Cerebral Palsy - Clinical Services Clinical services in the division of Neurodevelopmental and Behavioral Pediatrics are designed to address the special health and behavioral needs of children and teens with cerebral palsy. Physical Disabilities Program Our Physical Disabilities Program is a service where multiple specialists come together to provide evaluation and coordinated treatment recommendations for children with cerebral palsy and other physical disabilities. Our team includes Neurodevelopmental and Developmental Behavioral Pediatrics, Pediatric Nurse Practitioners, Pediatric Orthopedics, Pediatric Urology, Pediatric Physical and Occupational Therapy, Social Work, a Registered Dietician, Orthotics and Prosthetics, and Special Education. We work closely with the family’s pediatrician or primary care provider to prevent, monitor for, and treat health complications of cerebral palsy. We also address associated behavioral challenges. We work with the family to help the child be as independent and successful as possible at home, school, and in the community. Spasticity Management Program Our spasticity management program provides assessment and treatment for tight muscles that can make motor skills and daily living more difficult for a child with cerebral palsy. During this monthly clinic, a physiatrist (rehabilitation physician) and nurse practitioner provide individualized treatment plans that can include oral medications, Botulinum toxin (Botox) injections or referrals for surgical procedures like a selective dorsal rhizotomy or intrathecal baclofen pump. Participation from our Music Therapist (LINK), and physical and occupational therapy help with both treatment planning and child participation. Feeding Disorders Program Our pediatric feeding disorders program provides assessment and treatment for children who have difficulty eating related to food selectivity (being very choosy about type and texture of food), food refusals (refusing to eat certain types of foods), and disruptive mealtime behavior. We provide individualized assessment by a registered dietician, psychologist with expertise in feeding behavior, and speech pathology. We provide treatment to improve mealtime behavior and increase the range and nutritional quality of foods a child eats. For children with chewing and swallowing problems, gagging, coughing, or aspiration, we work with speech-language pathology to assess oral motor skills and difficulties. We collaborate with speech-language pathologists to improve oral motor and feeding skills and safety. Behavior Interventions for Families The BIFF program is for children with cerebral palsy or other developmental disorders who also have challenging behavior such as tantrums, feeding or sleeping problems, and poor following directions. Goals of the program are to teach families ways to prevent bad behavior, increase the frequency of positive behavior, and teach the child skills required to behave in a desirable way. This generally involves weekly meetings between the caregivers and our behavior specialist for 6-14 weeks. Collaborations Pediatric Orthopaedics The Pediatric Orthopaedics team works with us to monitor and treat bone and muscle issues in children with CP. They see children with cerebral palsy both in the pediatric orthopaedic offices on Westfall Road and in our Kirch Physical Disabilities program. Pediatric Neurosurgery Not every child with cerebral palsy needs a neurosurgeon. However, when children with CP have problems with too much fluid in the brain or require a shunt to drain fluid (ventriculoperitoneal (VP) shunt), neurosurgery becomes involved. Dr. Howard Silberstein is the pediatric and adult neurosurgeon who provides care for both children and adults with cerebral palsy when needed. Sleep Medicine Many children with cerebral palsy have sleep problems. High or low muscle tone can increase the risk for problems like sleep apnea, which can impact daytime behavior, learning, and overall health and functioning. Pediatric trained specialists in the Pediatric Sleep Medicine Service can evaluate and treat these sleep problems. Pediatric Gastroenterology Many children and teens with cerebral palsy have problems with slow bowel motility, constipation or gastro-esophageal reflux (GER). The physicians and nurse practitioners in Pediatric Gastroenterology can evaluate and offer suggestions for treatment. Pediatric Neurology Some children and teens with cerebral palsy have seizures, difficult to manage movement disorders or other neurologic issues. We work closely with physicians and nurse practitioners in Child Neurology to assure children have the evaluation and treatment they need. Physical Therapy In addition to the evaluation services provided in the Kirch Physical Disabilities Program, pediatric physical therapists are available in the outpatient setting to provide outpatient evaluation as well as intense and targeted therapy programs for children and teens. These programs to target specific home and community goals. For example, they may work with a child after surgery to regain strength or improve walking skills. They can also work with children on independent daily living skills (feeding, dressing and bathing needs) and evaluate for equipment like wheelchairs. Occupational Therapy In addition to the evaluation services provided in the Kirch Physical Disabilities Program, pediatric occupational therapists with expertise in working with children affected by cerebral palsy are available in the outpatient setting. They can provide evaluation of fine motor skills, handwriting, daily living skills, sensory processing and adaptive equipment needs. They provide ongoing treatment programs to target specific home and community goals such as self-feeding, handwriting, and daily living or self-care skills. Orthotics and Prosthetics In addition to the evaluation services provided in the Kirch Physical Disabilities Program, the orthotics and prosthetics team works with children in their Westfall Road office to provide evaluation and treatment services. They have expertise in evaluation of gait and in identifying and fitting orthotic devices to optimize gait. In addition, they work with children with scoliosis who require bracing and with children who require helmets for cranial molding. Speech-Language Pathology Children with cerebral palsy often have difficulties with speech, communication, oral-motor control and feeding/swallowing. We work with both Dawn Vogler-Elias (Kirch Speech-language pathologist) and with the team in URMC’s speech pathology department to meet the needs of children with cerebral palsy. Dentistry Children with cerebral palsy have special dental needs. They often have difficulty tolerating tooth-brushing and routine dental care due to problems keeping the mouth open, sensory differences and problems with gagging. Many children also have challenges due to crowding of the teeth, the way the palate is formed, and dental complications from medicines or health issues. We work closely with URMC’s dental department and with other pediatric dentists in the community to help children with cerebral palsy have good oral health.