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Cerebral Palsy

Cerebral palsy is the most common childhood disability in the United States, affecting an estimated 764,000 children and adults in the U.S. It is a developmental disorder of posture and movement caused by an injury to the brain occurring during fetal development, during or shortly after birth during infancy. The damage to the brain cannot be repaired. Children with this disorder will become adolescents and adults with the same disorder without progression of its severity.

Each person with cerebral palsy is unique. Depending on the location and extent of the injury, the clinical features may vary from barely imperceptible to severe. Cerebral palsy can affect movement, balance, speech, vision and coordination. The damage to the brain may also result in mental retardation, seizures, and problems with learning, eating and breathing.

Types of Cerebral Palsy
Cerebral palsy can be classified and named by the limbs involved or the type of movement disorder with majority of cerebral palsy patients having spasticity as their primary movement disorder. Often, the two are used together, e.g. "spastic quadriplegia".

Classification by limb involvement: 

  • Quadriplegia : all four limbs are affected, from quad meaning four and plegia meaning paralysis, or impaired ability to move. 

  • Diplegia : two limbs are affected, from di meaning two. Although diplegia typically refers to someone whose legs are most involved, the arms may also be affected, but to a lesser degree. 

  • Hemiplegia : one side is affected, from hemi meaning half. Often, the arm is more affected than the leg. 

  • Triplegia : three limbs are affected, from tri meaning three. Usually both legs and one arm are affected. Some clinicians will refer to this type of clinical picture as diplegia with a hemiplegic overlay. 

  • Monoplegia : one limb is affected, from mono meaning one. 

  • Total Body Involvement : this term is used to describe a person who, in addition to the involvement of four limbs, has impairments in speech, vision or cognitive function

Treatment in the Cerebral Palsy Clinic
While newer treatments are available to reduce the spacticity associated with cerebral palsy, traditional treatments remain the appropriate intervention to correct bony deformities and lengthen tendons and muscles. Physical and occupational therapy are important components of early intervention, helping the child achieve and maintain functional independence in mobility and self-care. Therapy is important at any age to increase mobility, improve endurance or maintain gains achieved following an intervention. Braces and upper extremity splints provide stability and improve function. Crutches, walkers and wheelchairs alllow for independent mobility.

The goal of the Orthopaedic Institute for Children (OIC) Cerebral Palsy Clinic is to create a place where children with cerebral palsy can be evaluated by doctors and physical therapists to treat the complex nature of the disorder, to provide the best quality of life for the child.

The OIC Cerebral Palsy Clinic continues to treat referred patients. With the implementation of Medical Treatment Units (MTUs) in the school systems, the clinic is often referred children from the MTUs when in need of surgery or more intensive treatment beyond the MTUs' capabilities. Once treatement is rendered, patients are referred back to the MTUs for follow-up care.

Cerebral Palsy Team
The Orthopaedic Institute for Children Cerebral Palsy Clinic team includes a pediatric orthopaedist, pediatric neurologist, physical and occupational therapists, social worker, pediatric nurse specialist, dietician, orthotist.

The Pediatric Orthopaedist is the surgeon who specializes in the musculoskeletal system of children, including fractures, trauma, bone diseases and disorders, soft tissue impairments and pediatric spinal deformity such as scoliosis and kyphosis. They manage the problems associated with spasticity and when necessary, provide surgical interventions such as tendon lengthening or correcting a bony deformity. Our physician offers insight into the orthopaedic issues facing both children and adults with cerebral palsy and provide treatments that minimize deformity and maximize mobility.

Richard Bowen, M.D.
William Oppenheim, M.D.
Anthony Scaduto, M.D.
Mauricio Silva, M.D.

The Pediatric Neurologist is a physician who specializes in disorders of the brain, spinal cord, peripheral nerves and muscles in children. Pediatric neurologists focus on establishing the underlying cause of neurological disorders, including cerebral palsy. They also treat the associated medical problems such as seizures, movement disorders, metabolic conditions and neurobehavioral issues.

Michel Philippart, M.D.

The Pediatric Urologist is a physician who specializes in the diagnosis and treatment of congenital and acquired urological conditions and diseases in children. The pediatric urologist at Orthopaedic Hospital provides medical management and surgical intervention for bowel and bladder function, one of the most persistent problems this patient population experiences.

Bernard Churchill, M.D.

The Pediatrician reviews medical issues and coordinates the general healthcare of the patient, in addition to working with the orthopaedic surgeon for pre-operative assessments if surgery is indicated and overseeing medical issues for hospitalized patients.

Marinda Tu, M.D.

The Physical Therapist is a health care professional trained to assess and treat movement and function. Physical therapists examine muscle range of motion, spasticity, strength and posture and assess their impact on function and mobility. Our physical therapists communicate with community therapists in the design and implementation of treatment interventions and equipment such as wheelchairs and braces. Gait studies at the Kameron Gait and Motion Analysis Laboratory are conducted by physical therapists.

Cindy Bailey, PhD, DPT, OCS., SCS, ATC, EMT
Physical Therapist

Eileen Fowler, PT, PhD
Physical Therapist
Director of the Kameron Gait and Motion Analysis Laboratory

Marcia Greenberg, MS, PT, KEMG
Clinic Coordinator 
Physical Therapist

The Occupational Therapist is a health care professional who provides skilled treatment to help individuals achieve independence in all facets of their lives. Occupational therapists give people the "skills for the job of living" necessary for independent and satisfying lives. Our occupational therapist assesses and makes recommendations for treatment of fine and gross motor skills, feeding and oral-motor development, computer use, dressing, bathing and other activities of daily living. 

The Social Worker provides psychosocial assessments, assists with locating community resources and assists in the coordination of schooling and social activities. 

Romana Crespo-Belarde, LCSW
Social Worker

The Nurse Specialist assists in making sure all medical orders are carried out, and provides case management and nursing assessment for the patient. 

Also part of the core team is a registered dietician and orthotist. The dietician provides assistance in meal plans so patients receive adequate caloric intake for healthy growth and development. The orthotist works with the team to prevent unequal or unbalanced muscle groups which can lead to deformities as the child grows. If a deformity is perceived, the orthotist works with the therapists in bandaging, casting, or bracing to bring the deformed extremity into the proper plane of function to maximize available motor function.

Under the leadership of William L. Oppenheim, M.D., in addition to the Cerebral Palsy Clinic at Orthopaedic Institute for Children, the resources of UCLA are available at the UCLA/Orthopaedic Hospital Center for Cerebral Palsy, with a team of specialists that treats both children and adults with the disorder. Visit the UCLA/Orthopaedic Hospital Center for Cerebral Palsy website.