guildford-based osteopath, Mark Matthews, as he found that when he treated children with learning difficulties their conditions and behaviour were improved. The method treats the child as a whole, on the basis that our physical, mental and emotional systems are interdependent. The principal diagnostic tool is applied kinesiology - testing whether individual muscles are strong or weak, which is an indicator of imbalances in the chemical and neurological system. The treatment programme involves an individually tailored combination of cranial osteopathy, acupressure, homeopathy, dietary adjustment, nutritional supplements and neuro-linguistic programming
(NLP) to redress weaknesses. The process has been compared to 'debugging a computer'.

The Sunflower method is most effective for children over seven years old. The child's suitability is assessed on the basis of a questionnaire, medical and neurological examination, osteopathic and kinesiology tests, and occasionally blood and urine samples. The parents are then presented with a report laying out the proposed treatment programme, and the estimated cost.

The treatment is divided onto four areas:

- Structural
Any problems found in the musculoskeletal system are corrected, through cranial osteopathy, manipulation, reflex point stimulation and soft-tissue balancing, in order to ensure that the child can lie down, sit, stand and walk without stress.

- Neurological
Over 200 reflexes are assessed and corrected if necessary (sometimes through exercises). These include: retained primitive reflexes, cranial dyslexia reflexes, eye-ear-tongue reflexes, proprioception.

- Biochemical
It is claimed that biochemical problems can hinder developmental and educational progress, even when there are no obvious symptoms. Problems such as gut dysbiosis, organ stress, intolerances, inflammation and oxidative stress are approached by means of nutritional supplements, special diets (commonly sugar-intolerance is implicated), and osteopathic treatment of the organs.

- Emotional
Negative emotional associations, caused by repeated failure, teasing, frustration or fear may hamper a child's ability to learn, and may result in behavioural disturbances as an avoidance strategy. Neuro-linguistic programming is used to establish a more positive attitude - patterns of thought may be altered, helping the individual take control of their actions. Homeopathic remedies may also be prescribed.

16 Sunflower practitioners work at Sunflower Treatment Centres across the UK; they are all registered osteopaths or chiropractors, and trained in applied kinesiology.

The average cost of the treatment programme, which typically lasts up to six months, is £300-£500.


In 2001, Leona Bull, a researcher at the University of Surrey at Roehampton began a four year study of seventy children with dyslexia who have been treated with the Sunflower Method. The long term effects and overall satisfaction with the Method are also being assessed. A report of the findings will be available in spring 2002, and further information can be obtained by contacting Leona Bull directly at:

Whitlelands College
West Hill
SW15 3SN

For further information contact:

The Sunflower Trust
10 Guildford Park Road
01483 267 537

Speech & Language Therapies

· Speech and Language

Therapy The aim of speech therapists is to improve communication skills of individuals with no or little speech. Speech therapy can help with speech impairments, understanding spoken or written language, using language and feeding. It involves talking, using sign language, or a communication aid.

For information contact the following organisations:

Overcoming Speech Impairments (AFASIC)
2nd Floor
50-52 Great Sutton Street
Helpline: 08453 55 55 77

ASLTIP (Association of Speech and Language Therapists and Individual Practitioners)
Colheath Bottom
Princes Risborough
HP27 0SZ
Tel: 0870 241 3357
Gives a list of therapists per area.

The Royal College of Speech and Language Therapists
2 White Hart Yard
Tel: 020 73781200

Great Ormond Street Hospital
For Children NHS Trust
Speech and Language Therapy Department
Great Ormond Street
Tel: 020 7405 9200

· Facilitated Communication

Facilitated Communication (FC) was devised by an Australian, Rosemary Crossley, thirty years ago. According to Rosemary Crossley, the difficulty that some disabled individuals have with language is not cognitive but due to the fact that they have a problem expressing themselves; as a result their intellectual skills tend to be underestimated but once they are able to communicate they often reveal unexpected understanding and academic skills. She believes that when individuals' communication skills improve they tend to become more confident and independent.

