Physical Therapy

images (10)Treatment associated with cerebral palsy is aimed at improving infant-caregiver interaction, giving family support, supplying resources, and providing parental education, as well as promoting motor and developmental skills. The parent or caregiver should be taught the exercises or activities that are necessary to help the child reach his or her full potential and improve function.[4, 5]

Daily range-of-motion (ROM) exercises are important to prevent or delay contractures that are secondary to spasticity and to maintain the mobility of joints and soft tissues. Stretching exercises are performed to increase range of motion. Progressive resistance exercises should be taught in order to increase strength. The use of age-appropriate play and of adaptive toys and games based on the desired exercises are important to elicit the child’s full cooperation. Strengthening knee extensor muscles helps to improve crouching and stride length. Postural and motor control training is important and should follow the developmental sequence of normal children (that is, head and neck control should be achieved, if possible, before advancing to trunk control).

Patients and their parents often like hippotherapy (horseback-riding therapy) to help improve the child’s tone, ROM, strength, coordination, and balance. Hippotherapy offers many potential cognitive, physical, and emotional benefits.

The use of Kinesio Taping can help in reeducating muscles for stretching and strengthening, and aquatic therapy can also be beneficial for strengthening, as can electrical stimulation. Short-term use of heat and cold over the tendon may help to decrease spasticity; vibration over the tendon also reduces spasticity. However, these treatments only decrease spasticity briefly and should be used in conjunction with ROM and stretching exercises.

Electrical stimulation of weakened muscles is usually tolerated well in the older child and can help strengthen muscle and maintain bulk. In a child with weak dorsiflexors that is causing foot drop or tripping for example, electrical stimulation to the anterior tibialis could be beneficial.

The child’s developmental age should always be kept in mind, and adaptive equipment should be used as needed to help the child achieve his or her milestones. For example, if a child is developmentally ready to stand and explore the environment but is limited by a lack of motor control, the use of a stander should be encouraged to facilitate the achievement of the milestones. Performance should be encouraged at a level of success to maintain the child’s interest and cooperation, and assistive devices and durable medical equipment should be ordered to attain function that may not otherwise be possible.

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