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Occupational therapists focus on assessing and developing an individual’s ability to function day-to-day to their highest level in normal daily activities at home, in school, out in public, and at work. The goal is to foster independence, productivity, and self-care. Occupational therapists will help a person improve strength, dexterity, and coordination while performing tasks, but they will also assist in decision-making, abstract reasoning, problem solving, perception, memory, sequencing, and more.

What is occupational therapy?

Occupational therapy (OT) is an integral part of a Cerebral Palsy patient’s overall treatment program. The goal of occupational therapy is to promote a child’s ability to perform daily rituals and activities in a way that will enhance their quality of life and make possible the enjoyment of independent living.

During occupational therapy, a trained therapist will guide the individual in adapting, compensating, and achieving maximum function levels. They take into account physical functioning abilities and limitations, cognitive functioning levels (i.e., reasoning and processing skills), emotional needs and desires, and ability and willingness to adapt and compensate. The existing home environment and support system play an important role, as well.

Occupational therapy is a form of therapeutic intervention. The goal of therapy is to ensure a child achieves the highest level of functional performance within their home, school, public and work environments. Occupational therapy employs adaptive processes to teach a child to perform tasks required in the normal course of a day.

This is accomplished by focusing on:

Everyday tasks – the ones an occupational therapist will focus on – can test a child’s physical and emotional resources. These tasks include:

Who benefits from occupational therapy?

Occupational therapy can have far reaching, positive consequences for the individual with Cerebral Palsy, his or her parents, and caregivers.

Individuals with Cerebral Palsy benefit from therapy because it teaches a child how to develop and maintain a daily routine – which contributes to independence and quality of life. As children grow, they want to handle everyday tasks to the best of their abilities without assistance or interference. They want to be accepted by their peers and participate socially with others. They would prefer not to be reliant on others for their basic needs.

Additionally, occupational therapy enables a child to respond to life’s demands, setting the stage for him or her to develop relationships, care for themselves, provide for their own physical needs, pursue education, maintain employment, and achieve economic parity with their peers.

What a child learns in occupational therapy is put into practice in their daily rituals, from the time they wake up in the morning to get ready to go to therapy or school, finishing homework, playing with siblings, to putting on their pajamas for a good night’s sleep.

The benefits for children are:

Children with severe cases of Cerebral Palsy can also benefit from occupational therapy; mostly through the use of specialized adaptive equipment and assistive technologies. In this circumstance, an occupational therapist will modify, then teach children how to use specialized equipment, including:

Parents/Caregivers

From the time a child is diagnosed with Cerebral Palsy, parents worry about their child’s quality of life, their ability to function, their health, their emotional status, their ability to be accepted and their future prospects. Occupational therapy can help quell some of those fears by fostering skills that will allow their child to play, interact with others, go to school, navigate the community and be productive within the workforce. Once the child masters skills within their own unique skill sets, parents will feel less overwhelmed by their child’s condition.

The benefits for parents and caregivers include:

Parents and caregivers also benefit from occupational therapy. The benefits include:

When is occupational therapy advised?

Occupational therapy is based on a child’s needs and can be recommended any time after a child is diagnosed with Cerebral Palsy. A referral to an occupational therapist will be made when a child demonstrates to members of the child’s medical team that assistance with everyday tasks is needed.

Every case of Cerebral Palsy in unique. A comprehensive assessment of an individual’s motor skills, cognitive functioning, developmental condition, overall environment and physical and psychological needs will determine therapy goals.

What happens during occupational therapy?

Occupational therapy begins with an assessment of a child’s physical and mental functioning, both of which figure prominently in a child’s ability to perform a task. The therapist will pay special attention to:

Psychological/Social:

External factors:

As a professional that is cast in the role of implementing treatment that takes into account all of these factors, the occupational therapist must ask several questions as part of his or her assessment. Some of the questions may not immediately seem relevant to a parent, but they are essential to the therapist’s ability to develop workable solutions for the child.

Some of the issues an occupational therapist will consider are:

Once an assessment is completed, the occupational therapist will implement the treatment plan. At this time, the therapist will teach children how to complete tasks using several paced steps, using adaptations when necessary, and teaching them to compensate if required in order to complete a task or activity successfully.

Further, the therapist will use exercises that will help the child understand the nature of the task and why it’s important. This is vitally important because a child must not only be able to approach and complete a task, but also understand the benefit of the task and have a desire to perform it.

To meet that end, a plan of treatment for occupational THERAPY must encourage:

Occupational therapists will also use some physical exercises to assist a child as they relate to tasks, including those that encourage dexterity, flexibility, and hand-eye coordination. Additionally, interventions such as biofeedback and relaxation may also be employed to treat anxiety in a child that becomes overwhelmed while learning.

During therapy, the therapist will also determine what, if any, assistive technologies should be used to adapt limitations. The child, and his or her parents or caregivers, will be trained in the use and maintenance of equipment.

Assistive technologies may include, but are not limited to:

Parents should expect that they will be an active participant in their child’s treatment. The occupational therapist should use their skills to teach parents as much about their child’s abilities as possible; parental involvement and support at all levels of Cerebral Palsy treatment is an essential component to a child’s ability to overcome their limitations. Additionally, parents must reinforce in home what is learned in occupational therapy, so it becomes part of a child’s daily routine.

Where does occupational therapy take place?

Occupational therapy will typically take place at any one of several facilities:

Parents must also be prepared to assist a child in the home setting. The occupational therapist will instruct the parent on how to complete exercises at home.

Additionally, a child’s condition, his or her plan of treatment and insurance coverage will likely play a role in how often a child will attend occupational therapy in a clinic setting, at home, or at school.

Who provides occupational therapy?

Occupational therapy services are provided by trained, licensed occupational therapists, often assisted by occupational therapy assistants.

Professionals engaged in the practice of occupational therapy are highly-skilled. It’s necessary that they understand the complex relationship between a patient’s physical condition, cognitive functioning, and psychological condition. To treat a child, a therapist must be able to assess a child in the context of the environment in which they live. They must understand how a child perceives their impairment.

Further, an occupational therapist must be able to factor in external issues such as a child’s level of support at home, and even a family’s economic status, when devising a plan of treatment that will bring improved functionality to a child.

According to the American Occupational Therapy Association, therapists typically practice in one of more subspecialties, including:

Educational requirements to practice occupational therapy are consistent across states; a therapist must hold a master’s degree or higher to enter the field. Candidates must successfully complete an educational program that is accredited by the Council for Occupational Therapy Education to pursue licensure.

Occupational therapy coursework is made up of several subjects, including:

Additionally, all states regulate the practice of occupational therapy, though licensure requirements can vary. Some states also allow practitioners to apply for a temporary license while they seek full licensure. To obtain licensure, all applicants must:

Occupational therapists will often work with an assistant. Occupational therapy assistants typically will have completed an associate’s degree in occupational therapy. According to the U.S. Bureau of Labor Statistics, the first year of such a program is comprised of classroom study that focuses on science, health and human development. The second year is largely made up of field work.

Assistants are also required to pursue licensure to practice in most states; some states require the national exam and other administer their own exam.

Parents with questions or concerns can obtain information about licensing requirements by visiting their state’s licensing board website.

occupational therapy cerebral palsy case study

Treatment for Cerebral Palsy

occupational therapy cerebral palsy case study

Therapy for Cerebral Palsy

A person’s ability to transcend his or her physical limits is in no small part due to the kinds of therapies that are used to fine-tune his or her abilities. Therapy fosters functionality, mobility, fitness, and independence. The types of therapies vary based on a person’s unique needs, type of Cerebral Palsy, extent of impairment and associative conditions. Therapy can also help parents and caregivers.  

Therapy for Cerebral Palsy includes

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Description of self-care training in occupational therapy: Case studies of five Kenyan children with cerebral palsy

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The purpose of this prospective case study design was to describe the changes in dressing skills for five Kenyan children with cerebral palsy who participated in a 10-week occupational therapy intervention programme. The training sessions were individually designed to meet the needs of the child. The children's performances on undressing and dressing and the time these tasks took was used as a baseline and outcome measure. These measurements were documented by video films and then analysed using visual inspection and converted into the scores of the Klein-Bell Activities of Daily Living (ADL) Scale. The results for each child were analysed using a simplified version of the Reliability Change Index. The results showed that four of the five children improved their ability to dress and that the children increased their time to undress significantly (p<0.05). Three children needed more time and two children needed less time for dressing (p<0.05). The results were influenced by the activity limitations among these children and the environmental, social backgrounds, cultural and economic situation unique to Kenya. It is recommended that case study research be used to validate clinical practice in paediatric occupational therapy and to understand cultural differences and its impact on health care.

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Cerebral Palsy- Young Adult Case Study

Abstract [ edit | edit source ]

This is a fictional case study involving a young adult living with Cerebral Palsy (CP) . For the purpose of this case study, we have outlined the presentation of a 24 year old male living with mild CP, who attends outpatient physiotherapy with musculoskeletal and neurological symptoms. For this case we have included a mental health disorder to outline the challenges of living with CP as a young adult.

