Physical Therapy for Children with Cerebral Palsy
Physical therapy is a branch of medicine directed at the rehabilitation of muscles and the musculoskeletal system. It helps improve mobility and uses a variety of equipment and exercises to help patients achieve or improve abilities. Although there is no standard therapy that works for every individual with cerebral palsy, many children with CP can benefit from physical therapy. Once the diagnosis is made, and the type of cerebral palsy is determined, a team of healthcare professionals will work to identify specific impairments and needs, and then develop an appropriate plan to address the core disabilities that affect the child’s quality of life.
How Does Physical Therapy Work?
Typically, children who require physical therapy will be referred to a private therapy group and, when they’re older, also receive physical therapy at school. Therapists who work with children are called Pediatric Physical Therapists and are accredited by the American Physical Therapy Association.
Physical therapy programs use specific sets of exercises and activities to work toward two important goals: preventing weakening or deterioration of the muscles that aren’t being used (disuse atrophy) and keeping muscles from becoming fixed in a rigid, abnormal position (contracture). Early detection and management of muscular problems are crucial in early childhood development. If left untreated, muscular issues where cerebral palsy is concerned can lead to contractures and long-term debilitation, compromising your child’s ability to participate in normal activities.
Resistive exercise programs (also called strength training) and other types of exercises are often used to increase muscle performance, especially in children and adolescents with mild cerebral palsy. Moreover, daily exercise routines keep muscles that aren’t normally used moving and active and less prone to wasting away.
Exercise also reduces the risk of contracture, one of the most common and serious complications of cerebral palsy. Children normally stretch their muscles and tendons as they run, walk, and move throughout the day. This ensures that their muscles grow at the same rate as their bones. But in children with cerebral palsy, spasticity prevents muscles from stretching. As a result, their muscles don’t grow fast enough to keep up with their lengthening bones. The muscle contractures that result can set back the gains in the function they’ve made. Physical therapy alone or in combination with special braces (called orthotic devices) helps prevent contractures by stretching spastic muscles.
Although vital in some cases, physical therapy alone may not be adequate in preventing contractures and complications of some movement disorders. In the case of severe spastic cerebral palsy, for example, the maximum benefits of physical therapy can only be realized when the muscle spasticity is addressed and reduced to the extent possible. In cases of ataxic or athetoid cerebral palsy, physical therapy is a vital tool in addressing muscle strengthening and range of motion issues.
What Are the Benefits of Physical Therapy for Children with CP?
For children with cerebral palsy, physical therapy can help in numerous ways. Some of the benefits include:
- Encouraging mobility and fitness
- Assisting with pain management
- Teaching self-care, independence, and daily functions
- Preventing further issues with posture and joint mobility
- Assisting with the use of adaptive equipment
- Expand the range of motion
- Build muscle tone
How Can a Physical Therapist Help?
According to the American Physical Therapy Association: “Physical therapists are experts in helping people with CP improve their physical functions. They help them stay active and healthy and perform daily tasks like walking, using a wheelchair, and moving from a wheelchair to and from a bathtub, bed, or car. Physical therapists also can help children and families get equipment to support someone with CP.”
Your child’s physical therapist will first assess your child’s muscle control, functions, limitations, and needs. They will review such important functions as the child’s physical strength, mobility, endurance, posture, flexibility, and balance. After a thorough assessment, your child’s therapist will work with you to come up with goals they hope to achieve in addressing issues and challenges your child may be experiencing.
Physical therapy can take place in many different settings, including the home, physical therapy centers, outpatient medical offices, the school, and more. In addition to sessions with the physical therapist, they may prescribe other exercises to be conducted at home periodically. The number of sessions and their frequency depends upon many factors, including the prescribed treatment, adaptive equipment, costs, and insurance coverage, among others.
What Should You Expect from Physical Therapy?
The Model Practice Act for Physical Therapy developed by The Federation of State Boards of Physical Therapy addresses the standards, rules, regulations, and patient consumer rights in regard to physical therapy. When working with your child’s physical therapist you should be made to feel like a part of a team. Engaging in physical therapy should be a team approach between you, your primary care physician, the therapist, and your child.
