An
Ayurvedic protocol for the management of Cerebral Palsy
A developmental disorder is impairment in the normal
development of motor or cognitive skills which occur at some stage in a child’s development, often retarding
the development. These may include psychological or physical disorders. According to the Developmental
Disabilities Act, section 102(8), "the term
'developmental disability' means a severe, chronic disability of an individual
5 years of age or older that attributable to a mental or physical impairment or
both, manifested before the individual attains age 22 and is likely to continue
indefinitely resulting in substantial functional limitations in three or more
of the following areas of major life activity viz. Self-care, Receptive and
expressive language, Learning, Mobility, Self-direction, Capacity for
independent living, and Economic self-sufficiency.
The
worldwide prevalence of such disabilities scores as high as 10% (UN report)
while in India, this figure stands at an alarming 40-70 million persons, with
nearly 150 million children affected (CRIN). With the intense untoward outcome
that such a condition imposes on the physical existence itself of an
individual, it is an area of utmost concern among all the existing systems of
medicine, Ayurveda, being no exception to this.
Amid the motor developmental disorders,
the most common are the neuro-developmental disorders, which manifest as an
outcome of the failure in the proper functional expression of a motor unit. Clinically,
such neuro-developmental disorders present in three varied forms, viz.
Atonicity (loose child/floppy baby), Hypertonicity (tight child), and Child With movement disorders (athetoid,epilepsy,myoclonic etc.). This
functional blockade can be understood under the terminology of Dhatukshaya
(tissue loss/underdevelopment) in Ayurveda, setting the stage for Vata prakopa.
The vitiated Vayu finds a harbor in the Sira, Medas, Snayu and Mamsa resulting
in the clinical manifestation of the motor developmental disorder in either of
three forms listed earlier.
Cerebral Palsy
Cerebral Palsy or Little’s Disease is the commonest
identified cause of childhood disability. It presents as a static
encephalopathy and is studied to be prevalent among 1.5-2.5 per 1000 live
births, its etiology being:Prenatal: Anoxia due to interference with
placental circulation, Eclampsia/pre eclampsia etc; Natal: Anoxia during
birth process, Asphyxia due to blockage of respiratory passage etc; or Post natal: Kernicterus, Trauma, etc., precipitating either a Diffuse cortical and scattered focal
atrophy,
or a Cystic softening of brain in small or large areas, or
Hypoplasia of the midbrain or cerebellum, or normal gross appearance with loss of cortical neuronal cells on
microscopy; clinically interpreted as Periventricular leucomalacia (Spastic
Diplegia),
Periventriculat leucomalacea, multicystic
encephalomalacia, (Spastic Quadriplegia), Stroke (in utero /neonatal).
An Ayurvedic overview of Cerebral Palsy
Cerebral Palsy (CP) is accommodated under the category
of hypertonic developmental disorder. Hypertonicity in CP may be a spasticity,
rigidity or contractures identified as Kubjata, Kunitwa and Stabdhata in
Ayurveda. The Doshic analysis here reveals the vitiation of Vata and Kapha presenting as Sangam
(obstruction), Sadam (reduced function) and Vartam (hardening), being a hyper expression of
the former, and the latter imparting Sthairyam (hardening) and Chirakaaritwa
(make it chronic). Thus, it can be concluded that spasticity is Vata
predominant Kapha Vatika manifestation. The Dooshya here, as previously
mentioned, involves Sira, Medas, Snayu and Mamsa. Snayu, is a much debated
still most applied terminology in Ayurvedic literature. The classical
description of Snayu describing it to be a thread like structure, quite
numerous in number, distributed all over the body and its pathological lesions
creating maximum harmful effects including convulsive disorders and tetanic
postures with marked spasticity, yields the anatomical identification of Snayu
as the Nerve tissue. Stabdhata etc, being the Hypertonicity, thus are due to a
neurological lesion.
Management of Cerebral Palsy
Management of such
disabilities require a multidisciplinary approach, Cerebral Palsy being no
exception to this. Thus management of Cerebral Palsy demands like, Symptomatic treatment, Procedure
Based Therapies of Ayurveda, Rasayana chikitsa, Medhyam, balya, Kapha Vata haram, Physiotherapy, Occupational
therapy, Educational intervention, Orthopaedic
support, Surgery if needed and Social
interventions.