Nathanial has a diagnosis of CP, hip pain, foot drop and a mental health condition. Our interventions include musculoskeletal interventions for his pain and function, as well as referrals, education and self management strategies. Our hopes for this case study are to bring awareness to the minimal evidence available for physiotherapy management of young adults living with CP and to demonstrate what we can contribute to their care as healthcare professionals. This case, including subjective and objective history, is purely fictional and our outcomes are based on how we hope this patient would progress following treatment.

Introduction [ edit | edit source ]

This case study involves Nathanial, an adult male living with Cerebral Palsy (CP). He is an active, 24 year old male who presents to physiotherapy with hip pain. Nathaniel was diagnosed with CP when he was 5 years old and has experienced intermittent hip pain since his teenage years. He has recently had worsening hip pain for about 6 weeks which is interfering with some of his regular activities including work and volunteering.

CP is an umbrella term for non-progressive motor impairment disorders [1] . The incidence of CP is about 2 in 1000 [2] .  It occurs during development due to brain damage which leads to physical and cognitive impairments [1] . CP is typically diagnosed in early childhood based on observation of motor milestones around the age of 2 [3] . Its severity is classified using the Gross Motor Function Classification System (GMFCS) [4] .

Adults with CP may experience premature aging between 20-40 years of age resulting from the increased energy cost and strain placed on their bodies during tasks of daily life [5] . Other complications may involve walking or swallowing disorders, and mental health conditions [5] . Post-impairment syndrome is common in adults with CP. This is often difficult to diagnose as its symptoms mimic other conditions related to CP including fatigue, weakness, and repetitive strain injuries [5] . Musculoskeletal impairments are very common in young adults with CP, with hip pain being the most frequently reported [6] . Hip pain may be a result of poor hip morphology at skeletal maturity [6] . Musculoskeletal impairments and pain may present secondary to changes in gait [2] . Many adults with CP experience a decline in walking ability and function despite that 70-80% walk independently or with gait aids. Maintenance of walking ability is important for independence, quality of life and participation in social activities [2] .

The purpose of this case presentation is to address the management of hip pain in adults with CP in an outpatient setting. We will discuss an example of clinical presentation, assessment, and treatment of hip pain in CP. This may be useful for student physiotherapists to increase awareness of the impairments associated with CP in adults and to recognize the importance of gait and mobility training with future patients. CP does not worsen with age, therefore this case study focuses on maintenance of function and addresses the specific mobility impairments causing hip pain. Adults with CP may present with other cognitive and physical impairments not mentioned in this case study.

Client Characteristics [ edit | edit source ]

Patient is a 24 year old male with a diagnosis of CP.  He was diagnosed at the age of 5, at Level 1 of the GMFCS score. He has no surgical history, but has a medical history of depression (3 years) as well as a history of cancer in his immediate family.  Patient is seeking physiotherapy care in regards to his L hip pain that has increased in the last 6 weeks. He reports intermittent hip pain since early teenage years, and has recently noted an odd sensation in his R foot. Patient also reports increased fatigue at work. The patient is an accountant at BDO Kingston. He lives in a 1 bedroom apartment, has 2 supportive parents, 1 sibling and good social support from friends in Kingston. As a former highschool athlete (hockey and baseball), he now volunteers his time coaching little league baseball with a friend. He is a single man with no children.

Examination Findings [ edit | edit source ]

Subjective [ edit | edit source ].

Current Sx/ Status:

Medications:

Social History:

Home/ Work [ edit | edit source ]

Functional Status (Current/ Previous) [ edit | edit source ]

Other [ edit | edit source ]

Sleep/ Stress [ edit | edit source ]

Objective [ edit | edit source ]

Observation [ edit | edit source ].

Vitals [ edit | edit source ]

AROM [ edit | edit source ]

PROM [ edit | edit source ]

Global Strength Testing [ edit | edit source ]

Sensory Testing [ edit | edit source ]

Gait analysis [ edit | edit source ]

Outcome Measures [ edit | edit source ]

https://www.pcpcc.org/sites/default/files/resources/instructions.pdf

http://www.best.ugent.be/BEST3_FR/download/moeheid_schalen/FSSschaal_ENG.pdf

Special Tests [ edit | edit source ]

Clinical Impression [ edit | edit source ]

Nathanial is a 24 year old male presenting with left side hip pain due to right hip circumduction during gait and foot drop on the same side. Pt has pre-diagnosed mild CP and presents with motor and sensory impairments. Severity is classified as Level 1 on the GMFCS. Patient is experiencing increased fatigue which is limiting participation in work and leisure activities.

Problem List [ edit | edit source ]

Intervention [ edit | edit source ]

Short-term goals [ edit | edit source ].

Long-Term Goals [ edit | edit source ]

Treatment [ edit | edit source ]

Education [ edit | edit source ].

According to a Cochrane review of exercise interventions for individuals with CP, there is no correlation between improvements in fitness and improvements in activity/participation [7] . This suggests that we would also have to assess the environment of the patient to determine what implementations we can make in his home or give him assistive devices when he is experiencing exacerbations of pain in his hip. For example, education regarding taking the elevator if experiencing fatigue with the steps leading into his apartment. We will also provide education about taking breaks throughout the work day. Any further environmental changes that may be required in order to improve activity and participation could be implemented by an Occupational Therapist (OT) in the future.

Patient educated about post-impairment syndrome and premature aging in adults with CP. Given strategies and ideas on ways to manage fatigue resulting from these conditions:

Stretching [ edit | edit source ]

To be performed each hour during work break:

Strengthening [ edit | edit source ]

HEP.png

Research indicates that improving strength in adults with CP can illicit changes within the International Classification of Functioning, Disability and Health (ICF) including an increase in self selected walking speed.

Functional Electrical Stimulation (FES) [ edit | edit source ]

The current research favors FES over orthoses for individuals with mild CP experiencing foot drop [9] . Using an AFO may lead to a decrease in function. The research is more thorough for FES intervention for children with mild CP [10] . According to the literature, FES in children is used to improve dorsiflexion but there is no direct improvement in speed of gait or overall function of gait [11] .

We have decided to clear contraindications and precautions and proceed with this intervention and monitor progress. We will provide FES in combination with tibialis anterior strengthening exercises to assist with dorsiflexion during gait.

Parameters for FES:

Based on patient fatigue levels, we will measure patient’s rate of perceived exertion (Borg Rating Of Perceived Exertion ) throughout intervention and post intervention to ensure that patient is able to continue with ADLs post treatment. We can also decrease the pulse width if patient fatigue occurs.

Gait [ edit | edit source ]

Walk 3 sets of 2 laps in clinic (200m) with focus on:

Referrals [ edit | edit source ]

If no reduction in pain by 12 weeks (both seated and during activity), we can refer for imaging. There is evidence that CP patients can have poor hip morphology which may contribute to levels of pain [6] .

Home Exercise Programme [ edit | edit source ]

Outcome [ edit | edit source ]

Following initial consult, we continued to see Nathaniel 2x/week for 8 weeks. We saw an improvement in right side ankle dorsiflexion, a decrease in foot drop, and improved glute strength. We also saw a decrease in hip pain at rest and during activity, as well as a decrease in his Fatigue Severity Scale score. Nathaniel was approved through ADP for a transitional standing desk which was implemented at work. He was able to help self manage his fatigue by intermittently standing at his desk throughout the work day. He also incorporated the stretch breaks to reduce tension and pain in his hips. His discharge plan included a HEP, education and referrals to appropriate health care providers.

Referrals: OT for assistance with workplace and home. Psychologist for management of depression.

Discussion [ edit | edit source ]

Due to the non-progressive nature of cerebral palsy, there tends to be more research surrounding rehabilitation and function in the early years. The lifespan of those living with cerebral palsy is increasing, therefore more individuals with CP are living into adulthood [14] . Although the condition is non-progressive, there are other complications that may arise in adulthood that would benefit from physical therapy. These include premature aging and post-impairment syndrome [5] . By increasing strength in young adults with CP, we can work to offset some of the effects of post impairment syndrome such as fatigue and weakness [5] .

There is a gap in the research regarding rehabilitation and exercise training for adults living with CP and little guidance regarding specific protocols for managemen [1] . Previous studies have shown that incorporating exercise and gait training into rehabilitation can help to prevent chronic pain and physical deterioration [15] . In addition, exercise will increase independence and help to maintain activity and participation in these individuals [1] , [15] .

The foot drop seen in this case is of interest as it did not have a clear mechanism. It presented later in Nathaniel’s life, therefore two possible mechanisms are post-impairment syndrome and peroneal nerve palsy. Although there is no way to clearly define the true cause, it is useful to discuss both scenarios. Post-impairment syndrome is common in CP and may lead to increased fatigue, atrophy of certain muscles, or repetitive strain injuries [5] . This could explain the decreased strength of tibialis anterior resulting in foot drop. Peroneal nerve palsy is also a potential cause of foot drop as the deep peroneal nerve nnervates tibialis anterior and one of the peroneal muscles [16] . This nerve could become entrapped due to compression over the fibular head from sitting with legs crossed at work [16] . There is an interesting case study of an older adult male with severe depression who presented with bilateral foot drop [17] . Despite this, however, there is little supporting evidence that this is a direct result of depression or the sedentary lifestyle adopted secondary to depression. Regardless of the cause of foot drop, Nathaniel’s decreased tibialis anterior and peroneal muscle strength was addressed to reduce foot drop and improve gait.