Your child’s physical therapist should be communicating openly with you as to what they are doing, what muscles they are working with, and why they are taking the approach they have chosen. You should also expect the therapist to communicate with your child, treating them with patience and respect. Most young children are anxious and fearful of strangers—the therapist should be working with your child to allay some of those issues and win your child’s trust and confidence.
Your child’s physical therapist should not only be working with your child but also teaching you so that you can be consistent in your child’s care and contribute to helping your child achieve and maintain goals in the absence of the therapist. Ask the therapist what you can do between therapy sessions to help your child maintain any progress realized, and how often and for how long you should be working with your child. If necessary, keep a journal and note problems and challenges you see your child may be experiencing between therapy sessions.
If your child has been prescribed adaptive equipment, inquire as to how often you should use the equipment and the duration of each session. Ask about what adverse side effects you should be aware of. For instance, in the case of adaptive or custom orthopedic equipment, wheelchairs, standers, and similar equipment, you should watch for any chaffing, pressure sores or skin breakdown indicating that an adjustment needs to be made.
In addition, your child’s therapist should also be coordinating and communicating with your primary care physician in obtaining physician’s orders for any needed adaptive equipment or devices and should keep the physician informed of your child’s progress or challenges. If the therapist feels your child would benefit from custom-made orthopedic shoes, or other adaptive equipment, it’s the responsibility of the therapist to communicate with the physician the need and to follow up in acquiring custom equipment/devices deemed medically necessary.
It is important to note that the term “No pain, no gain” does not apply to children with cerebral palsy. Your child’s therapist should be patient, caring, and respectful of your child’s unique needs and preferences. For example, in the case of range of motion (the extent to which a muscle/limb can be extended), the therapist should do periodic measurements to assess your child’s range of motion, provide you with goals for improvement, and notify you of progress or regression.
Lastly, it is important to note that not all forms of physical therapy are considered effective for children with cerebral palsy. Some forms of physical therapy are considered to be controversial, for example:
- Patterning. “Patterning” is a physical therapy based on the principle that children with cerebral palsy should be taught motor skills in the same sequence in which they develop in normal children. In this controversial approach, the therapist begins by teaching a child elementary movements such as crawling—regardless of age—before moving on to walking skills. Some experts and organizations, including the American Academy of Pediatrics, have expressed strong reservations about the patterning approach because studies have not documented its value.
- Bobath technique. Experts have similar reservations about the Bobath technique (which is also called “neurodevelopmental treatment”), named for a husband and wife team who pioneered the approach in England. In this form of physical therapy, instructors inhibit abnormal patterns of movement and encourage more normal movements. The Bobath technique has had a widespread influence on the core physical therapies of cerebral palsy treatment, but there is no evidence that the technique improves motor control. The American Academy of Cerebral Palsy and Developmental Medicine reviewed studies that measured the impact of neurodevelopmental treatment and concluded that there was no strong evidence supporting its effectiveness for children with cerebral palsy.
- Conductive education. Conductive education, developed in Hungary in the 1940s, is another physical therapy approach that at one time appeared to hold promise. Conductive education instructors attempt to improve a child’s motor abilities by combining rhythmic activities, such as singing and clapping, with physical maneuvers on special equipment. The therapy, however, has not been able to produce consistent or significant improvements in study groups.
Was Your Child’s CP a Result of Negligence?
In some cases, medical malpractice may be the cause of a child’s cerebral palsy. The Cerebral Palsy Family Lawyers at Janet, Janet & Suggs, LLC have consulted with over 30,000 families nationwide, helping to recover the compensation they deserve. If your child experienced medical malpractice that led to cerebral palsy, contact us today for a free, no-obligation consultation.
Claire Surles, RN
Claire comes to JJS after a 10-year career as a labor and delivery nurse. She dedicated her hospital efforts to advocating for families, providing the safest birthing environment possible as Newborn Admission Nurse at UMMC St. Joseph Medical Center in Towson, Maryland. Her passion for helping those who experienced losses at any stage of gestation led to her appointment as Coordinator of the hospital’s ROOTS perinatal loss program. READ FULL BIO