Writing a comprehensive scientific book about the cerebral palsy (CP) is a great challenge. The book is international; the nine chapters represent different professional approaches on the topic of cerebral palsy, from Australia, Bosnia and Herzegovina, India, Mexico, Saudi Arabia, Spain, to USA.
Many different interventions are available for persons with CP. Increasingly, it is recognized that intervention needs to be evidence based and family centered. Related therapies can offer improvement in some cases but do not offer a cure.
Lifelong re/habilitation (habilitation and rehabilitation) in person with cerebral palsy is first section of this book which has four chapters about management in children and adults with cerebral palsy through the life span, providing supports and services.
In families who have children with CP the “constant attendance” of the disease is present, through strict consistent long-term care of family and many other factors, such as services, support and physical aspects of the environment, which all can lead to deterioration of the patient's quality of life.
Spasticity can be associated with cocontraction, clonus and hyperreflexia. Children with spastic cerebral palsy generally have a typical pattern of muscle weakness, impairment in selective motor control and sensory impairment.
Many adults with CP face challenges with declining mobility and the emergence of secondary musculoskeletal conditions as they age. Decline in walking and falls are common, potentially comprising activity, participation and health-related quality of life. Current healthcare services for adults with CP currently lack the evidence-based knowledge needed to develop and implement best practice clinical guidelines.
Home modifications are part of the worldwide commitment for universal design standards, which are encouraged by the World Health Organization. Occupational and vocational therapists are trained to analyze an individual's home, school, and work environments to prescribe and recommend modifications to meet specific needs.
Three chapters of the second section are exploring the new therapy options which could improve the family quality of life.
Since hypoxic ischemic encephalopathy (HIE) is a potentially preventable cause of cerebral palsy, much interest has been focused on prevention as well as research on neuroprotection therapies. The authors of fifth chapter proposed a model of “off-label combined therapy” based on hypothermia /antiepileptic drugs in combination with antioxidants, phospholipase A2 inhibitors, glutamate receptor antagonists or EPO using a staggered design in function of the intensity of the perinatal asphyxia and severity of the encephalopathy.
A well-planned and executed SEMLARASS, in the context of a multi-disciplinary team, provides the child with CP, spasticity or movement dysfunction and lever arm dysfunction, with the best hope for a dramatic, predictable and lasting functional improvement.
Stem cell therapy has been extensively studied but still needs to be standardized before it becomes a definitive treatment modality. Autologous BMMNCs are safe and feasible option but their effectiveness needs more clinical trials. Other types of stem cells need to establish safety and efficacy. Though not a cure, stem cell therapy has emerged as a novel therapeutic option to improve the quality of life.
Third section has two chapters about complementary therapies with new possibilities for the future.
Future progress will depend on recognition that brain-computer interfaces (BCI) research is an interdisciplinary work: rehabilitation engineers, speech pathologists, occupational therapists, physiatrists and rehabilitation therapists are professionals who can provide access to these technologies and assistance in their use.
I strongly recommend this InTech scientific book to all physicians, specialists in physical medicine and rehabilitation, pediatricians, orthopedics, physiotherapists, occupational therapists, rehabilitation nurses, psychologies, sociologies, social workers, other medical workers, teachers of all profiles, students of various studies, but first of all to parents of children with disabilities and to general public.
Emira Švraka, MD, PhD