This case study is an example of adapting the available evidence to fit the needs of the individual patient. There may not be guidelines specifically for the treatment of adult cerebral palsy, however there is available research that can be applied to this case. We completed a thorough assessment and designed a patient centered treatment plan for Nathaniel based on his presentation. In adulthood, our goal is to maintain function and to minimize the effects of premature aging and post-impairment syndrome [5] . In order to do so we focused our treatment on mobility and strengthening to decrease pain and increase functional mobility. We provided education surrounding fatigue management, strength exercises to target muscle weakness, stretches to decrease pain and improve mobility, as well as gait training focused on decreasing hip and foot drop. Referrals to an occupational therapist and psychologist were recommended upon discharge.

With the limited evidence available for management of adult CP, it is crucial to address each patient’s unique presentation and focus on their specific goals. Our aim is to maximize patients’ function and improve quality of life regardless of their diagnosis [14] . In adults with CP it is important to recognize the increased fatigue that may result from complications of the disease. Each individual will present with unique symptoms, goals, and needs. A thorough assessment with attention to your patient’s goals will lead you on the right track when managing adults with CP.

References [ edit | edit source ]

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occupational therapy cerebral palsy case study

Evidence-Based Occupational Therapy Practice for Cerebral Palsy

occupational therapy cerebral palsy case study

Summary of Evidence for CP

Constraint-induced movement therapy constrains the dominant hand in a mitt or a cast to enable intensive training in the hemiplegic hand. For children with CP, CIMT was found to improve hand function of the hemiplegic hand. This approach is supported by randomized-control trials including reviews that confirm its effectiveness. If children meet the protocol for CIMT, often referred to as the 10 x 10 x 10 eligibility criteria in selecting a patient for CIMT:

Orthotics and Casting

Goal-Directed Training

Bimanual Training

Context-based Therapy

Home Programs

References [ + ]

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CHAPTER 19:  Case Study: Cerebral Palsy

Donna Cech, PT, DHS, PCS

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Introduction.

This case study focuses on the physical therapy management of Kayla, a young woman with spastic, diplegic cerebral palsy (CP). Kayla is now 20 years old and a sophomore in college. She was born prematurely and has received physical therapy services in a variety of settings since infancy. She has been followed for early intervention, early childhood, school-based, outpatient, and home health physical therapy services. At this time she does not regularly see a physical therapist, but does continue with occasional sessions to monitor adaptive equipment and to address episodes of foot pain or back pain. Kayla walks in her home/dormitory settings and on campus using bilateral forearm crutches. For longer distances, she uses a motorized cart.

Children and young adults with CP are reportedly less socially and physically active than their peers without a physical disability ( Shikako-Thomas, Majnemer, Law, & Lach, 2008 ; Engel-Yeger, Jarus, Anaby, & Law, 2009 ; Maher, Williams, Olds, & Lane, 2007 ). Individuals with CP frequently present with impairments of range of motion (ROM), soft tissue mobility, strength, coordination, and balance, resulting in motor control difficulties. CP implies damage to the immature cortex, involving the sensorimotor system. Associated problems with vision, seizures, perception, and cognition may be seen if areas of the cortex associated with these functions are also damaged. Although the cortical lesion is nonprogressive, as the infant grows and strives to become more independent, functional limitations become more apparent, as do restrictions in activities and community participation. Secondary impairments in body structures and function, such as ROM limitations, disuse atrophy, and impaired aerobic capacity, may further limit functional motor skills and ability for activities and participation. Multiple episodes of physical therapy management are frequently warranted as the child attempts more complex functional skills and as the risk for secondary impairments increases. The goal of physical therapy intervention for children and young adults with CP is to maximize the individual's ability to participate in age-appropriate activities within the home, school, and community settings.

Children with CP present with a variety of functional abilities, reflecting the location and severity of their original neurological insult. Distribution of motor involvement varies and may include hemiplegia, diplegia, or quadriplegia. The degree to which the neurological insult impacts motor ability and function also varies. The Gross Motor Function Classification System (GMFCS) provides a mechanism to classify these children, based on their gross motor abilities and limitations ( Palisano, Rosenbaum, Bartlett, & Livingston, 2008 ; Palisano et al., 1997 ). Based on Kayla's ability to ambulate with an assistive device and need to use power mobility for community mobility, she would be classified as functioning at the GMFCS level III through elementary and high school.

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CASE REPORT 1

Baby AR, is a known case of dystonic cerebral palsy, with no positive history of cerebral palsy in the family. When she was a mere six months old, her parents noticed that she did not display the normal milestones of an infant her age. It distressed her parents and they decided to visit her pediatrician. They were advised to undergo a few diagnostic investigations like MRI. On the basis of those tests, Baby AR was diagnosed with Cerebral palsy.

Without further ado, her parents began the rounds from doctors to therapists and back again. She started with basic physiotherapy exercises to strengthen muscles and to regain her functions. But her parents were not satisfied with the results. They started looking out for alternate treatment options and it was then that they came across Dr Alok Sharma and Dr Nandini Gokulchandran and the concept of regenerative medicine for cerebral palsy treatment in India.

Baby AR’s family first approached NeuroGen Brain and Spine Institute in February 2012. On examination, it was seen that she exhibited delayed milestones. Besides that she displayed poor head and oromotor control, midline activities and had difficulty in balance. Baby AR underwent cell therapy in July 2012. Along with cell treatment for cerebral palsy treatment in Mumbai, she was put on an extensive rehabilitation programme. The rehabilitation program was customized in a manner such that it benefits her to the maximum limit. The aim of rehabilitation program was to help improve her muscle tone to help develop her major milestones. Post her cell therapy for cerebral palsy treatment in Mumbai, Baby AR showed major improvements in balance and neck holding. Her grip and hand movements showed improvements as compared to before and the rigidity in her legs also reduced.

“Dealing with a child having cerebral palsy is a full time job. When my daughter was diagnosed with cerebral palsy, it was definitely a shock to my family. We rushed around major hospitals and consulted several doctors to discuss the future of my child. Everyone gave us one response saying that nothing can be done and that regular physiotherapy can be the only option. But I did not give up and my search led me to cell therapy for cerebral palsy treatment in India. In spite of a reluctant response from my dear ones, my husband and I decided to go for it and are extremely pleased with our decision. Cell therapy for cerebral treatment in Mumbai, and the staff at NeuroGen Brain and Spine Institute have turned my hope into belief!” says Baby AR’s mother.

Following the improvements, Baby AR has undergone cell therapy for cerebral palsy treatment in Mumbai twice at NeuroGen Brain and Spine Institute.

Clinical improvements seen in Baby AR after first cell therapy :

Tongue protrusion was more spontaneous.

Drooling had reduced.

Overall awareness had increased.

Sucking and chewing was initiated.

Vocalizations became more spontaneous.

Clinical improvements seen in Baby AR after second cell therapy :

She began moving around.

Oral motor skills improved. She started drinking on her own with less spillage. She could start chewing

She began trying to communicate, sometimes by speaking a few unclear words.

Neck holding improved.

She could now roll from a prone to supine position.

Her static sitting balance improved.

There was a slight improvement in her dynamic sitting balance as well.

Her kicking of legs increased.

Grip improved.

Her lower limb dystonia reduced and upper limb dystonia improved as well.

Began transitional movements.

Started trying to reach for objects/ toys.

She began laughing aloud and playing with other children and parents.

She became more attentive.

Her understanding of concepts and commands improved.

She started indicating before passing urine.

Her focusing on objects improved.

Her GMFM score improved from 8.4 – 11.4

“Accepting our problems is one thing, but losing hope over them is not. Even if there is a 5% or 10% chance of things looking brighter, we should grab them and move on in life.” said Baby AR’s mother.

Currently, Baby AR is undergoing physiotherapy at our centre. Her parents continue to work with as rigorously as before and hope their daughter will show even further improvements.

CASE REPORT 2

Master HS is a known case of diplegic Cerebral Palsy with autistic features. On examination, it was seen that he had poor social skills, stereotypical features and was slightly aggressive as compared to other children his age. He also displayed problems with his fine motor skills and balance, and was dependent for most of the activities of daily living.

“It was never in our wildest imagination that my son may have problems with achieving his regular milestones. We come from a family of doctors and my husband is a surgeon himself. So of course I had taken the utmost care of myself during my pregnancy. However, due to some stroke of misfortune, my son had a brain injury at day 3 of his birth leading to delayed developments.” says Mast. HS’s mother.

“At first, everything was going smoothly. We were enjoying being the proud parents. However, when at three months Harish had not achieved his milestones, I started to worry. We met a couple of pediatrics in town, but were not satisfied with the response. Finally, we went to Mumbai for a consultation with a well renowned pediatrician and there, HS was diagnosed with Cerebral Palsy and the doctor also reported to us that he showed autistic features as his social interactions and responses were poor. Being from the medical field, I was well aware of what Cerebral Palsy was and honestly, it was a shock for me because I was aware about the difficulties involved with the condition.” said HS’s father.

Not giving up, his parents tried everything they could, from physical rehabilitation to private counseling sessions. However, his progress was not what they expected to be. After an interval of progress, his improvements would show a downfall again. This went on for quite a while, until they realized that they needed to look for alternative options for their son. It was then that a colleague of Mast. HS’s father, who is also a doctor, advised them to consult with Dr Alok Sharma and introduced to them the concept of Cell Therapy.