The aim of FC is to help individuals with limited or no speech find other ways of communicating using Alternative and Augmentative Communication strategies (AAC). The technique involves gesture and body language such as pointing, eye gaze, touching or sound. A "facilitator" helps a child or adult by giving them physical support, for example holding their hand, wrist, forearm or finger while they point to objects, signs or letters or even type or write. Each session is individualised. After assessing the client, the "facilitator" chooses a specific type of communication or technique which is appropriate to the needs of the client: Graphics: pictures, drawings, abstract symbols, text; voice; sign language; gestures; speech; vocalisations; concrete objects touched or pointed to.

Various tools and devices may be used such as alphabet or picture boards, mouth or headsticks, switches, keyboards or typewriters and synthesisers. Emotional support, for instance giving encouragement, also plays an important role in FC.

FC is very controversial, Douglas Biklen, from the Facilitated Communication Institute at the Syracuse University in America, claims that "Facilitated Communication is not a cure for autism or other developmental disabilitiesÂ…but a means of communicating". Opponents to the technique argue that the "facilitator" can influence or manipulate the users as they attempt to point or type. Recent scientific studies have not been conclusive.


The National Autistic Society (NAS)
393 City Road
Tel: 020 7833 2299

DEAL Communication Centre Inc
538 Dandenong Road
Caulfield Victoria 3162
Tel: (0061) 3 9509 6324

Facilitated Communication Institute
Syracuse University
370 Huntington Hall
New York
NY 13244-2340
Tel: (001) 315 443 9657
The institute has a list of research documents on its website.

· Tomatis method

This method was invented fifty years ago by Dr Alfred Tomatis, a French Ear, Nose and Throat specialist. The aim is to improve the auditory system. People who can hear sounds may not be able to take in the full spectrum of these sounds, which means they might find it difficult to listen properly. According to Dr Tomatis this happens when muscles are not working properly and through auditory stimulation it is possible to retrain the muscles of the inner ear so that it
can function without distortion.

Dr Tomatis believes that the ear has several functions:

- The initial purpose of the ear is to help grow the brain of the unborn child. Hearing is the first sense to be developed when the foetus is only a few months old, the foetus can hear its mother's voice in the womb and it is thought that it gets nourished by it.

- After birth the ear's role is to energise the neo-cortex of the brain, the area were the central nervous system is located. It is thought that if there is malfunction of the ear, the nervous system won't be able to digest information, which could damage communication, expression and social behaviour.

- The inner ear controls muscles, balance and co-ordination. It may be an important relay for all sensory information that our body sends to our brain since touch -vision- hearing are all interpreted through our vestibular-cochlea system (the part of the inner ear concerned with balance and body orientation is the vestibular and the part concerned with hearing is the cochlea). Dr Tomatis claims that the ear also plays a significant role in speech as it controls the voice: "the voice produces only what the ear can hear". Patients who undergo the treatment will find that their voice changes as they improve their listening capacities.

According to Dr Tomatis, hearing and listening is not the same, hearing implies a passive attitude whereas listening implies an active attitude. This can be noticed in children with attention deficit, these children usually find it difficult to read and concentrate and although they have very good hearing, their listening capabilities are very poor. Hearing and listening capacities may not be the same in both ears, the Tomatis method is said to improve these capacities in the right ear as it is the one which has better control over the parameters
of voice.

The tools used by the therapists are:

- An electronic device (the electronic ear) which can filter sounds.
- Special headphones which enable sound to be transmitted directly to the bones, as it is thought that people hear first through the bones in their ears and then the muscles.
- A microphone

The Tomatis method is based on sound stimulation, individuals listen to high frequency sounds which seem to stimulate the brain's neurons. Dr Tomatis believes this type of sound will have a positive effect on the central nervous system, individuals will feel more energised, they will concentrate better, learn better and will feel calmer at the same time. Low-frequency sounds have the opposite effects.

The sounds played include music (Mozart and Gregorian Chant) and speech, which can be filtered to produce high frequency sounds, according to Dr Tomatis a mother's voice can be filtered to sound as if it was heard in the womb.

The treatment consists of:
- 15 days of 2 hours a day of listening
- 3/5 weeks off
- 30 sessions over 8 consecutive days.
- 4 weeks off
- 7 days of listening

Few studies have been conducted on the efficacy of the method.

It is claimed that some of the positive effects noticed include increased eye contact, children start making sounds, they are more in touch with their environment.

