Cerebral palsy is often characterized by muscle weakness. Research supports interventions to help make muscles stronger for patients with cerebral palsy. Physical and occupational therapists can evaluate your child to provide recommendations for participation in intensive therapy programs and/or home programs that will promote increased strength and endurance.
Splinting and Bracing
Patients with cerebral palsy with issues relating to poor postural alignment in an extremity should be evaluated by a therapist for splinting needs. Splints can decrease the progression of postural deformities, assist with improved function, and may be worn during the day and/or night. For arms and hands, an OT is usually involved. For legs and feet, an PT is usually involved.
There are many benefits to standing including promoting improved bone health, strengthening the cardiovascular system, improving circulation, improving bowel function, etc. Children who have difficulty standing should be evaluated for a standing device, which will help them assume and maintain a standing position. A physical therapist can provide recommendations for a standing schedule for your child.
Burst and Break Model of Therapy
Once an area of concern is identified, a short intensive course (four to six weeks of two to three times a week of therapy) is pursued to focus on a few targeted goals. Once the skill is mastered, a break from therapy occurs where the new skill is incorporated into daily activities. When a new goal is identified another burst of therapy can occur. This maximizes the functional gains and allows appropriate breaks.
The role and importance of consultative therapies are to have regular check-ins to update the home program, discuss any new areas of concern, monitor range of motion, assess for equipment needs and to be able to identify changes early.
Constraint Induced Movement Therapy (CIMT)
CIMT is a form of rehabilitation therapy that improves upper extremity function in patients who have had a stroke and other central nervous system damage by increasing the use of their affected upper limb. The focus of CIMT is to combine restraint of the unaffected limb and intensive use of the affected limb. Types of restraints include a sling or triangular bandage, a splint, a sling combined with a resting hand splint, a half glove, and a mitt.
Determination of the type of restraint used for therapy depends on the required level of safety vs. intensity of therapy. Some restraints restrict the wearer from using their hand and wrist, though allow use of their non-involved upper extremity for protection by extension of their arm in case of loss of balance or falls. However, restraints that allow some use of the non-involved extremity will result in less intensive practice because the non-involved arm can still be used to complete tasks. Constraint typically consists of placing a mitt on the unaffected hand or a sling or splint on the unaffected arm, forcing the use of the affected limb with the goal of promoting purposeful movements when performing functional tasks. The use of the affected limb is called shaping.
Bimanual Training (BIT)
Bimanual training helps children with hemiplegic cerebral palsy to learn to use both hands together to complete everyday activities. To be of benefit, an intensive block of therapy is necessary.
Constraint induced movement therapy (CIMT) and bimanual training (BIT) are effective for children with hemiplegia. Children begin with wearing a constraint on their uninvolved upper extremity (CIMT). Then, they end with therapy using both hands (BIT) to promote the functional use of both limbs. Patients with cerebral palsy can be evaluated by an occupational therapist to determine program and frequency recommendations.
Pre- and Post-Surgical Seating
Often a patient with complex conditions will be a candidate for surgical intervention. The most common orthopaedic surgeries include soft tissue and tendon lengthening, hip osteotomies, spinal fusion and rhizotomy.
Pre- and post-surgery considerations for postural positioning can greatly affect the positive outcome of a surgery. Otherwise the patient may have no functional options to adapt their posture following the surgery and will be placed into a seating system that does not support or compliment the surgical intervention. Pre-surgical seating assessment may be recommended if there is a planned surgery for a patient.
Augmentative and Alternative Communication (AAC)
Augmentative and alternative communication (AAC) is a term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. AAC refers to communication methods that help or replace speaking or writing for individuals who struggle to produce or comprehend spoken or written language. Some examples of AAC include sign language, picture symbols, communication board, and electronic speech generating devices. Devices may need to be accessed through alternative means such as head pointing, switch scanning or eye gaze.