Without further delay, they came down to Mumbai for a consultation with Dr. Alok Sharma at NeuroGen Brain and Spine Institute. They were explained at length what cell therapy is and how it can benefit their son. “Hearing Dr Sharma talk and clearing out doubts it was like a window of hope and a promising future opened for us. I finally felt that we had reached the place we were looking for.” his father said.

Mast. HS underwent Cell Therapy for Cerebral Palsy Treatment in India at NeuroGen Brain and Spine Institute in May 2014. Along with cell therapy he was put on an extensive rehabilitation program. The rehabilitation program was customized in a manner such that it benefits him to the maximum limit. The aim of rehabilitation program was to improve his motor performance, to channelize his aggression and to help him develop his vocational skills.

“It’s like a miracle I feel. My son has responded so well to the treatment. We see the change in his behavior now. He has improved several levels on the social front and physically also his balance and coordination have improved. I’m grateful to the entire team at NeuroGen for their efforts into making my son better.” the father said.

Clinical Improvements seen in HS post Cell Therapy :

Concentration & attention improved

Drooling of saliva decreased

Cooperation for medicine improved

Become more cheerful

Duration of reflex seizure improved but frequency remained the same.

Head nodding reduced.

Command following improved.

Dynamic sitting balance has improved.

He could do activities like walking, staircase climbing, better, & did not take much visual & tactile stimulus to perform these activities

Posture also improved.

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occupational therapy for children with cerebral palsy

Occupational therapists (OTs) treat a wide range of conditions in children. This post focuses on occupational therapy for children with cerebral palsy and treatment. One of the more common neurological diagnoses that OTs treat is cerebral palsy. This post breaks down what cerebral palsy is, and how an occupational therapist can provide interventions and services to address the functional deficits caused by this condition. Some families may need to start with this post: What is Occupational Therapy?

Occupational therapy and cerebral palsy

WHAT IS CEREBRAL PALSY?

Cerebral Palsy (CP) is a group of disorders that can affect the body in different ways, depending on the type and severity. According to the CDC, it is the most common motor disorder among children in the United States.

The broad condition is better understood by breaking down the meaning of the words: “cerebral” meaning brain, and “palsy” meaning muscle weakness. In the case of CP, the muscles of the body become weak due to an injury to the brain. 

This injury in the brain can happen during the brain’s development in utero, or early on in an infant’s life. The neural pathways get interrupted or damaged, causing a dysfunction in the way that the brain communicates to the muscles of the body. 

types of cerebral palsy

It’s important to cover the various types of cerebral palsy because each type can involve differing occupational therapy interventions. The most common types are spastic, ataxic, dyskinetic, and mixed cerebral palsy.

Spastic Cerebral Palsy- The most common type of Cerebral palsy is spastic CP. The term”Spastic” refers to the presentation of the musculature affected by the condition. The muscles are spastic, or stiff and tight . The stiffness in the affected muscles, or increased muscle tone, causes difficulties with movement. They may be too “stuck” to move properly. 

Occupational Therapy for Spastic Cerebral Palsy

Occupational therapy for spastic Cerebral Palsy can include:

Ataxic Cerebral Palsy- Results in balance and coordination deficit. This type of palsy results in abnormal gait patterns, decreased safety in mobility, low muscle tone, tremors, and generally reduced coordination for fine or gross motor activities. 

Occupational Therapy for Ataxic Cerebral Palsy

Occupational therapy for Ataxic Cerebral Palsy can include:

Dyskinetic Cerebral Palsy – This type of CP describes many different muscle deficits: dyskinetic means uncontrolled muscle movement . Those with dyskinetic CP may have too tight or loose muscles, uncontrollable movements that are fast or slow, or an ever-changing combination of any of these symptoms. In more severe cases, these uncontrollable movements occur often, resulting in requiring more assistance for daily activities. In milder cases, the involuntary movement may be smaller and infrequent, therefore the individual can be more independent. 

Occupational Therapy for Dyskinetic Cerebral Palsy

Occupational therapy for Dyskinetic Cerebral Palsy can include:

Mixed Cerebral Palsy – There is also a category of “mixed” cerebral palsy, meaning more than one type of palsy is present. The diagnosis of Mixed Cerebral Palsy is given when a child shows symptoms of multiple types of cerebral palsy. When this occurs, there may be differences in different areas of the brain. Mixed cerebral palsy type can present with a wider variety of physical and neurological symptoms.

Occupational Therapy for Mixed Cerebral Palsy

Occupational therapy for Mixed Cerebral Palsy can include:

No matter the type of CP, every case will be different, because each child comes with their own unique abilities. 

Cerebral palsy occupational therapy interventions

Occupational Therapy for children with Cerebral Palsy

Aspects of the occupational therapy interventions for cerebral palsy are listed below. Because each individual with cerebral palsy diagnosis is so different in the way of tone, musculature, abilities, difficulties, environmental considerations, family environment, and other aspects, there will be no two treatment plans that are exactly alike.

Neurodevelopmental Treatment (NDT) : NDT is a holistic movement based approach, involved in handling and moving the child. In the most serious cases of cerebral palsy, an individual may require total assistance, or be dependent, for the majority of their activities of daily living.

An OT and a PT provides treatment to control the muscles, and reduce the likelihood of joint contractures. If a joint is bent for too long due to high spasticity, the bones of the joint may begin to “fuse” and a joint contracture is formed.

This happens often at the elbows, hips, and knees preventing that joint from moving.

In order to avoid joint contractures, therapists can provide skilled therapy, such as NDT , to correct the spasticity and promote functional movement in the affected muscles.

Splinting for Cerebral Palsy: In milder cases, a child with spastic CP may be able to perform most tasks independently, but benefit from a splint to guide their upper extremity posture.

A commonly used splint is a thumb splint with a supinator strap. Many children with cerebral palsy present with tightly closed fingers, and a pronated forearm.

A thumb splint with a supinator strap can help to position the thumb, wrist, and forearm in a more functional position. This splint is typically prefabricated, made of a soft fabric, attached with velcro. 

Environmental Modifications : Safety is the number one priority. Occupational Therapy and for children with cerebral palsy might involve an environmental assessment for safe mobility in the home.

Recommendations may include: non-slip mats, professional railings installed in bathroom/ hallways/stairs, lighting accommodations, removal of clutter/cords/rugs/other tripping hazards, depending on the unique needs of the child.  

Weight Bearing: Occupational therapy for children with cerebral palsy includes upper extremity weight bearing activities. These can be used on the affected arms to help increase muscle tone in a child with ataxic CP.

Weight bearing can also increase bone density, to reduce the chance of fractures. It can also improve sensory awareness and proprioception that sends information to the brain about where the body is in space.

Effective strength and sensory processing can increases safe, functional movements. To make weight bearing fun and playful, try placing the child prone over a physioball, having them reach for preferred toys with one hand, then the other.

Adaptive Equipment: Feeding tools like the ones in this article on adaptive feeding equipment from the OT Toolbox, may help increase independence, by compensating for shaky movements while feeding.

To increase coordination for handwriting skill, a variety of adaptations can be used (Amazon affiliate links):

It is important to make these activities as client-centered and motivating as possible. Having uncontrollable movement can be very frustrating, especially for small children who don’t understand what his happening to their body. Celebrate the little victories and find out what motivates your client to try, try again! 

Compensatory Techniques: Based on the unique movement needs of the child, occupational therapy for children with cerebral palsy may include alternative methods for the child to complete activities as independently as possible. One example; practice and identify the most functional order to get dressed and undressed.

Teach which arm to thread into a sleeve first, when to pull the shirt over their head, or how to orient the shirt to efficiently motor plan the following step. Create a song, social story, or picture book to help the child and their family learn.

A Final Note on occupational therapy and cerebral palsy

It is important to note that while some children with cerebral palsy may also have cognitive deficits, it is not a trademark of this diagnosis. Many children with CP meet their cognitive milestones.

A cerebral palsy diagnosis does not mean an individual can not learn, see, hear, and communicate as well as their peers. Seizure disorders, communication deficits, feeding, and swallowing disorders are common comorbidities for individuals with cerebral palsy.

Be sure to understand the medical needs of your clients in order to provide the best practice and occupational therapy for children with cerebral palsy.

As with any other patient, once you understand what their barriers and goals are, therapy can be meaningful and fun! 

occupational therapy cerebral palsy case study

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her background is in Human Development and Family Studies, and she is passionate about providing individualized and meaningful treatment for each child and their family. Sydney is also a children’s author and illustrator and is always working on new and exciting projects.

cerebral palsy occupational therapy interventions

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Your Guide to Cerebral Palsy

Occupational therapy for cerebral palsy

Occupational therapy can help with managing everyday activities and functions, like eating, getting dressed and using the bathroom. It does so by improving physical and cognitive ability and fine motor skills.

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What to expect in occupational therapy

How Does Occupational Therapy Help?

Occupational therapy helps people develop or recover the skills needed to lead independent, satisfying lives. The “occupation” in occupational therapy does not refer to one’s profession. Rather, it refers to the everyday activities that give life meaning.

For a child, these meaningful activities include playing and learning. Pediatric occupational therapy focuses on improving the child’s ability to play and learn, which are important for development and becoming independent.