Laying down the
Ayurvedic principle for the management of CP, bearing in mind that the
condition is a Vata predominant Vata Kapha manifestation both Snehana
(unctuating) and Rukshana (dry/coarse)
therapies ought to be incorporated to pacify them respectively. The statement
may seem to be controversial theoretically as Rukshana and Snehana may
deteriorate the condition by stimulating further vitiation of Vata and Kapha correspondingly.
So, these therapies have to be applied alternatively with keen monitoring to
aptly decide the shift in therapy.
However, Swedana (fomentation), being a common treatment for both Kapha
and Vata, yields promising results. The practical efficacy of Sodhana
(purificatory) therapy is questionable as it is impossible to eliminate doshas
(humors) in the above discussed Ayurvedic pathogenesis of CP. Hence, Samana (palliative) plays the
pivotal role, with the prime concern being set for Brimhana (nourishing), Medhya
and Rasayana (). In the nutshell, the Ayurvedic protocol for
the management of CP includes:
o Rukshana: Udwarthanam /Dhanyamla parisheka/ Utkharshanam/Danyamla potali
o Snehanam: Snehapaanam/ Abhyangam / Matravasthy / Pizhichil /Pichu /Sirovasthy
o Swedanam: Abhyangam/Pizhichil /
Nalee swedam / Pindaswedam/Avagaham
o Brimhanam: Snehanam/Balaaksheerapakam/Abhyangam,
Shashtika Sali Pinda Sweda
o Medhyam and Rasayanam:
Guluchee , Nagabala
, Brahmee ,
Sankha pushpee
o Symptomatic Management.
A protocol
developed on these hypothetical principles is being subject to practice in the
Kaumarabhriya OPD of VPSV Ayurveda College, Kottakkal. The 31 days protocol
includes alternate application of Snehana and Rukshana in various forms,
throughout the day, each for three days consecutively. For Rukshana,
different modes applied include: Madhoodaka panam (6 am); Udwarthanam/KK/ etc (8 am) ; Pradhamanam (3 pm);
Rukshathalam (4 pm). Snehana is applied in following forms: Abhyanga/pizhichil
etc. (8 am); Matra vasti (8 am) ; Pratimarsa nasya (3 pm); Siro pichu (4 pm) ;
Snehapanam (4.30 pm)
Based on the analysis of the gross motor functions on
Gross Motor Function Classification System-Expanded and Revised
(GMFCS-E&R), usually it is required for the patient to undergo multiple
courses of this therapeutic protocol. The result, as observed in practice,
generally include:
1. Achievement of
a new motor milestone or improvement in an existing one, within a period of 3
months after a course of treatment
2. A positive
improvement in spasticity as measured on Modifies Ashworth scale for hypertonia
Discussion
The
promising results obtained with this protocol in CP provoked the thought for
its scientific analysis in terms of Modern principles of physiology and
pathology. As previously discussed, the neuro-developmental disorders are a
manifestation of the malfunctioning of the motor unit. The functional
capability of such an inactive nerve can be achieved either by stimulating the
Sensory end (sensory nerve), the effector end (motor nerve), or both (mixed
nerve). Unfortunately, though, the
property of nervous tissue adaptability hurdles the constant application of a
uniform stimulus as quite soon the nervous tissue gets adapted and stops
responding to the applied stimulus. To overcome this hurdle, the altering short
term application of various stimuli can safely be adopted. In the literature
regarding the conventional therapy for CP also the principle of management of
such motor developmental disorders by application of altering stimulus to the
inactive areas of the brain to stimulate their normal functioning thereby
enhancing the motor skills is quite apparent. This may be achieved by drugs,
external therapies (medical/para medical) or behavioral trainings ensuring the
exposure of the tissue to varying stimuli. This concept forms the basis of
adoption of the Ayurvedic protocol for the management of Cerebral Palsy as
discussed here.
Conclusion
To conclude, Ayurveda has in store immense hopes to
promise a better quality of life to children with developmental disorders. The
success of the treatment lies in precise diagnosis in Ayurvedic terminology of
tridoshas which directs to the planning of a sharp treatment principle.
Cerebral Palsy, the commonest cause of developmental disability, can
theoretically be interpreted as a Vata pradhana Kapha Vata condition, clinically
responding astoundingly to the alternate application of various Snigdha-Ruksha
therapies. The protocol discussed in this piece of literature is in practice in
our OPD with absolute physician and patient satisfaction and so can safely be
recommended in the cases of Cerebral Palsy.
