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222
Review Article
Alaekhya. EUROPEAN JOURNAL OF PHARMACEUTICAL
European Journal of Pharmaceutical and Medical Research
AND MEDICAL RESEARCH ISSN 2394-3211

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CEREBRAL PALSY - AN AYURVEDIC COMPREHENSION

*Dr. P. L. Alaekhya, B.A.M.S.

India.

*Corresponding Author: *Dr. P. L. Alaekhya, B.A.M.S.

India.

Article Received on 23/08/2019 Article Revised on 12/09/2019 Article Accepted on 03/10/2019

ABSTRACT
Cerebral palsy is the leading cause of childhood disability affecting cognitive function and developments in
approximately 1.5 to 3 cases per 1,000 live births It is a group of non progressive but often changing motor
impairment syndromes which are secondary to anomalies or lesions of brain arising in early stages of its
development. There is no similar disease or symptom complex in Ayurveda similar to Cerebral Palsy. It is
considered as Shiro Marma abhigathaja bala Vata Vyadhi and classified under Janma Bala Pravritti Vyadhi. The
diagnosis of Phakka roga is considered while approaching the cases of cerebral palsy. There is no specific
treatment for cerebral palsy as there is no cure for it. All the treatment modalities focus around improving the
functional capacity of the child. The Ayurvedic treatment of cerebral palsy focuses on treating the presenting
symptoms and attempting to reverse the brain damage. Overall goal of treatment is to help the individual with
cerebral palsy reach his or her greatest potential physically, mentally, and socially. It is to improve the quality of
life by establishing optimal independence. Therapies like Abhyanga swedam, Nasyam, Pichu, Shirodhara,
Pizhichil, Navara or mamsakizhi, Vasti along with oral drugs are the Ayurvedic options based on the presentation.

KEYWORDS: Cerebral Palsy; Janma bala pravrutta Vyadhi; Phakka roga;.Vata Vyadhi; Shiro Marma
Abhighata.

INTRODUCTION advances in neo-natal and obstetrics care, the cases of CP

Cerebral Palsy is a group of permanent, but are increasing with increasing survival of pre-term and
not unchanging, disorders of movement and /or posture low-birth weight infants.
and of motor function, which are due to a non-
progressive interference/lesion, or abnormality of the Presentations may change with time due to growth and
developing/ immature brain. Here the word Palsy refers developmental plasticity and maturation of Central
to Paralysis. It is the leading and most common Neuro – nervous system.[4] Spasticity is the most common feature
motor and non progressive disability in childhood found in 80% of cases.[5] Affected limbs demonstrate
affecting the cognitive function and developments in increased deep tendon reflexes, tremors, muscular hyper
approximately 2.5 cases per 1,000 live births, with male, tonicity, weakness with characteristic scissors gait with
female ratio being 1.33:1.[1] It includes heterogeneous toe walking.
clinical states of variable aetiologies with severity
ranging from a minor incapacitation to total handicap. Chronic spasticity can lead to muscular stiffness,
Most of the cases have multiple neurological deficits and contractures, atrophy and fibrosis; there by making prone
variable mental handicap. In fact, it is a presentation of for orthopaedic problems like scoliosis, equines
cerebral cortical and Sub-cortical insults occurring deformity, subluxation, dislocation of joints etc. Mental
during first year of life. retardation is common in 60% of cases, visual
impairment, and disorders of ocular motility common in
Mechanism of CP in a larger proportion remains unclear 28% of cases. Increased presence of strabismus,
and a variety of Pathological lesions can be observed. amblyopia, nystagmus, optic atrophy and refractive
The etiological factors of CP are diverse and multi- errors are also seen. Hearing impairment occurs in about
factorial. Factors may operate during Pre-natal, Peri- 12% of cases and epilepsy in 35 – 62% of cases as
natal or in the Post-natal periods.[2] Pre-natal factors associated feature.
account for 75 – 80% cases while birth-trauma or
asphyxia constitute for less than 10% of cases.[3] Its
incidence increases with premature and low birth weight
babies regardless of quality of care. Due to recent

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Alaekhya. European Journal of Pharmaceutical and Medical Research