For children with cerebral palsy , occupational therapy can help with muscle and joint coordination issues — issues that can make everyday tasks difficult. Some of these tasks include eating, brushing teeth and bathing. Occupational therapy can help to improve physical, cognitive and social abilities, as well as fine motor skills and posture. This therapy can also help address difficulties with processing sensory information.

Benefits of Occupational Therapy

Occupational therapy is beneficial for children with cerebral palsy in many ways.

By optimizing upper body function and improving the coordination of small muscles, occupational therapy can help children with CP master the basic activities of daily living.

Occupational therapy can help children by:

Parents and caregivers spend a lot of time helping children with cerebral palsy perform basic day-to-day activities. As the child begins to see the benefits of occupational therapy, the parents and caregivers do, too.

For parents and caregivers , occupational therapy helps by:

Each type of cerebral palsy presents different symptoms that may hinder a child’s ability to live independently and complete daily activities.

Occupational therapy can help with the following issues related to each type of CP:

Find out how we can help you cover the cost of your child’s treatment.

As with physical therapy and speech therapy , occupational therapy is different for every child with cerebral palsy. Each child’s occupational therapy treatment plan is highly individualized and tailored to their individual physical, intellectual and social-emotional abilities.

During your child’s first therapy session, the occupational therapist will perform a complete evaluation. This includes testing the child’s fine motor, perceptual and oral-motor development, and observing how the child responds to touch and movement. The occupational therapist will also interview the parent to find out about the child’s strengths and weaknesses when performing daily activities, as well as pinpoint the specific goals for the child to work toward.

Most children with cerebral palsy need to be reevaluated every six to nine months. After these evaluations, the occupational therapist will tweak the treatment plan accordingly based on progress and change.

Exercises Used in Occupational Therapy

Occupational therapy involves using functional activities to progressively improve functional performance.

Occupational therapy exercises focus on the following skill areas:

Occupational therapists use specific techniques to help children reach their goals, including:

Equipment Used in Occupational Therapy

Many different tools and assistive devices are used in occupational therapy. Equipment can range from common household items to high-tech assistive technologies.

Assistive Devices

Occupational Therapy by Age

Occupational therapy helps people of all ages. For children with cerebral palsy, treatment will be based on the child’s physical, intellectual, social and language abilities, as well as their age.

Finding an Occupational Therapist

Occupational therapists are licensed healthcare professionals. Finding an occupational therapist who has experience working with cerebral palsy patients is very important to ensure your child gets the best treatment possible.

If you need help finding an occupational therapists, ask your child’s pediatrician if they have any recommendations. Occupational, physical and speech therapists often work together to create comprehensive treatment plans. If your child is seeing a physical or speech therapist, they may be able to connect you with an occupational therapist.

To learn more about how to locate an occupational 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.

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Registered Nurse (RN)

Kristin Proctor began her nursing career as a U.S. Army Nurse and has been a Registered Nurse (RN) more than 20 years. She has specialized experience in labor and delivery, as well as prenatal, antepartum, and postpartum care. Kristin uses this experience to educate and support families affected by birth injuries.

Cerebral Palsy Guide

Cerebral Palsy Guide was founded upon the goal of educating families about cerebral palsy, raising awareness, and providing support for children, parents, and caregivers affected by the condition. Our easy-to-use website offers simple, straightforward information that provides families with medical and legal solutions. We are devoted to helping parents and children access the tools they need to live a life full of happiness

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article information

Comparison of priority occupational performance of children with cerebral palsy from the perspective of children, parents, and occupational therapists in isfahan in 2021.

Shima Torkan 1 , Mohammad Saeed Khanjani 2 , * , Kianoush Abdi 1 , Mohsen Vahedi 3

how to cite: Torkan S, Khanjani M S , Abdi K, Vahedi M. Comparison of Priority Occupational Performance of Children with Cerebral Palsy from the Perspective of Children, Parents, and Occupational Therapists in Isfahan in 2021. Middle East J Rehabil Health Stud. 2023;In Press(In Press):e133218.  https://doi.org/10.5812/mejrh-133218 .

Background:

Objectives:, conclusions:.

Cerebral Palsy Canadian Occupational Performance Measurement (COPM) Parents Children with Cerebral Palsy Occupational Therapists.

1. Background

Cerebral palsy (CP) is the most common chronic motor disability and neurological complication in children, resulting from a non-progressive impairment to the developing brain. This impairment may occur before, during, or after birth and is often accompanied by sensory, cognitive, communication, and behavioral disorders, as well as epilepsy and musculoskeletal problems. It causes limitations in activities and reduces social participation ( 1 ). Its incidence rate is 1.4 to 2.4 per 1000 live births ( 2 ). In the Iranian population, the prevalence of CP is estimated to be two to three per thousand live births ( 3 ). Neurological defects of children with CP include neuromuscular and musculoskeletal problems, spasticity, muscle contracture, incoordination, loss of selective movement control, and weakness in motor performance and daily activities of these children. Therefore, the primary goal of rehabilitation interventions, and especially occupational therapy in these children is to increase the child's abilities to perform activities of daily living ( 4 , 5 ). The participation of children with CP in society is lower than normal children of the same age ( 6 ). According to the international classification model of functioning, disability, and health, participation is the involvement of a person in life situations and is mentioned as one of the important components of function and health ( 7 ). A child's disability affects the child’s life and the lives of family members and caregivers ( 8 , 9 ). On the other hand, the client-centered perspective emphasizes shared cooperation between the patient and the therapist ( 10 - 12 ), and it increases the patient's satisfaction and improves the patient's performance ( 13 ). Therefore, client-centered occupational therapy on respect for the patient and the participation of the patient and family in decision-making as the most important factor of treatment and defends the needs of the patient ( 14 ), and to achieve the goals needed by children with CP and their families, it has been introduced in the course of the healthcare system. Considering that parents know their child better than anyone else, they can help to achieve and set therapeutic goals and priorities in terms of functional levels, which are more focused on the child's participation and activity levels, as well as facilitate therapeutic strategies to promote children's participation in society ( 15 ). Also, the family plays an essential role in ensuring the health and well-being of children, which is why today’s attention to health and development-related services has changed from the traditional child-centered model to the family-centered model. Therefore, it is very important to understand the priorities of parents and occupational therapists to participate in the daily activities of children's lives to provide client-centered services ( 16 ). Treatment for children with CP should be based on the needs, values, and abilities of the family environment. These needs are better known when all family members are involved ( 17 ).

The main goal of rehabilitation is to improve the child's participation in the activities of daily living. Therefore, it is necessary for therapists to be aware of the child's priorities and needs from the parent's perspective because parents have sufficient knowledge of their child's skills and needs ( 15 , 18 , 19 ). Knowledge of these priorities can help therapists to prepare rehabilitation strategies according to the needs of the child and the family's priorities, and family-centered treatment can be carried out ( 20 ). Therefore, occupational therapists must know the occupational performance priorities of children and parents so that they can advance the treatment goals of the rehabilitation program exactly to the priorities and needs of children with CP and increase the participation of the child and family in the treatment process to make the treatment more effective.

Children with CP often face challenges in their occupational performance, including self-care, productivity, and leisure. The main goal of the occupational therapy profession is the full and useful use of all capacities and abilities of people throughout their lives so that the person can perform activities and roles that are beneficial for life with satisfaction ( 21 ). The focus of the occupational therapy profession is on occupational performance ( 22 ), and the client's occupational performance should be evaluated to obtain information about the client's capacity to perform occupational duties ( 23 ). Therefore, it is necessary to have a suitable scale to evaluate the client’s occupational performance and design an effective treatment program ( 24 ). One of these well-known reference-oriented tools that determine occupational performance problems is the Canadian Occupational Performance Measure (COPM). This scale was established in 1988 by the National Health and Welfare Department of the Canadian Occupational Therapy Association and is under extensive research. The COPM is based on a specific occupational therapy model and includes occupational performance areas, including personal care, productivity, and leisure, as main outcomes. This scale includes the client's roles and role expectations from the moment the client enters occupational therapy and can be used in all developmental stages and all disabilities groups ( 25 ). This questionnaire can be completed by parents and occupational therapists or other people who are in contact with clients, which is implemented through a semi-structured interview by occupational therapists ( 26 ).

In previous research, the occupational performance priorities of children with CP have been investigated from the perspective of parents based on the COPM ( 16 , 20 - 24 ) ( Table 1 ), and the results showed that the occupational performance priorities of children with CP from the perspective of parents in different age groups are the same in children with CP and are mainly focused on self-care activities. According to the conducted studies, the greatest need and priority of CP children and their families are related to activities of daily living, especially activities related to self-care. In previous studies, the occupational performance priorities of children with CP were examined only from the perspective of parents, and the perspective of children with CP and occupational therapists was not considered. Occupational therapists must know the occupational performance priorities of children and parents so that they can advance the treatment goals of the rehabilitation program exactly to the priorities and needs of children with CP and increase the participation of the child and family in the treatment process for more effective client-centered treatment. It is necessary to complete the previous studies to determine and compare the priority of occupational performance from the perspective of all three groups of children, parents, and occupational therapists, so that rehabilitation programs are carried out in coordination with the needs of these three groups. Therefore, in the present study, the comparison of the priority of occupational performance from three groups has been made for this purpose.

