Physical Therapy for Spastic Cerebral Palsy
Physical therapy is aimed at promoting motor and developmental skills. The parent or caregiver should be taught the exercises or activities that are necessary to help the child reach her full potential and improve function.
Daily range-of-motion (ROM) exercises are important to (1) prevent or delay contractures caused by
spasticity and (2) to maintain the mobility of joints and soft tissues. Stretching exercises increase range of motion. Progressive resistance exercises increase strength. Age-appropriate play and adaptive toys and games based on desired exercises make therapy fun and get 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; head and neck control should be achieved, if possible, before advancing to lower body (trunk) control.
Children and their parents often enjoy hippotherapy (horseback-riding therapy) to help improve the child’s muscle tone, ROM, strength, coordination, and balance. Hippotherapy offers many social, cognitive, physical, and emotional benefits.
The use of Kinesio taping (elastic therapeutic tape) can help reeducate muscles for stretching and strengthening, and aquatic therapy and electrical stimulation can also be beneficial for strengthening weakened muscles and maintaining muscle size. In a child with weak dorsiflexors (muscles in the lower leg that act on the foot) that are causing foot drop or tripping, for example, electrical stimulation to the anterior tibialis (shin muscle) could be beneficial. Electrical stimulation of weakened muscles is usually well-tolerated in older children.
Vibration and short-term use of heat and cold over the child’s tendons may decrease spasticity. These treatments, however, only decrease spasticity briefly and should be used in conjunction with ROM and stretching exercises.
Physical therapy is crucial when a child has had surgery to help correct spasticity; it helps the child obtain maximum benefit from surgery.
Occupational Therapy for Spastic Cerebral Palsy
Occupational therapy for children with spastic cerebral palsy should focus on daily life activities, such as feeding, dressing, toileting, grooming, and transfers. Occupational therapy also focuses on the upper body. The goal should be for the child to function as independently as possible with or without the use of adaptive equipment.
Children who can follow directions and have spasticity of certain muscles in the wrist, forearm, or muscles that control the thumb may benefit from intensive therapy. Activity-based interventions such as modified constraint-induced movement therapy (mCIMT) and bimanual intensive rehabilitation training (IRP) can improve the child’s ability to use the impaired upper limb(s) and improve performance in personal care. One study found that more benefits were seen from intensive treatment than in standard treatment; in mCIMT, grasp improved, and, in IRP, spontaneous use in bimanual play and activities of daily living in younger children increased.
Speech Therapy for Spastic Cerebral Palsy
Some children with spastic cerebral palsy have involvement of the face and upper airway, causing drooling and difficulty swallowing and speaking. Speech therapy can be used to help improve swallowing and communication. Some children benefit from assistive communication devices if they have some motor control and adequate cognitive skills.
Recreational Therapy for Spastic Cerebral Palsy
Incorporation of play into a child’s therapy program is very important. The child should view physical and occupational therapy as fun, not work. Caregivers should seek fun and creative ways to stimulate children, especially those who have a decreased ability to explore their own environment.
Recreational activities that can help fitness include hippotherapy, sports, cycling, water therapy andspecial camps created for special needs children.