There are over 25 Tomatis centres in the world.


The Tomatis Centre U.K Ltd
3 Wallands Crescent
East Sussex
Tel: 01273-474877
The centre was opened by Alex and Sally Smith after their son was treated at the Tomatis Centre in Paris.

Sound Listening & Learning Center (Tomatis USA)
301 E. Bethany Road
Suite A107
Arizona 85012
Tel: (001) 602 381 0086

Recreational Therapy

Recreational therapists work with children on leisure activities or other sport skills which include dance, swimming, swimming and Hippotherapy.

· Hippotherapy

"Hippo" means horse in Greek, in hippotherapy the therapist uses a specially trained horse as a tool. It is believed that the horse's rhythmic and repetitive movement can influence children's motor function. It is three-dimensional: from side to side, forwards and backwards, up and down and therefore similar to the way a person walks.

Hippotherapy can benefit children in several ways:

- It improves muscle tone without over stimulating muscles. Children have a better head and trunk control. Hippotherapy also helps with balance, breathing, attention, co -ordination and spatial orientation.
- It helps develop Children's tactile, language and visual senses.
- Children become more confident, it gives them a sense of responsibility and independence.
- The therapy is enjoyable, a close relationship is formed with the animal and the child.
- Children who can't walk get a sense of what it feels like.

Children are helped by physical therapists, occupational therapists, speech and language therapists. The horse used during the therapy is friendly, docile and trained. Hippotherapy is safe, there is no risk that the child may fall off the horse as therapists are here to help, safety helmets and belts are also used. Specific riding skills are not taught, most children with cerebral palsy can try the therapy.

Hippotherapy has been used for over 15 years as a form of treatment in Europe, particularly West Germany and Switzerland, it is also popular in America and Canada.


A study published in the Developmental Medical children Neurology in 1998 indicates that "hippotherapy may improve energy expenditure during walking and gross motor function in children with CP". McGibbon, Andrade, Widener, Cintas (Effect of an equine-movement therapy program on gait, energy expenditure, and motor function in children with spastic cerebral palsy: a pilot study. Dev Med Child Neurol 1998 Nov;40(11):754-62)

- Rothhaupt D, Ziegler H, Laser T. Orthopedic hippotherapy--new methods in treatment of segmental instabilities of the lumbar spine.] Wien Med Wochenschr 1997;147(22):504-8
"Due to the varying pressure load during the riding exercise the trophic conditions of the active and passive structures of the spine are improved."

- Rothhaupt D, Laser T, Ziegler H, Liebig K. Sportverletz Sportschaden 1997 Jun;11(2):63-9 Orthopedic hippotherapy in postoperative rehabilitation of lumbar intervertebral disk patients. A prospective, randomized therapy study. " the OHRT is a serious therapy concept in postoperative treatment of patients with lumbal disc herniation."

- Equest
- Capital Area Therapeutic Riding Association


North American Riding for the Handicapped Association (NARHA)
P.O. Box 33150
CO 8 0233
Tel: (001) 303 452 1212

Riding for the Disabled Association
Lavinia Norfolk House
Avenue R
National Agricultural Centre
Stoneleigh Park
Tel: 02476 696510

· Dolphin therapy

For the last decade dolphin therapy has been largely publicised by the media who reported several successful case stories. Dolphin therapy was started in the early seventies by Dr Betsy Smith an educational anthropologist who noticed the therapeutical effects of dolphins swimming with her disabled brother. A few years later dolphin therapy was developed by Dr Nathanson at the Dolphin Human Therapy centre in Florida, America.

The aim of the therapy is to increase sensory activities, programmes take place in a pool with captive or semi-captive dolphins and therapists who assist the children, children are asked to swim, touch, feed or pat the animals. Therapists work on specific areas such as speech, behaviours and motor skills, they customise programmes to the needs of the children.