Because no study has been conducted in Iran and other countries to compare the priority of occupational performance of children with CP from the perspective of children, parents, and occupational therapists, and the studies have examined the priority of occupational performance only from the perspective of parents, there is little information in this field. Currently, treatment priorities are mostly determined by occupational therapists, and less attention is paid to the priorities of children with CP and their parents, in which case referral-based treatment is not carried out effectively, and the participation of children with CP and their parents in the treatment and rehabilitation process is reduced. Therefore, in this research, we determined and finally compared the occupational performance priorities from the perspective of children with CP, parents, and occupational therapists so that by identifying the possible differences in priorities from the perspective of these three groups, a suitable model for the rehabilitation team and especially occupational therapists should focus on client-centered approaches to consider the priorities of occupational performance, take into account the child's and parent’s perspective, and manage the child's rehabilitation process with greater participation between the therapist, the child, and the family.

The general purpose of this research was to compare the priority of occupational performance from the perspective of children with CP, parents, and occupational therapists in Isfahan city, and the specific goals were determining the priority of occupational performance from the perspective of children with CP, parents, and occupational therapists, comparing the priority of occupational performance from the perspective of children with CP and parents, from the perspective of children with CP and occupational therapists, and from the perspective of parents and occupational therapists.

We considered six questions: Q1: What is the priority order of occupational performance of children with CP from the perspective of these children? Q2: What is the priority order of occupational performance of children with CP from the perspective of the parents of these children? Q3: What is the priority order of occupational performance of children with CP from the perspective of occupational therapists? Q4: Is there a difference in the occupational performance priorities of children with CP from the perspective of children and parents? Q5: Is there a difference in the work performance priorities of children with CP from the perspective of children and occupational therapists? and Q6: Is there a difference in the occupational performance priorities of children with CP from the perspective of parents and occupational therapists?

2. Objectives

Priorities of occupational performance from the perspective of children with CP, parents, and occupational therapists were determined and finally compared so that by clarifying the possible differences in priorities from the perspective of these three groups, a suitable model for the rehabilitation team and especially occupational therapists focusing on client-centered approaches should take into account the child's and parent’s perspectives to consider occupational performance priorities, and manage the child's rehabilitation process with greater participation between the therapist, the child, and the family.

3.1. Study Design

The current descriptive-analytical study is of a comparative type and was conducted to investigate the occupational performance priorities of 115 children with CP, their parents, and occupational therapists, and compare these priorities with each other in Isfahan in 2021. Ethical approval was obtained from the Ethics Committee of the University of Rehabilitation Sciences and Social Health (Code: IR.USWR.REC.1399.239).

3.2. Inclusion Criteria

3.2.1. inclusion criteria for children.

- Diagnosis of CP by a pediatric neurologist (based on the child's medical record)

- A minimum IQ of 70 on the Sparkle IQ scale (measured by the researcher)

- Willingness to participate in the study

- Absence of psychiatric problems in children with CP, such as autism and hyperactivity (based on the child's medical record)

- The age range of 6 to 12 years

- no hospitalization for a long time in the last three months

- Speech and verbal understanding (with the speech therapist of the clinic or rehabilitation center and interview with the child and mother)

3.2.2. Inclusion Criteria for Parents of Children with CP

- The father or mother of the child with CP who are responsible for the main care

- Consent to participate in the research

- Parents' age (20 - 55 years)

3.2.3. Inclusion Criteria for Occupational Therapists

- Having at least a bachelor's degree in occupational therapy

- Having at least six months of work experience in the occupational therapy department of rehabilitation clinics, rehabilitation centers, or the occupational therapy department of Isfahan hospitals

- An occupational therapist who is currently working with a child with CP

3.3. Exclusion Criteria for Children with CP, Parents, and Occupational Therapists

- Unwillingness to continue participating in the research

3.4. Procedures

After the approval of the proposal, in the Department of Rehabilitation Management and Postgraduate Education of the University of Welfare and Rehabilitation Sciences and the approval of the Ethics Committee, the necessary permits to conduct the study were obtained and after referring to the occupational therapy department of ten rehabilitation clinics, five rehabilitation centers and the occupational therapy department of three hospitals in Isfahan, people who met the inclusion criteria were selected. After obtaining informed consent and explaining the objectives of the research to them, a semi-structured interview was done based on the Canadian occupational performance measurement (COPM) by the researcher individually and separately with the children with CP, and their parents and occupational therapists. After completing the questionnaires, the results of all three groups were compared and analyzed, and finally, the findings were reported.

3.5. Sample Size

The target population was children with CP, parents, and occupational therapists of children with CP in Isfahan city. The number of samples was obtained using the following equation:

3.6. Contributors

The researcher referred to the occupational therapy department of ten rehabilitation clinics, five rehabilitation centers, and the occupational therapy department of three hospitals in Isfahan city, and based on the diagnosis of neurologists and medical records, children who were diagnosed with CP and their parents and occupational therapists, who met the inclusion criteria were selected as available.

3.7. Research Tool

3.7.1. canadian occupational performance measurement.

The Canadian occupational performance measurement (COPM) is a client-centered measurement scale that measures the client's self-perception in three domains: self-care, productivity, and leisure using a semi-structured interview. This scale helps clients identify goals. Then, the clients are asked to rate their performance and satisfaction based on a 10-point scale. The test takes about 20-60 minutes (depending on the client) ( 25 ).

This scale determines the problem areas in occupational performance, prioritizes the occupational performance of the clients, and evaluates the performance and satisfaction with the problem areas. The first step in administering the COPM is a semi-structured interview about daily living problems or priorities with children, parents, or therapists. The second step involves rating the importance, in which the child, parent, or therapist is asked to rate the activities according to their importance in daily living. Importance is rated on a 10-point scale. In the third step, using the information obtained in the previous steps, the test takers (children, parents, and occupational therapists) are asked to choose the five most important problems. In this step, the completer of the questionnaire prioritizes the problems in occupational performance according to the rank obtained in the previous step, and the most important problems and the least important problems are determined ( 26 ).

The COPM can be used for all clients and may require modifications in several items for some individuals. Also, this questionnaire can be completed by parents and occupational therapists. The COPM has been used extensively in clinical and research practice in over 40 countries since it was first published ( 27 ). It has established reliability, validity, and responsiveness to change and has been translated into over 35 languages and featured in more than 3000 articles with wide use in several health conditions ( 26 ).

In 2015, Dehghan et al. translated the COPM into Persian and evaluated the psychometric properties of the Persian version in Iranian mothers of children with CP. The Persian version demonstrated a high content validity (80.95 ± 0.222). The Spearman correlation coefficients of the test and retest scores ranged from r = 0.84 for performance to r = 0.87 for satisfaction, and this indicated a high correlation between scores and acceptable reliability of the Persian version of COPM ( 26 ).

3.7.2. Sparkle IQ Scale

It is a form to estimate the cognitive level of children with CP, which is derived from the Sparkle project. Cognitive levels are according to ICD 10, where 70 indicates mild learning disability, 50 to 70 indicates moderate learning disability, and below 50 severe learning difficulties. If, according to the child's mother or therapist, he learns different things like children of the same age and plays with his friends, the child's cognitive level is considered above 70. If the answer to the above questions is negative and from the point of view of the child's mother or therapist, he/she has severe problems in learning various things and is more like children who are half his/her age in reading and understanding, the cognitive level is below 50. If these issues are not accepted by the mother or the therapist, and in their opinion, the child needs more help in learning, like reading and understanding, compared to other children and is better and more comfortable with younger children, the cognitive level is considered 50 - 70 ( 28 ).

3.8. Data Analysis

Descriptive statistics, such as mean, standard deviation, and percentages, were used to describe the data. Stuart Maxwell test was used to compare occupational performance preferences in children, parents, and occupational therapists. In this research, data analysis was done through SPSS version 27 software. A probability value of less than 0.05 was considered significant.

In this research, 115 children with CP, their parents, and occupational therapists participated. In terms of gender, most of the participants were boys (71.3%), in terms of the type of CP, most of the participants were spastic CP (80.9%), and in terms of age group, most of the participants aged six years old (50.4%).

4.1. Descriptive Results

The order of the priority of the occupational performance of children with CP from the children's perspective includes walking (43 people (37.4%)), toileting (38 people with a frequency of 33%), going up and down the stairs (15 people (13%)), and bathing (7 people (6.1%)).

The order of the priority of occupational performance of children with CP from the parent's perspective includes toileting (47 people (40.9%)), walking (39 people (33.9%)), and going up and down the stairs (9 people (7.8%)).

The order of the priority of occupational performance of children with CP from the occupational therapist's perspective includes toileting (45 people (39.1%)), walking (41 people (35.7%)), and going up and down the stairs (17 people (14.8%)).

The priority of the occupational performance of children, parents, and occupational therapists is related to the field of self-care ( Table 2 ).

4.2. Analytical Results

Based on the data obtained according to the Stuart Maxwell test (statistic = 19.88, probability value = 0.177), the priority of occupational performance of children and parents had no statistically significant difference. The priority of 37 children with CP and their parents was walking, the priority of 35 children with CP and their parents was toileting, and the priority of six children with CP and their parents was going up and down the stairs, the priority of four children with CP and their parents was bathing ( Table 3 ).