CLASSIFICATION
LIMBS
S.No. PHYSIOLOGICAL MOTOR STATISTICS
AFFECTED
Spastic About 10, 000 babies born each
1. Spastic (70-80%) Monoplegia
(70-80%) year will develop CP
Non – Spastic Male : 57%
2. Ataxic (6%) Diplegia
(30%) Female: 43%
3. Dyskinetic (6%) Mixed Triplegia Cognitive disability (40%)
4. Hypotonic --- Quadriplegia Epilepsy (35%)
5. Mixed --- --- Vision impairment (15%)
6. --- --- --- Developmental disability (60%)
7. --- --- --- Limited Motor ability (41%)
Requiring assistance to move
8. --- --- ---
(31%)
Estimated life-time cost for CP
9.
care 1 million $

S.No. PREVENTION TREATMENT MODALITIES

Cerebral palsy is chronic, permanent, non-life threatening,
Prevention of Maternal
1. non-contagious, non-curable and non-progressive,
Infections
manageable condition.
2. Prevention of Peri-natal injuries Prevention of contractures Physiotherapy
3. Prevention of foetal injuries Maintaining range of motion Speech therapy
4. Good maternal care Inhibition of spasticity Rehabilitation therapy
5. Good neonatal care Achieving postural balance Occupational therapy
Suppression of abnormal
6. Early diagnosis Stem – cell therapy
movement
Facilitation of normal
7. Regular exercise ---
movements
Symptomatic treatment for
8. Prompt & adequate management ---
seizures etc..
Attending all ante-natal There is no cure for Cerebral Palsy and the main aim is to
9.
appointments maximize the Functional Capacity of the Child.
Avoidance of alcohol, tobacco & The team may include a Clinician, Pediatrician, Neurologist,
10. other illegal drugs during Physiotherapist, Speech therapist and Education
pregnancy Psychologist

AYURVEDIC PERSPECTIVE considered as Shiro marma abhighata janya Vata vikara

There is no similar disease or symptom complex similar manifesting clinically all over the body (Vatadhika
to Cerebral Palsy in Ayurveda. Some consider it as, Vata sannipataja sarvanga roga) with primary lesion in brain
vyadhi[6] and some as Janma bala pravritta vyadhi[7] (Mastishka). The important causative factors have been
(congenital disorder) while others state that Shiro marma categorized under the following four groups.
abhighata bala vata vyadhi[8](disease caused by injury to
head in children), few compare with Bala samvardhana
vikara[9] (growth and developmental disorder of children)
and some Balaka pakshaghata[10] (paralysis in children).
This creates a major diagnostic and management
dilemma in clinical Ayurvedic paediatric practice while
approaching a case of CP.

Causative factors will produce undesirable effects on the

foetus in-utero and they hamper the normal growth and
development of the child and cause several diseases,
deformities, and even death.[11]

ETIOLOGICAL CONSIDERATIONS
According to Ayurvedic etiolo-pathogenesis, Cerebral
Palsy is viewed as disease with vitiation of all the three
doshas with predominance of vata. More precisely, it is

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Alaekhya. European Journal of Pharmaceutical and Medical Research

GARBHA PRASAVA PRASAVOTTARA

GARBHA KALEENA
POORVA KALEENA KALEENA
Vilambita prana
Tulyagotra Vivaha Improper Garbhini paricharya Vilambita avi
pratyagama
Asatmya/ahitakara ahara Graha dosha
Bija – Dushti[12] Akala pravahana
Sevana Nija/agantuja vikara
Kala – Dushti Ahitakara Vihara Moordha Abhighata ---
Ashaya – Dushti Dauhridya apachara[13] --- ---
--- Jata harini --- ---
--- Abhighata --- ---
--- Dhumapana --- ---
--- Vata prakopakara kriya --- ---

LAKSHANA wasting at gluteal, extremities and thigh region)

Mandagni (lack of digestive capacity), pangu pramlaana adhara kaya / nischeshta adhara kaya
(paragplegia), muka (dumbness), jadata (psychomotor (paraplegia or weakness of both lower limbs), pradushta
retardation), ksheena mamsa and bala (muscle wasting grahani (diarrhoea / loose motions)
and weakness), samsushka spicha, bahu and uru (muscle

EVALUATION
S.NO LEVEL FUNCTION
1. I Ambulatory in all settings
2. II Walks without aides but has limitation in community setting
3. III Walks with aides
4. IV Mobility requires wheelchair or adult assistance
5. V Depended for mobility