Dolphin therapy is not a cure but it can help alleviating some symptoms associated with children conditions by enhancing their healing process. Samples of blood were analysed before and after the therapy, results showed that after swimming with dolphins there is a change of hormones, endorphins and enzymes as well as T-cells, how this is possible is still not well understood. There is ongoing research in universities and dolphin research centres but the evidence that dolphin therapy works remains anecdotal. Several theories have been hypothesised:

Therapy in a pleasant environment

Encounters with dolphins evoke a deep emotional response and trigger the release of deep feelings and emotions. It is believed that children are more responsive to the therapy because they play in a pleasant environment, they are motivated to complete the tasks, they are happy and therefore they pay greater attention to the therapists' work. It has also been suggested that dolphins can sense areas of disability and physical trauma in the human body, they motivate children to use these parts.


For others, the healing principle is similar to that of sound therapy: rhythm and vibrational sound facilitate an altered mood. According to Dr Cole, Chairman of the Aquathought Foundation in Florida, swimming with dolphins can create physiological cell and tissue change in the body. Dr Cole explains that dolphins have natural sonar, they emit ultrasound waves to localise things and to communicate, this process is called "echolocation". Sounds emitted by the dolphins are so intense that that they can cause "cavitations" - they create holes in the molecular structure of fluids and soft tissues. Cole believes that the dolphins' signal frequencies can have a profound effect on the human brain by modifying the brainwave activity.

Results of EEG tests carried out on people who experienced the echolocation showed that the dominant human brain frequency drops from beta to alpha. I was also noted that both sides of the brain enter into synchronisation which means there is a far better communication between the left and right sides of the brain, this is an uncommon neurological state, which is typically associated with heightened awareness and increased learning ability.

Results noticed:
- Strong emotional change
- Children calm down
- Improved communication
- Increased attention span
- Increased confidence and self esteem
- Improved gross or fine motor skills
- Better co-ordination
- Better eye contact, smiling, laughing, touching
- Better immune system.

Dolphin therapy is expensive and it is important not too expect dramatic results. For prices contact the centres directly.

Dolphin Human Therapy (DHT)
13605 South Dixie
Highway #523
Florida 33176-7252
Tel: (001) 305 378 8670
Dr Nathanson is the president of the DHT.

Island Dolphin Care, Inc
Dolphins Plus
31 Corrine Place
Key Largo
Florida 33037
Tel: (001) 305 453 5399
Cost: $2000 per week

The Alexander Trust
Richard Conibear
14 Ashford Road
Tel / Fax: 01225 337178
The Alexander Trust is a charity run by the parents of a child with special needs. The charity has issued a report dolphin therapy centres with some information on accommodation and transport. The Trust hopes to fund treatments for children with special needs in the future.

The Aquathought Foundation
15921 McGregor Blvd.
Suite 2C
FT Myers
Florida 33908
Tel: (001) 941 437 2958
Dr Cole is the Director of Aquathought

Operation Sunflower
Dr Horace Dobbs
International Dolphin Watch
10 Melton Road
North Ferriby
East Yorks
HU14 3ET
Tel: 01482 844468
Dr Dobbs believes that dolphin therapy is beneficial in the treatment of depression

Other Therapies

· Hyperbaric oxygen therapy (HBO)

Hyperbaric oxygen therapy involves the administration of 100% oxygen at a controlled pressure, which is greater than surface pressure. The purpose of HBO is to increase the oxygen amount in the cells of the body to promote healing of damaged tissues.

Cerebral palsy is characterised by the destruction of certain nerve cells in the brain and swelling. Swelling can cause reduced blood flow. Cells around the damaged area of the brain are dormant, they are not active due to low blood supply. It is hypothesised that these cells are not dead and that HBO can reverse the degeneration of tissues and revive them.

Oxygen absorbed on a daily basis is not enough to raise tissue oxygen levels at a high level because red blood cells cannot carry enough extra oxygen to do that, this is why the treatment has to be carried out in a pressurised chamber. HBO takes place in a special chamber that can accommodate one or several individuals. The patients undergo a series of single photon emission computed tomography (SPECT) scans which help identify which parts of the brain are damaged or dormant. The duration of the treatment is around 60 minutes and parents can accompany their child in the hyperbaric chamber. A course of several sessions is needed.

Increasing the oxygen intake to the bloodstream promotes the formation of new capillaries (tiny, thin-walled blood vessels). These capillaries improve blood flow to the body and enrich the plasma with oxygen thereby reducing swelling in the brain.