Based on the data obtained according to the Stuart Maxwell test (statistic = 14.79, probability value = 0.192), the priority of occupational performance of children with CP and occupational therapists had no statistically significant difference. The priority of 39 occupational therapists and children with CP was walking, the priority of 33 people of occupational therapists and children with CP was toileting, the priority of nine occupational therapists and children with CP was going up and down the stairs, and the priority of three occupational therapists and children with CP was bathing ( Table 4 ).

Based on the data obtained according to the Stuart Maxwell test (statistic = 16.31, probability value = 0.177), the priority of occupational performance of parents and occupational therapists had no statistically significant difference. The priority of 38 parents and occupational therapists was toileting, the priority of 36 parents and occupational therapists was walking, the priority of eight parents and occupational therapists was going up and down the stairs, and the priority of six parents and occupational therapists was bathing ( Table 5 ).

5. Discussion

Considering the decisive role of occupational therapy in the field of rehabilitation of children with CP, it is important to consider the family's priorities according to client-centered approaches. In this study, the occupational performance priorities of children with CP aged 6 - 12 years, from the perspective of children, parents, and occupational therapists in three areas of self-care, productivity, and leisure, were examined and compared to make it clearer for the rehabilitation team, especially the occupational therapists, by focusing on client-centered approaches to consider the priorities of occupational performance and the views of children and parents and to manage the child's rehabilitation process with greater participation between the therapist, the child, and the family.

In response to the first question of the research, the most important priority of the occupational performance of children with CP from the perspective of these children was related to the field of self-care. CP children have problems and limitations in performing activities of daily living, such as toileting, mobility, dressing, eating, and bathing. Restrictions in performing these activities cause long-term dependence of children on parents and caregivers and create special needs in the child that the caregiver must meet, and on the other hand, these children tend to be independent in doing their activities of daily living ( 29 ). Due to the significant role of personal care in childhood independence, it seems that personal care is one of the most important challenges of occupational performance in children with CP. Gharebaghy et al. investigated occupational performance in children with cancer. The results of the mentioned study were in line with this study, and self-care was the most important priority of occupational performance in doing daily affairs of children with cancer ( 30 ).

In response to the second question of the research, the most important priority of the occupational performance of children with CP from the parents' perspective was related to the field of self-care. Brando et al. investigated the priority of occupational performance by the parents of 75 children with CP aged 3 - 16 years, and the results indicated that the main functional need of caregivers was related to self-care activities (48.2%) ( 20 ). Gimeno et al. examined the occupational performance priorities in the daily life of 57 children and adolescents aged 3 - 18 years with dystonic disorder from the parents' perspective using the COPM, and the results showed that the most important priority of caregivers and parents was the participation of children and adolescents with a dystonic disorder in self-care activities ( 21 ). The most important priority for the occupational performance of children with CP from the parent’s perspective in all children with CP aged 6 - 12 years is self-care. The results of this study are consistent with those of Gimeno et al., Chiarello et al., and Brando et al. ( 20 , 21 , 24 ).

In response to the third question of the research, the most important priority of the occupational performance of children with CP from the perspective of occupational therapists was related to the field of self-care. Occupational therapists in the treatment and rehabilitation of children with CP should pay attention to the active participation of these children and their parents, possibly by identifying the needs and priorities of children and parents in activities of daily living ( 31 ). An occupational therapy program designed to improve occupational performance can lead to improved independence in daily living activities and occupational performance. Therefore, the attention of occupational therapists to the needs and priorities of occupational performance makes the rehabilitation program of CP children successful, and the satisfaction of CP children and their parents with occupational therapy programs increases ( 32 , 33 ). For this reason, based on the results obtained in this research, the highest priority of occupational performance of occupational therapists for children with CP was related to the field of self-care so that these children can actively participate in personal and social life and achieve independence and self-efficacy. There has been no research on the occupational performance priorities of children with CP from the perspective of occupational therapists.

In response to the fourth research question, comparing the occupational performance priorities of children with CP from the perspective of children and parents, showed that the occupational performance priorities of children and parents are the same and related to the field of self-care. Identifying the physical and psychological needs of children with CP by parents and warm and intimate communication between mother and child increase the child's sense of participation in activities of daily living and reduce parental stress. It can be concluded that parents' better understanding of the needs and occupational performance priorities of children with CP makes it easier to establish a proper relationship between parents and children, and as a result, it reduces the child's behavioral problems and increases the parents' mental health ( 34 ).

Verkerk et al. showed that the parents of children under eight years of age with CP who were referred to occupational therapy reported personal care, functional mobility, play, and social relations of the child as their highest priority ( 23 ). Also, Turk et al. showed that a high percentage of CP people need physical assistance and care in personal care and activities of daily living ( 35 ). In an interview with the parents of 12 children with CP aged 1 - 4 years, Anttila et al. showed that personal care, mobility, movement, sitting and standing, as well as exercises related to occupational therapy and physiotherapy, are among their priorities ( 36 ). In a similar study conducted by Ostensjo et al., parents of 13 CP children aged 2 to 4 years stated their children's priorities and needs in the order of individual care, mobility and movement, playing, and social relationships ( 22 ). Jalili et al. investigated the occupational performance priorities of CP children and adolescents aged 3 to 18 years based on the parent's perspective, and the parents reported functional priorities in similar performance dimensions in different age groups in children with CP, which is mainly focused on self-care activities ( 16 ). The results of the mentioned studies are consistent with the results of the present study.

In response to the fifth question of the research, comparing the occupational performance priorities of CP children from the perspective of children and occupational therapists, showed that the occupational performance priorities of children and parents are the same and related to the field of self-care. If occupational therapists correctly consider the needs and priorities of children with CP in their treatment and rehabilitation process and base the treatment goals based on the priorities and special needs of these children in activities related to occupational performance, the level of participation of these children in the process rehabilitation will increase ( 37 ). Based on the data obtained in this research, occupational therapists' knowledge of the needs and priorities of children with CP will facilitate the better rehabilitation of these children and will lead to greater independence and participation of children in individual activities. No study has compared the occupational performance priorities of children with CP from the perspective of children and occupational therapists.

In response to the sixth research question, comparing the occupational performance priorities of children with CP from the perspective of parents and occupational therapists, showed that the occupational performance priorities of occupational therapists and parents are the same and related to the field of self-care. If the occupational performance priorities of parents and occupational therapists are the same, rehabilitation will be done more effectively, treatment will take place in a client-centered and family-centered manner, and the success of the rehabilitation program for children with CP will increase ( 38 ). Egilson analyzed the perspective of parents regarding rehabilitation measures for children with physical disabilities and emphasized the willingness of parents to participate in the treatment decision-making process ( 39 ). Hurlburt et al. by examining the characteristics of child rehabilitation services, observed that the mismatch between the views of therapists and family members regarding the rehabilitation process can hinder the family's full understanding of therapeutic interventions and reduce the results of the child's functional treatment ( 40 ). Oien et al. investigated the views of parents and therapists on setting meaningful goals for the families of children with CP and noted that the involvement of parents in setting treatment goals can increase their participation in the intervention and treatment process and lead to greater parental coordination and help therapists ( 41 ). The results obtained in this study are in line with those of Egilson, Hurlburt et al., and Oien et al..

The field of self-care in this research, according to the COPM, includes personal care, functional mobility, and social management ( 42 ). of which personal care activities (such as bathing, toileting, opening, and closing buttons, brushing teeth, etc.) and functional mobility (moving and shifting) have been of special importance.

For children with CP, their parents and occupational therapists sought to gain independence and increase the participation of children with CP in personal care and mobility. Previous studies have also shown that the most important occupational performance priority for parents of children with CP and other children with physical problems is self-care activities ( 22 - 24 , 43 ). CP is one of the most common causes of movement problems in children, which, due to other accompanying problems, creates a lot of restrictions in carrying out the daily activities of the child's life, and a large part of their individual affairs is done by the family ( 44 , 45 ).

Therefore, considering the strong and decisive role of occupational therapy in the field of rehabilitation of children with CP, it is important to consider the priorities of the family and children according to client-centered approaches. In previous studies, the occupational performance priorities were only considered from the perspective of the parents of children with CP, and no study has been conducted comparing the occupational performance priorities of children with CP from the perspective of children, parents, and occupational therapists. Contrary to the fact that the priorities of these three groups are different, the occupational performance priorities of children, parents, and occupational therapists are the same and related to the field of self-care, which shows that these three groups are compatible with each other in occupational performance priorities. In this study, the occupational performance priorities of children with CP from the perspective of children, parents, and occupational therapists for children with CP aged 6 to 12 years were identified and compared, and it makes the path for occupational therapists to rehabilitate and increases the participation of these children.

5.1. Conclusions

The results showed that the occupational performance priorities of children with CP are the same from the perspective of children, parents, and occupational therapists and are mainly related to self-care activities. Increasing the independence of children with CP in self-care activities not only leads to the reduction of care pressures but also leads to an increase in self-confidence, facilitating the establishment of social relationships with peers and social participation. According to the research conducted and the results obtained, occupational therapists should pay special attention to this important issue, considering the importance of client-centered interventions in the field of occupational therapy services, and focus their interventions on all areas related to the important and meaningful needs and priorities of children with CP and parents. In this regard, the cooperation between occupational therapists and parents is strengthened, and the goals of children with CP and their parents can be achieved.

