A cornerstone of cerebral palsy treatment be it for mobility, speech, or daily tasks, is therapy. The skills that a two-year-old needs to discover his or her surrounding are different from those that an older child needs in school, or an older person needs to become independent. Thus, the CP therapy must reflect these changing goals and requirements.
Once the diagnosis of CP has been confirmed, physical therapy can start in the first few years of the child’s life. Physical therapy (PT) uses explicit sets of exercises to achieve work two goals:
- Prevent the deterioration of muscles that often results from disuse (atrophy) and
- Avoid a state where the muscles become fixed in a rigid position (contracture).
Contracture, a common and serious difficulty of CP, is a chronic shortening of a muscle due to the abnormal tone and weakness of the muscle. It limits movement of a joint – the knee for instance, disturbs balance and can result in the loss of motor abilities. Physical therapy either by itself, or in conjunction with orthotic devices (braces), can prevent this complication by stretching spastic muscles.
If a child’s hamstrings (the tendons behind the knee) are spastic, he should be encouraged to stretch his legs by sitting with legs extended.
Physical therapy programs also improve motor development. The Bobath technique is based on the premise that the inherent reflexes CP children retain present formidable impediments to achieving voluntary control. This technique places the child in the opposite position in order to reverse these reflexes. Thus, if a CP child normally keeps his/her arms flexed, the therapist will purposefully extend them.
“Patterning” is an alternate approach to P.T. based on the premise that motor skills can be learned in the order they develop normally. In this approach (considered controversial by some,) the therapist trains the disabled child in a way that corresponds to normal motor development. Thus, the child needs to learn movements like pulling up to a standing position and crawling before learning how to walk. The American Academy of Pediatrics’s position on “Patterning” is highly critical given the fact that academic evaluations have not proven its value.
Like all children, the CP child needs new encounters with his environment in order to grow and learn, and P.T is just one element of a development program that provides a multi-experiential environment. Stimulation should be activated to bring this necessary experience to the child who is unable to explore due to a physical handicap.
As the CP child gets a bit older, the focus of therapy shifts away from early motor development to preparing for the classroom by emphasizing daily living activities, and communication skills.