Oxygen therapy also increases the function of white blood cells in their fight against viruses and bacteria. It is also claimed that HBO can neutralise toxic products in the brain.

The treatment may have some side effects such as ear discomfort (some children will require tubes in their ears) or myopia which can occur for a short term. HBO is not recommended to patients with a lung abnormality.

Although HBO has been accepted to treat people suffering from carbon monoxide poisoning or divers with decompression sickness not much research has been carried out on its effects in the treatment of cerebral palsy. A recent study in the medical journal The Lancet 2001 Feb 24;357(9256):582-6 was not conclusive.

The cost of one session is between £10 to £20.

- Personal Website
- Gillette Children


Hyperbaric Oxygen Trust for Brain Injured Children (HOT)
Ryton House
Primrose Lane
Forest Row
East Sussex
RH18 5LT
Tel: 01342 823127

The initial evaluation fee will be £400 and will include physical consultation and programme. Each HBOT session, on the basis of collective use of the chamber, will be £15. Oxygen receiving helmet for each patient will cost £85.

There are 60 multiple sclerosis centres in the UK that are currently treating children with CP, for further information contact the Federation of Multiple Sclerosis Therapy Centres on: 01234 325 781.

A Breath for Life
Unit 4
Lake Enterprise Park
Ladies Walk
Tel: 01524 380 363
This charity offers various treatments: naturopathy, homeopathy, osteopathy and craniosacral therapy.

The Hyperbaric Medical Centre
Tamar Science Park
Research Way
Tel: 01752 209999

· Biofeedback

Biofeedback was first used in the 1930s to detect electrical signals from the brain, in the 1960s doctors emphasised its therapeutic properties, it has been very popular since then in America. Based on the principle that the mind is intrinsically linked to the body and that our emotions affect our body, biofeedback teaches patients how to be aware of physiological functions that are normally automatic and unconscious and how to use this internal information to improve their health. Using measuring devices patients learn how to monitor their body responses (heart beat, skin temperature, blood pressure, respiratory patterns, brain wave activity or muscle tension) in order to control them. Biofeedback is a non-invasive and painless process, the information is fed back in the form of a light, sound or needle sign on a screen. Patients can be trained to inhibit unwanted spastic motor activity. Once the patients recognise changes in their
physical states, they learn how to alter them with guided imaginary or relaxation techniques. After a few sessions they are able to notice these responses and can control them without devices.

Biofeedback takes practice, it requires discipline and commitment and several sessions are generally needed to master the technique. It appears attractive to children as they are asked to play with a computer game and perform tasks, however it may be difficult for some children who have electrodes attached to their head to stay still during a session.


- Biofeedback is believed to be effective in treating pain. Many clinical trials have been conducted on biofeedback, some of them are available on the internet, at the Medline website: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=&DB=PubMed

- Mauersberger K, Artz K, Duncan B, Gurgevich S. Can children with spastic cerebral palsy use self-hypnosis to reduce muscle tone? a preliminary study. 1096-2190 2000 Mar 21;2(2):93-96 "This study used the Biocomp 2000 biofeedback electomyogram device to measure the degree of muscle tension in two muscle groups before, during, and after hypnosis in four children with spastic quadriplegic CP. Three of the four children were able to show a very significant decrease in muscle tension while under "trance" and were able to use self-relaxation techniques when confronted with stressful situations. "

- Toner LV, Cook K, Elder GC. Improved ankle function in children with cerebral palsy after computer-assisted motor learning. Dev Med Child Neurol 1998 Dec;40(12):829-35
"These results suggest that biofeedback training can improve ankle function, and the implications for gait are discussed."


EEG Spectrum Neurofeedback Research and Clinical Services
16500 Ventura Blvd
Suite 418
CA 91436-2011
Tel: (001) 818 789 3456

EEG Neurofeedback Services
Dolphin Lodge
Dolphin Yard
Holywell Hill
St. Albans
Herts AL1 1EZ
Tel: 01727 839533

Association for Applied Psychophysiology and Biofeedback (AAPB)
10200 W. 44th Avenue
Suite 304
Wheat Ridge
CO 80033-2840
Tel: (001) 303 422 8436

· Electrical Stimulation

Therapeutic Electrical Stimulation (TES) is a home based therapy created by Dr Karen Pape at the Magee Clinic in Toronto. It involves the stimulation of muscle tissues using a low-level electrical current to increase the blood flow to muscles in which fibres are atrophied. Electrodes from the TES unit are attached onto the skin over certain muscles at night during sleep. TES doesn't cause the contraction of muscles, it is therefore considered safe and painless.

