Cerebral Palsy (CP) Treatment in the Republic of Cuba

Cerebral Palsy (CP) is a group of neurological disorders that affect a person’s movement, muscle tone, and posture caused by abnormal brain development or damage to the brain during birth or shortly after. Symptoms of CP vary widely among individuals and can include difficulties with coordination, tremors, involuntary movements, difficulty with precise movements and problems with speech and swallowing.  

While there is no cure for CP, various treatments can help manage symptoms and improve quality of life. In Cuba, treatment involves a comprehensive approach that combines medical, neurological, and physical rehabilitation. Patients receive care from a multidisciplinary team that includes physiatrists, neurologists, psychologists, nutritionists, podiatrists, and speech therapists.  

The treatment process begins with a comprehensive medical history review and a thorough physical examination to identify treatable causes of the impairment with the primary focus on improving movement, motor skills, muscle tone, reflexes, and posture.  

Additionally, attention is given to the patient’s cognitive abilities, motor sphincter control, the presence of seizures, and any vision, hearing, or speech problems.  

Furthermore, surgical options may be suggested for patients who can walk with or without help in order to improve movement and alignment in the legs, ankles, feet, and hips, to increase autonomous motor function, and to enhance gait and range of motion. 

DIAGNOSIS STAGE:  

Assessing a patient with CP before initiating treatment is crucial in developing a personalized treatment plan, identifying comorbidities and complications and maximizing independence and improving quality of life. 

• Review of medical history 
• Review of family history 
• Consultation with medical professionals including neurologist, psychologist and psychiatrist 
• Past medical interventions 
• Physical examination 
• Neurological assessment 
• Musculoskeletal examination 
• Functional abilities 
• Cognitive and behavioral assessment 
• Sensory assessment including vision, hearing and speech abilities 
• Nutritional and growth assessment  
• Seizure activity  
• Laboratory investigations and clinic analysis 
• In-depth clinical evaluations 
• Meeting with family or legal guardian 

TREATMENT STAGE: 

Even though there is no known cure for CP, various treatments can help manage symptoms and enhance quality of life. In Cuba, the program is typically between 28 and 31 days and consists of the following, among other things: 

• Botulinum toxin (Botox) therapy: Botox is a form of medical treatment used to reduce muscle spasticity and stiffness by temporarily paralyzing overactive muscles by blocking the nerve signals that cause muscle contractions, allowing the muscles to relax and lengthen.  

• Physical Therapy: Intensive physiotherapy, consisting of 38 sessions of strengthening exercises, aims to improve motor skills, normalize postural control, overcome persistent impairments, facilitate normal movement patterns, and readapt balance and gait. This program may also include swimming exercises to enhance cardiovascular function, muscle strength, and tone. 

• Occupational Therapy: Rehabilitative treatment focuses on helping individuals perform daily life activities and their ability to carry out tasks, such as dressing, eating, and personal hygiene, independently and efficiently. The primary goal of this therapy is to develop fine motor skills, improve hand-eye coordination, and adapt to physical limitations.  

• Speech Therapy: This type of therapy assists with speech, language, and swallowing difficulties. Beyond enhancing communication skills, speech therapy also focuses on strengthening and improving control of facial and oral muscles. 

• Neurological rehabilitation: Focused on enhancing cognitive, emotional, and psychosocial aspects, the primary aim is to improve information processing, memory, attention and concentration, planning and prioritizing, and visual perception. 

• Pressotherapy: This is a therapeutic technique that involves the use of controlled air pressure to stimulate the lymphatic and circulatory systems. This treatment aims to reduce muscle stiffness, improve blood flow, alleviate pain and decrease swelling, thereby enhancing overall comfort and mobility. 

• Ozone therapy: Ozone therapy for cerebral palsy patients involves the administration of ozone gas to enhance oxygen delivery to tissues, reduce inflammation, and promote healing. The therapy aims to improve cellular metabolism and boost the body’s natural antioxidant defenses. By increasing oxygen levels in the blood, ozone therapy may support better overall function and well-being.   

• Magnetic bed therapy: This therapy involves using a bed embedded with magnets to create a magnetic field to improve circulation, reduce inflammation, and alleviate pain. The therapy aims to enhance muscle relaxation, reduce spasticity, and promote overall physical well-being by influencing the body’s natural magnetic fields.  

• Functional Electrical Stimulation (FES): FES is particularly beneficial in improving gait patterns, hand function, and overall mobility. This form of therapy uses low-level electrical currents to activate specific muscles to improve motor function and strength and hence enhance movement control, reduce spasticity, and promote muscle re-education.   

• Orthopedic surgery: For CP patients who can walk with or without help orthopedic surgery may be performed to correct musculoskeletal abnormalities and improve mobility, posture, and overall function. This type of surgery may involve lengthening or releasing tight muscles and tendons, realigning bones and joints, or stabilizing joints to reduce pain and improve movement.