Physical therapy for cerebral palsy

How does physical therapy help?

Physical therapy is often the first step in treating cerebral palsy. It can help improve motor skills and can prevent movement problems from getting worse over time. Physical therapy implements strength and flexibility exercises, heat treatment, massages and special equipment to give children with cerebral palsy more independence.

The extent to which physical therapy helps depends on the severity and type of each case of cerebral palsy. Children with milder cases of CP may only require some physical therapy to treat their condition. In more severe cases, it may be used alongside other treatments or medications. Beginning physical therapy as early as possible usually gives children the best chances at improvement.

Benefits of physical therapy for cerebral palsy

There are many benefits of physical therapy, from improving mobility to preventing future issues such as contractures and joint dislocations by keeping the body strong and flexible. Many children with CP increase their level of self-reliance through physical therapy.

Physical therapy can improve:

• Coordination
• Balance
• Strength
• Flexibility
• Endurance
• Pain management
• Posture
• Gait
• Overall health

The types of exercises used vary and have specific benefits for each type of cerebral palsy.

Some of the benefits by cerebral palsy type include:

• Spastic - Physical therapy can reduce the muscle tension and jerky movements associated with spastic cerebral palsy. Exercises such as stretching can even relieve stiffness over time.
• Athetoid - People with athetoid cerebral palsy use physical therapy to increase muscle tone and gain more control over their movements.
• Ataxic - There are exercises that can improve balance problems faced by those with ataxic cerebral palsy.

Physical therapists also tailor treatment based on the location of movement issues. Movement issues in children with cerebral palsy can be limited to one half of the body (hemiplegia), the legs (diplegia) or in the torso and all four limbs (quadriplegia). Therapists prescribe special exercises and routines for hemiplegia, diplegia, and quadriplegia that may help the child regain movement in the affected area over time.

Physical therapy can also treat a range of other issues experienced by children with CP, including:

• Scoliosis - an abnormal curvature in the spine, common in up to 30 percent of children with cerebral palsy
• Thoracic kyphosis – a curvature of the upper spine bending it forward
• Lumbar lordosis - a contortion of the lower spine
• Pelvic inclination - a protrusion of the pelvis either in the front or rear
• Pelvic rotation - one hip rotates more forward
• Pelvic obliquity - one hip is higher than the other
• Knee deformity - abnormally straight or bent knees that may be caused by pelvic deformities
• Shortened Achilles tendon - a shortened tendon that causes issues with walking and standing
• Hand and wrist deformities - abnormal flexing in the hand and wrist that prevents development of fine motor skills

What to expect in physical therapy

Physical therapy is different for every child with cerebral palsy. First, the therapist has to evaluate the child’s movement problems to create a treatment plan. Then, generally, a combination of exercises, muscle relaxing techniques and special equipment is used to improve movement. The degree to which physical therapy can improve a child’s specific issues depends on the severity of the condition.

Exercises

Exercises for cerebral palsy are geared toward treating either high or low muscle tone. High muscle tone causes stiffness and spasticity, whereas low muscle tone causes too much flexibility and weakness.

Improving muscle tone

Flexibility exercises and massages are often used for children with spastic cerebral palsy; these exercises not only help improve mobility, but also can prevent painful muscle tightening that could require surgical correction. Strength training exercises are used to increase muscle tone in children with athetoid cerebral palsy.

Assisting posture and walking

Special exercises are also used to help with walking, posture, transitional movements and sensory impairments like touch and balance. Posture is improved through exercises that emphasize sitting, kneeling and standing. Transitional movements are those used by infants that lead to walking, such as rolling over and sitting up.

Equipment

Physical therapists use a range of mobility aids to make therapy more effective. Braces, casts, splints and shoe inserts are types of orthotic equipment used to help with walking, posture and joint mobility.

Physical therapy also often includes the following tools:

• Exercise balls
• Resistance bands
• Free weights
• Swimming pools
• Hot and cold packs
• Electric muscle stimulation

In some cases, electric stimulation is used to improve gait and upper limb function. This therapy uses small electrodes to stimulate certain muscles.

Physical therapy by age

As children get older, their physical therapy needs change. Physical therapists have to adjust and adapt treatments at different stages in development. The most important stages are when the child is a toddler and in the early school years.

• Toddlers - Therapy for toddlers tends to focus on playtime. Children in early developmental stages learn and experience a lot through play, making it an important aspect of early therapy. Toddlers with CP are often reluctant to touch their face or practice certain movements that are necessary for learning and physical development. A therapist can help children overcome this reluctance.

• Young children - During school age, roughly ages 5 to 12, children with cerebral palsy experience new movement issues in part because their bodies are growing. Physical therapy can help ensure children grow in a way that is conducive to their motor function. Exercises and orthotics are most commonly used at this age. Therapy also helps instill healthy habits and a proactive mindset.

Finding a physical therapist

Parents looking for a therapist need to find someone who has experience treating children with cerebral palsy. Physical therapists with experience treating CP understand the unique needs of these children and can tailor an individualized treatment regimen.

Physical therapists use observation and a series of standardized tests to measure motor function. They look for specific postures and movements that could be corrected and develop a physical therapy plan for your child. It can be hard to find a physical therapist who has experience treating children with cerebral palsy. However, parents generally do not need to settle for an inexperienced therapist.

To learn more about how to locate a physical therapist, try downloading our free Cerebral Palsy Guide, which includes over 12 pages of in-depth information for children and parents of a child with CP.