Gross Motor Function Measure (GMFM) is used to  D (standing)

evaluate  E (walking, running, jumping)
Gross Motor Function in CP. The original GMFM, an 88
item measure also known as GMFM-88, is divided into 5 The items are scored from 0 to 3. All items are
domains, which are. summarized and expressed as a value of total points for
 A (lying and rolling) each dimension of GMFM-88. The GMFM-88 total
 B (sitting) score is calculated as the mean score of all five
 C (quadruped and kneeling) dimensions.[14]

PREVENTION
DURING DURING NEONATAL
BEFORE CONCEPTION[15] DURING LABOUR[17]
PREGNANCY[16] PERIOD
Avoiding Consanguineal Following Garbhini Proper bearing-down
Prana pratyagamana[18]
Marriages paricharya efforts
Observing the rules of Avoiding Avoiding abhighata to
Jata karma[19]
Ritukala Garbhopaghatakara Bhava head
Avoiding pregnancy in very
Honouring Dauhrida Avoiding infections Raksha karma[20]
young and advanced ages
Avoiding Dhuma pana,
Madyapana and other Dhupa karma
--- ---
intoxicants
--- --- --- Dharana[21]

TREATMENT As per Ayurveda, each patient of CP needs an

There is no cure for cerebral palsy, but treatment can individualized approach as the aetiology and pathology
help manage symptoms and increase independence. The are variable from patient to patient. Agnimandya,
team may include a doctor, a paediatrician, a speech Amaavastha, Kaphavastha should be assessed and
therapist, and an educational psychologist, among others. considered while planning the treatment protocol.
Treatment depends entirely on individual needs. The aim
is to help the child achieve as much independence as
possible.

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Alaekhya. European Journal of Pharmaceutical and Medical Research

PRINCIPLES OF MODALITIES OF
S.No. AREAS OF INTERVENTION
TREATMENT TREATMENT
Prevent/ decrease/control
1. Relieve Muscle spasticity Deepana
complications
2. Improve quality of Life Control Seizures Pachana
Prevent orthopedic complications
Facilitate early
3. like Hip-subluxation, Scoliosis, Sroto-shodhana
rehabilitation
Equine’s deformity etc.
Improve/enhance
4. Improve cognition/learning Snehana
functional capacity
Make the child self- Acquisition of better skilled
5. Swedana
dependent movements
6. --- --- Virechana
7. --- --- Udwartana
8. --- --- Vasti[22]
9. --- --- Medhya Rasayana[23]
10. --- --- Physiotherapy
11. --- --- Vata Shamana
12. --- --- Brimhana
13. --- --- Swarnaprashana[24]
14. --- --- Aushadha sevana

AUSHADHA
S.No. DOSAGE FORM DRUGS
Ashwagandha, Shatavari, Mandukaparni, Brahmi, Shankhapushpi, Jyotishmati,
Vacha, Twak, Yashtimadhu, Vidarikanda, Kushmanda, Haritaki, Guduchi,
1. Single
Vansha, Karavira, Tagara, Jatamamsi, Bala, Shanapushpi, Bhringaraja, Balamula,
Ashwattha, Triphala, Chitraka, Trivrit, Danti, Nagabala, Pippali
Rajata Taila, Maha Masha Taila, Bala Taila, Balashwagandha Taila,
2. Taila Dhanwantara Taila, Ksheerabala Taila, Prasarini Taila, Maharaja Prasarini Taila,
Jyotishmati Taila, Maha Narayana Taila, Karpasastyadi Taila,
Brahmi Ghrita, Kalyanaka Ghrita, Maha Kalyanaka Ghrita, Ashwagandha Ghrita,
3. Ghrita Shatavari Ghrita, Vidaryadi Ghrita, Panchagavya Ghrita, Samvardhana Ghrita,
Panchatikta-Guggulu-Ghrita, Ashtanga Ghrita
Yogaraja Guggulu, Kanchanara Guggulu, Kaishora Guggulu, Panchatikta Ghrita
4. Guggulu
Guggulu, Lakshadi Guggulu
Swarna Bhasma, Rajata Bhasma, Abhraka Bhasma, Ekanga veera Rasa,
5. Rasaushadha Vatakulantaka Rasa, Kumara Kalyana Rasa, Vata Vidhwamsini Rasa, Vata
Gajankusha Rasa, Smritisagara Rasa, Brihat Vatachintamani Rasa, Tapyadi Loha
Panchakarma Abhyanga, Patrapottala Sweda, Shashtika- Shali -Pinda Sweda, Anna lepa,
6.
Procedures Murdha Taila, Virechana, Vasti, Nasya, Ksheera Vasti.
 Swarna + Vacha + Kushta with Ghrita
 Swarna + Vacha + Matsyakshi with Ghrita+Madhu
7. Others
 Swarna + Vacha + Shankhapushpi with Ghrita+Madhu
 Swarna + Kaidarya + Shweta Durva with Ghrita+Madhu

