MANAGEMENT OF DROOLING IN CHILDREN WITH CEREBRAL PALSY WITH AYURVEDIC TREATMENT MODALITIES

Drooling is common among children with cerebral palsy, affecting roughly one third of them. It is believed that between 25 to 35% of these children experience drooling to some extent. This condition is often caused due to impaired swallowing because of uncoordinated tongue movements, high tonus and spastic contraction of the pharyngoesophageal sphincter, dyscoordination between the pharynx and sphincter, and a lack of coordinated control of head and neck musculature. Drooling can significantly impact children's social life and their overall quality of life, which can be upsetting both for the child and their family. The issues stemming from drooling include the possibility of being rejected socially, wet and smelly clothes, bad odours, dry, cracked skin, and oral infections. Effective management of drooling can solve many of these issues, improve how the child looks and feels about themselves, and reduce the amount of time needed for nursing care. However, treatments like oral motor physiotherapy and behavioural therapy, which have been around for a long time, have mixed results and can be time-consuming. Recent treatments like certain medications and botulinum toxin injections are not very effective because of their side effects or the number of complications they cause. Therefore, there is a pressing need to develop new treatments for drooling that are safe and effective. Ayurvedic treatment modalities like greevapichu, pratisarana and siro abhyanga are effective in the management of drooling in children with cerebral palsy to a significant level.

1.Greeva Pichu-

GreevaPichu (application of cotton soaked in oil) with murivenna along with Areca catechu juice and egg white for a duration of 30 minutes at back of the head and nape of neck. Areca catechu juice and egg white was taken in equal quantity with double amount of murivenna.

The spasm of neck and head musculatures in children with cerebral palsy results in lack of coordinated control of head and neck thereby dysfunction in swallowing. Murivenna has kaphapradhana tridosha hara action may help in reducing the spasm of the musculatures of head and neck and improves swallowing.

Areca catechu holds a remarkable place in the ayurvedic therapeutic system. It alleviates pitta kapha doshas and it is used as a nervine tonic. The methanolic extract of the drug was also reported to be anti-inflammatory in action.Areca catechu extract topical application inhibits hyaluronidase activity and found to be an effective anti-inflammatory agent.The inflammation associated with the spasm of neck and head musculatures can be addressed with the drug extract.Egg white is an effective binding agent and is used to bind the murivenna and areca catechu extract. Again, swallowing phase is coordinated by the swallowing centre on the medulla and pons which is the area where which the pichu is applied.

2.Pratisarana-

Pratisarana (application of paste inside the oral cavity) can be done with kalyanaavaleha choornam with honey and lime juice (frequently advised).It aids in voluntary movements of the tongue thereby helps in attaining a more coordinated tongue movements. It helps to remove the stambha over the tongue through kapha vilayana by its major ingredient saindava. It also helps in vakpravruthi and acts as swarya which acts as an additional benefit of improving the speech in children.The more coordinated tongue control helps in swallowing saliva.

3.Siro abhyanga

It is the process of smearing the herbal medicated oil by specific manoeuvres & strokes on the head, neck and shoulders helping in reducing the spasm of the same. Siroabhyanga (head massage) with vatahara tailam like Dhanwantaram/mahamasham/maha Narayana taila(15 -20 mints).The 1st part of Shiroabhyanga includes right & left parietal regions and the 2nd part consists of frontal, vertex & occipital region. The voluntary initiation of swallowing involves bilateral areas of prefrontal and parietal cortices anterior to precentral gyrus in the primary motor cortex. Abhyanga over these areas helps in its stimulation by improving the blood circulation and thereby helps in a better coordinated swallowing.

Drooling occurs in about one third of children with cerebral palsy. Drooling associated with cerebral palsy is due to neuro-muscular dysfunction. Management of the same is difficult and all the conventional modalities are either time consuming or with serious complications. Ayurvedic treatment modalities are effective in the management of drooling in children with cerebral palsy to a significant level.

 This method was commonly applied to kids with cerebral palsy, and it was passed down to me by my cherished mentor, Dr. Mini S. Muraleedhar, while I was pursuing my postgraduate studies.