Ataxic cerebral palsy is caused by damage to the cerebellum, the part of the brain that controls body movements. This type of cerebral palsy is most associated with balance and coordination problems. The word ‘ataxia’ means ‘failure of muscular coordination; irregularity of muscular action’. People who have this type usually walk unsteadily with their feet wide apart. An awkward gait may assist balance control in some cases. Balance problems are usually most noticeable when people are walking or sitting upright unaided. This type may also cause difficulty performing tasks requiring fine motor skills such as writing or feeding due to uncontrollable shaking and leaning forward or lolling due to weak trunk control.
Spastic cerebral palsy is associated with excessive muscle tightness or tone (this is called hypertonia). Muscle tone impairments and abnormal postural control in people with this condition affect balance capacity. Excess muscle tone pulls on the bones and joints and can lead to permanent joint deformities and contractures. On the other hand, a person may have overly relaxed muscles and may struggle to sit up straight and maintain head control (this is called hypotonia).
Athetoid cerebral palsy is associated with involuntary body movements in the arms, legs, and hands. This type significantly affects balance, both in sitting and standing. Involuntary movements whilst walking can affect balance.
There are many treatments which may help improve balance and coordination for people with cerebral palsy. Identification of those with impaired balance at an early age can identify factors that contribute to the persons gait disorder and help to facilitate treatment. Physiotherapy techniques such as stretching can decrease muscle tightness and reduce the risk of deformity. Prior assessment of postural control when a person is sitting can be used to determine the weakness of the trunk muscles causing the insufficient balance. There are strengthening and resistance exercises that can improve ability to hold the body upright and improve balance and coordination. Mobility aids such as crutches, braces and walkers may assist. Braces or splints are often worn to hold the ankle at approximately 90 degrees to improve posture. Treadmill walking is sometimes performed in cases where a person can walk with support by using a harness. This may improve coordination by sending messages to the brain through repeated movements.
Medications such as baclofen are sometimes used to relieve spasticity and improve balance. Also localised botox injections into the tight muscles followed by intense physiotherapy can be given to reduce spasticity.
Surgery (orthopaedic) may improve balance and coordination in some cases, for example hamstring lengthening may reduce spasticity or hip surgery to improve posture and prevent dislocation. Further examples include correction of spinal curvatures and correction of joint deformities (like in-toeing).