Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy are the most commonly used therapies for people with cerebral palsy. Therapists from these disciplines provide different types of specialized therapies depending on the problem and treatment goals. Therapy helps children with cerebral palsy develop and learn gross motor (big muscle movements), fine motor (small muscle movements) and sensorimotor skills (integrating the use of senses with movement), communication, and daily living skills. Therapy services may be covered by insurance or through Early Intervention benefits. These services may be at your home, a school, or in an outpatient location.
Commonly Used Cerebral Palsy Therapies
PT, OT and Speech therapies are used to treat a diversity of symptoms of cerebral palsy. More than one treatment and therapy can be used together to support overall development. When it comes to therapies for people with CP, there are varying amounts of research to support their use. It is helpful to discuss the frequency and intensity of therapy that will be effective for your treatment goals and concerns.
There are also alternative therapies, or CAM’s, that parents and adults with CP often explore. These are therapies or interventions that lack research and are often less accepted than mainstream treatments. It’s important to keep in mind that safety may not have been sorted out for using certain alternative therapies in people with cerebral palsy.
Physical Therapy (PT) for Cerebral Palsy
PT treats strength, gross motor skills, and mobility. Gross motor skills involve the large muscles of the body.
Evaluations for PT include:
- Looking at the child’s posture
- Sensory processing
- Muscle tone
- Coordination
- Developmental skills
- Adaptive equipment
Activities include exercises to strengthen muscles, increase range of motion and improve balance.
Physical therapists often work with the family and local medical equipment vendors to look at, order, and maintain adaptive equipment to help the child’s sitting, stability, posture, and mobility. Equipment for people with CP will depend on their symptoms and need for support, alignment and mobility. They may include things such as orthotics, activity chairs, car seats, walkers, adaptive strollers and wheelchairs.
Common PT Treatments
Common Cerebral Palsy Treatments Used in Cerebral Palsy Therapies:
- Resistance/Strength training
- Functional balance training
- Coordination exercises
- Treadmill/Gait training
- Robotics—robotic assisted movement
- Endurance training
- Sports skills training
- Stretching
- Support with adaptive and assistive equipment, selection and fitting
- Aquatic Exercise Therapy
Occupational Therapy (OT) for Cerebral Palsy
Occupational Therapy (OT) is about all of the “jobs” that make up daily life. An OT looks at a child’s ability to care for themselves, how they play, and work or skills needed for navigating the school day. An OT can help the child with improving strength, muscle tone, eye-hand coordination, visual perceptual skills, and sensory processing skills. Therapy is driven by the child, based on activities that have meaning and purpose to a task specific to the child and the child’s family. The OT will look at potential adaptive equipment and assistive technology that may increase the child’s independence. Adaptive feeding utensils, switches to access computers and electronics, adaptive scissors and writing utensils, splints, and adaptations to clothing such as zipper pulls and button hooks are examples of the kinds of tools and accessories an OT may elect to have the child use.
Common OT Treatments for Cerebral Palsy
- Constraint induced movement therapy (CIMT)– These are a group of interventions that have three distinct characteristics including:
- Some form of constraint (preventing the person from using the limb during therapy) a less impaired or unimpaired hand.
- Shape new skills (breaking down a task into smaller tasks that build upon each other) in the impaired limb and the opportunity for repetitive practice.
- High intensity of therapy.[1]
- Hand-Arm Bimanual Intensive Therapy (HABIT)– This approach includes specific activities that are functional or fun and that coordinate the use of both hands and arms. It has similar principles as CIMT (above), but without constraining a limb. Like CIMT, HABIT is dosed much more intensely than conventional therapies (often one or two days a week for an hour). HABIT is provided 6 hours per day for 10-15 days at a time.[2]
- Sensory integrative therapy (SI)– Therapies that support the coordinate use of the five senses and the vestibular system. This system coordinates information for balance and understanding where we are in space.[3]
- Vision related therapies– Therapies that help the child practice hand and eye coordination.
- Some feeding therapies and use of utensils or adaptive tools for eating.
Speech-Language Therapy for Cerebral Palsy
Speech language pathologists (SLPs) can help develop communication between parents or caregivers and children.
This may be through:
- pre-language skills (vocalizations)
- manual sign language
- gestures
- picture communication boards
- voice output communication devices
Choices for communicating can lessen your child’s frustration, and improve their chances for expressing themselves.
Common Speech Treatments
Below are listed some methods for CP therapies:
- Language Intervention Activities– The SLP works with a child by playing and talking, using pictures, books, objects, or ongoing events to help language development. The therapist may also show or act out correct ways to say things and use repetition exercises to build speech and language skills.
- Articulation Therapy– Exercises making sounds involve having the therapist act out or show correct sounds and syllables for a child, usually during play. The level of play is based on age and the child’s specific needs. The SLP will physically show the child how to make certain sounds, such as the “r” sound, and then show the child, in front of a mirror, how to move the tongue to make those sounds.
- Oral Motor or Feeding & Swallowing Therapy– The SLP will use many types of oral exercises. This could be facial massage and different tongue, lip, and jaw exercises that strengthen the muscles of the mouth. The SLP also may work with different food types and temperatures to help a child’s oral awareness during eating and swallowing.
- Augmentative & Alternative Communication (AAC)– AAC is any type of communication, other than talking. Communication boards, charts or sign language are commonly the first options to help communication for young children. As your child grows, specialized communication programs can be used on a computer, an i-Pad, or other tablet devices. These devices make it possible for your child to have options in how they use them beyond typing. AAC systems give way for both speech and written communication.
The information here is meant as a starting point for learning about possible types of therapies for cerebral palsy.
Cerebral palsy therapies can be different for each person. Ask your medical team about their thoughts and approach to the treatments they present. Talk about the quality of evidence, the risks and how the therapy may meet your child’s and family’s specific goals.
The information from this page appears and is sourced from our free and downloadable cerebral palsy tool kit.
References
- Landesman Ramey, S., Coker-Bolt, P., & DeLuca,, S. C. (2013). Handbook of Pediatric Constraint-Induced Movement Therapy (CIMT) (p. 19). Retrieved June 14, 2021, from https://library.aota.org/Handbook_of_Pediatric_CIMT
- Landesman Ramey, S., Coker-Bolt, P., & DeLuca,, S. C. (2013)(p.223). Handbook of Pediatric Constraint-Induced Movement Therapy (CIMT). Retrieved June 14, 2021, from https://library.aota.org/Handbook_of_Pediatric_CIMT
- American Academy of Pediatrics. (2019, October 7). Sensory integration therapy. Retrieved June 14, 2021, from https://www.healthychildren.org/English/health-issues/conditions/developmental-disabilities/Pages/Sensory-Integration-Therapy.aspx