A trained therapist sets up criteria and the intensity of the stimulation. It is a slow process which can take at least six months to see any result. According to Pape, TES is not a substitute therapy, it should be used in combination with other therapies. Physical exercise is recommended in order for the child to cope with muscle growth.

TES is said to promote muscle growth and improve posture and balance. Views on this form of treatment are mixed. According to the United Cerebral Palsy (UCP) in America, this therapy seems to be working as a preventive tool.


- Sommerfelt K, Markestad T, Berg K, Saetesdal I. Therapeutic electrical stimulation in cerebral palsy: a randomized, controlled, crossover trial. Dev Med Child Neurol 2001 Sep;43(9):609-13. "No significant effect of TES on motor or ambulatory function was found on the blinded evaluation, but parents of 11 of the 12 children stated that TES had a significant effect. We conclude that it is unlikely that TES has a significant effect on motor and ambulatory function in spastic diplegia."

- Park ES, Park CI, Lee HJ, Cho YS. The effect of electrical stimulation on the trunk control in young children with spastic diplegic cerebral palsy. J Korean Med Sci 2001 Jun;16(3):347-50. "This study suggests that electrical stimulation over the trunk become a beneficial therapeutic technique in improving the sitting posture and trunk control in young children with spastic diplegic cerebral palsy."

- Wright PA, Granat MH. Therapeutic effects of functional electrical stimulation of the upper limb of eight children with cerebral palsy. Dev Med Child Neurol 2000 Nov;42(11):724-7 "Hand function in this group of children improved after they were exposed to FES of wrist extensor muscles. This suggests that FES could become a useful adjunct therapy to complement existing management strategies available for this patient population."

- Steinbok P, Reiner A, Kestle JR. Therapeutic electrical stimulation following selective posterior rhizotomy in children with spastic diplegic cerebral palsy: a randomized clinical trial. Dev Med Child Neurol 1997 Aug;39(8):515-20 "TES may be beneficial in children with spastic CP who have undergone a selective posterior rhizotomy procedure more than 1 year previously."

For more information visit the Mayatek website at: http://www.mayatek.com/

TES is available from:
Technology Assisted Self Care
Tel: (001) 877 827 2242

Cerebral Palsy Organisations

United Cerebral Palsy Association
1660 L St, NW,
Suite 700
Washington DC 20036-5603
Tel: (001) 800- 872-5827

The Cerebral Palsy network
1448 Goldenrod
S.E. Lacey
Washington 98513
Tel: (001) 360 432 1269

American Academy for Cerebral Palsy and Developmental Medicine
The AACPDM is a multidisciplinary scientific society devoted to the study of cerebral palsy.

March of Dimes Birth Defects Foundation
1275 Mamaroneck Avenue
White Plains
NY 10605
Tel: (001) 914 428 7100


- Vickers A. (1994) Health options: Complementary therapies for cerebral palsy and related conditions. ISBN 1852305622
- Nancie R., Finnie J., Bavin M. (1997) Handling the young child with cerebral palsy at home. Butterworth-Heinemann Medical . ISBN: 0750605790
- Geralis E. (1998) Children with cerebral palsy : A parents' guide. Woodbine House. ISBN: 0933149824
- Miller F., Bachrach S.J. (1998) Cerebral Palsy : A complete guide for caregiving Johns Hopkins Univ Pr; ISBN: 0801859492


- An excellent web forum run by the Harvard Massachusetts General Hospital Department of Neurology. This website contains a long list of messages from parents asking and offering information.

- The Quest for Children Foundation is dedicated to promoting public awareness, family support and to help provide financial assistance for alternative medical treatments for
children with cerebral palsy and other brain injuries

- Excellent website on alternative treatments created by Dr Lewis Mehl Madrona.

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