According to acharya Kashyapa, external oil massage (Phakkaratha) – Stand with three wheels. Similarly in
with Raja taila and internally Amruta ghrita/ Kalyanaka Cerebral Palsy we can advocate use of a four wheeler
ghrita / Shatpala ghrita or Bramhi ghrita is indicated after made in a round shape (a walker) to assist and inculcate
virechana (therapeutic purgation) in phakka roga. Vasti the faculty of walking.[25]
(medicated enema), swedana, udwartana, senhapana
(internal oleation) are indicated in Vata samsrushta (vata CONCLUSION
dosha associated with other dosha’s) phakka roga. Cerebral Palsy is a syndrome like presentation rather
than an individual disease entity believed to arise from
Acharya Kashyapa is the first among the ancient an injury or insult to the developing foetal brain. This
scholars, who had made the provision for physiotherapy group of disorders affects muscle tone, movement, and
and considered its importance in rehabilitation of motor skills (the ability to move in a coordinated and
crippled child. Practice of walking should be encouraged purposeful way).
with the help of specially prepared tricycle

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Management of cerebral palsy always remained a quest 7. Shailaja U, Rao Prasanna N, Debnath P, Adhikari A.
for the physicians all over the world. Even with Exploratory Study on the Ayurvedic Therapeutic
introduction of newer and better possible ways to Management of Cerebral Palsy in Children at a
improve the functions of the child, it still remains a tertiary Care Hospital of Karnataka, India. Journal of
challenge. Overall goal of treatment is to help the Traditional and complementary Medicine, 2014; 4:
individual with cerebral palsy reach his or her greatest 49–55.
potential physically, mentally, and socially. It is to 8. Shailaja U, Jain CM. Ayurvedic approach towards
improve the quality of life by establishing optimal cerebral palsy. AYU (An International Quarterly
independence. Journal of Research in Ayurveda), 2009; 30: 158.
9. Shailaja U, Rao Prasanna N, Arun Raj GR. Clinical
There is no similar disease or symptom complex in study on the efficacy of samvardhana ghrita orally
Ayurvedic science that can be taken as synonym of and by matra basti in motor disabilities of cerebral
Cerebral Palsy. Its diagnosis, approach to treatment are palsy in children. Int. J. Res. Ayurveda Pharm,
based on the considerations of aetiology, pathology and 2013; 4: 373-377.
clinical manifestations. 10. Weerakoon S, Amarsinghe APG. Study of the
efficacy of an Ayurvedic treatment regimen on
Though it is having no definite proven therapeutics, balaka pakshaghata with special reference to
recent studies show that Ayurveda with its treasure of cerebral palsy. Sri Lanka Journal of Indigenous
herbal drugs, Panchakarma procedures can provide an Medicine, 2011; 1: 55-58.
alternate, effective treatment option in the management 11. Vyas AG, Kori VK, Rajagopala S, Patel KS.
of cerebral palsy and its associated problems through Etiopathological study on cerebral palsy and its
their neurogenic and neuro vitalising capacity. management by shashtika shali pinda sweda and
samvardhana ghrita. AYU (An International
There is no effective treatment for the underlying brain Quarterly Journal of Research in Ayurveda), 2013;
damage formulated till date. Though cerebral palsy may 34: 56-62.
not be fully cured, Ayurvedic treatment can definitely 12. Sharma Ananta Ram, Translation of Sushruta
help to reduce disability and improve the functioning of Samhita, Vol.I, Chaukambha Surabharati Prakashan,
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stimulation for better functional recovery. Vol.I, Chaukambha Surabharati Prakashan,
Varanasi, 1999.
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Repetition of therapies in small courses either individual Gross Motor Function Measure (GMFM-66 and
or in combination intermittently will yield great benefit GMFM-88): User’s manual. London, United
and stands as long term support for Cerebral Palsy child. Kingdom: Mackeith press, 2002.
The maximum benefit can be achieved if Ayurvedic 15. C.H.S. Sastry, Principles and practice of Pediatrics
procedure modalities are incorporated with in Ayurveda, SDM college of Ayurveda & Hospital
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16. Agnivesha, Charaka, Dridhabala, Shareer stan,
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