5.2. Limitations

In this research, as in other research, there were limitations and problems: the spread and epidemic of COVID-19 during the stages of the study; the restrictions of intra-urban traffic and closure of Rehabilitation centers and occupational therapy clinics caused many problems and time-consuming sample collection. Among the most important limitations that existed, we can mention the non-cooperation of parents and rehabilitation centers to complete the questionnaires. Extending the interview time and filling in the COPM, which should have been done as a semi-structured interview.

5.3. Research and Executive Suggestions

(1) Occupational performance priorities of children in different disability groups should be investigated and compared from the perspective of these children.

(2) Priorities of occupational performance in different disability groups from the perspective of children, parents, and occupational therapists should be investigated and compared.

(3) Sharing the experiences of the studied statistical population for rehabilitation clinics and rehabilitation centers for the maximum effectiveness of rehabilitation programs.

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occupational therapy cerebral palsy case study

When my son was born with cerebral palsy, I thought we'd never play baseball together. After an innovative surgery, we made it happen.

Brett Seifried with his family

Brett Seifried's son, Archer, was born with cerebral palsy and had a hard time walking.

Archer had surgery to reduce high muscle tone in his legs.

This is Seifried's story, as told to Kelly Burch.

This as-told-to essay is based on a conversation with Brett Seifried. It has been edited for length and clarity.

When my son was diagnosed with cerebral palsy at a year old, I thought about the activities I'd done that I hoped to one day share with him — sports, especially baseball , and military service. Those seemed totally unobtainable.

Of course, it wasn't just my hopes and dreams — cerebral palsy affected Archer daily. Once, the day care he went to sent a video of the children playing hopscotch, but Archer was sitting on the sidelines. I asked him about it and he explained he couldn't hop like his friends could. Hearing that hurt.

Rather than living life with Archer, I was hyperfocused on keeping him safe. He had high muscle tone in his legs, which made it hard for him to move around. Often, I carried him or pulled him in a stroller while other kids ran or rode scooters. Archer fell over a lot, which made even calm activities like cooking together dangerous.

Our doctor recommended we explore surgery

After his diagnosis, Archer was getting Botox shots and casts on his legs to help develop his mobility. That was something we would have to do until he was a teenager, getting new casts every three months. It was a lot.

Then our doctor mentioned a new surgery for kids like Archer at Seattle Children's Hospital. He connected me with Dr. Samuel Browd, a neurosurgeon performing selective dorsal rhizotomy, also known as SDR. The surgery cuts abnormal nerves in the lower spinal cord that cause spasticity, or high muscle tone, in the legs. Once they're cut, the brain and spinal cord can rewire those connections, leading to improved gait and mobility for kids like Archer.

Surgery sounded scary — but so did a decade of casts and Botox. Browd explained that the best time to do SDR is when kids are 4 or 5, exactly Archer's age.

Being at the hospital was valuable father-son time

After lots of evaluation, Archer was approved for the surgery. So he and I packed up and moved from our home in Portland, Oregon, to Seattle Children's Hospital. We were in the hospital for five weeks. That sounds rough, but it was a sweet time, just two guys hanging out together. When Archer asked to go fishing one day, the hospital organized an entire excursion for us. I was shocked that being in the hospital was truly fun.

But there was plenty of hard work, too. For the first three days after the surgery, Archer had to lay completely flat. After that he had physical therapy twice a day, plus a daily session of occupational therapy.

The change in Archer was immediate. Doctors had warned us he might go home in a wheelchair. Instead, Archer walked out of the hospital himself, dressed as Captain America. When we got home he started playing soccer with his sister right away.

Archer has come out of his shell

Browd said that research around SDR can point to physical outcomes, like an improved ability to walk. But patients often notice other benefits that are even more important. That's certainly been the case for our family.

Archer was always a quiet, shy kid. But now that he is more confident in his body, he's come out of his shell. He can play rough and tumble with his sister, who's a year older than him. We hike and bike together. He even played baseball last summer, something I never thought I'd see. Nine months after the surgery, Archer doesn't hold back on anything — he dives in head first.

As a parent, that's been transformational. I no longer have to worry about watching and protecting Archer every minute of the day. Now, I get to experience his life with him, not constantly making sure he won't get hurt.

Read the original article on Insider

occupational therapy cerebral palsy case study

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Physical And Occupational Therapy Case Study

Jackson Brown is a 65 year old single male, no children. He is present at Ochsner due to being found down by his neighbor. Social worker met with patient and his sister, Annie Taylor at his hospital bedside. His sister is the legal next of kin and primary support. Patient and sister reported patient lives alone and has been experiencing frequent falls and difficulty with self care. Both request skilled nursing facility admission for physical and occupational therapy....

occupational therapy cerebral palsy case study

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...August 8, 2011 Project Topic: Autism Spectrum Disorder (ASD) “Putting Together the Pieces” Introduction:. The diagnosis of autism in one’s child can shatter a parent. There is a substantial amount of confusion and controversy found in all areas of the disorder, from diagnosis to treatment. Most parents who seek treatment for a child labeled with autism face many dead-ends and obstacles concerning what are best for their child. . Having a child who is autistic will be a struggle throughout both of your lives. Autism Spectrum Disorder (ADS) adversely affects a child’s communication, socialization, and behavior. It has symptoms ranging from mild cognitive, social, and behavioral deficits to more severe symptoms where children may suffer from intellectual disabilities and be nonverbal. The five subtypes of ASD are: Autistic Disorder, Asperger’s Syndrome, Childhood Disintegrative Disorder (CDD), Rett Syndrome, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). Because each are so broad, I narrowed down my research to Autism Disorder, a sever disorder that affects the development and function of the brain. It causes problems in such areas as social contact, emotional response, intelligence, language and speech impediments, along with ritualistic or compulsive behaviors, as well as different responses to the environment that an autistic individual may have that differ with individuals not having autism would exhibit. I will be talking generally about......

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...Dom (case study) By: Dian Herron ota/s Diagnosis • Dom has a CVA • He has a history of hypertension • Dom also had a coronary bypass • His CVA has affected his left side Demographics • Dom is 56yrs old • He lives with his wife of 30yrs in a first floor condominum on Miami beach. • Dom's primary residence is in NY, but lives in FL during the winter months. • He is on disability from the NY fire department due to cardiac problems and a CVA 3yrs ago. Etiology • Stroke can affect many aspects of vision, and visual losses after stroke decrease safety. • As in Dom's case he has a left visual field cut and left side inattention. Tactile deficits in touch, pain, pressure, temperature, and proprioception are common after a stroke. Body awareness deficits affects knowledge of body construction, spatial relationships, awareness of body parts in relation to one another and right and left discrimination. • Dom's sensation in his left upper extremities are mildly impaired for light touch, superficial pain, and stereognosis. • Dom suffered a CVA during surgery for a coronary bypass. A stroke occurs when the blood supply to your brain is interrupted or reduced. This deprives your brain of oxygen and nutrients, which can cause your brain cells to die. Medications, medical management, surgical intervention Dom's case makes no mention of any medications in the past or currently that he is taking. For scenario process a doctor may......

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Key to CP

Client background:

Tom is a 3 year old boy, born at 28 weeks. He has a diagnosis of evolving dyskinetic Cerebral Palsy, GMFCS V. Tom has a history of seizures.

Pia met Tom while teaching a therapist course about the Key to CP approach. Tom was a demo child, meaning he only spent about an hour with Pia.

Tom was not receiving direct Physical Therapy at home and he did not have any positioning equipment at the time. He was spending his days held by caregivers or on the floor.

Tom’s journey

See how doing the right thing, at the right time, in the right order helped set the stage for Tom to develop play and communication skills during an hour therapy session at Key to CP in this case study, or continue reading below.

Goals before treatment:

Family goals for Tom were to achieve better trunk and head control, to gain strength, and to achieve a level of independence.

It was quickly clear that Tom need support of his trunk in order to improve his head and trunk control for sitting and standing. At Key to CP we often use trunk orthoses to help the child gain upright control. For Tom, a TheraTogs garment was the obvious choice.

occupational therapy cerebral palsy case study

As soon as Tom was fitted with TheraTogs there was an immediate improvement in his head and trunk control. He became much more animated and was easily interacting with his parents and with me. He gained a whole new perspective of the world in just the 15 minutes it took to fit him with TheraTogs.

occupational therapy cerebral palsy case study

Tom’s parents were surprised to see the changes and they immediately ordered TheraTogs for him. They were also able to try a corner seat and a low table and Tom was happy and interactive.

occupational therapy cerebral palsy case study

What does this case teach us? If a child with poor trunk and head control is given the right trunk support, not only does their body control improve, but also their ability to interact with their environment. For Tom, TheraTogs brought his trunk muscles into mid-range alignment (where they are strongest) and the compression gave him sensory input. This tool allowed Tom to better experience his body in relation to his environment. 

It also teaches us that when children have to struggle less to maintain body control, they can focus on communication and learning more.

Tom is now able to develop communication and play skills, and he can participate in activities with his family. 

And it took less than an hour to bring about this transformation.

Doing the RIGHT thing

Adding TheraTogs and appropriate seating, and most importantly, abundant parent coaching

At the RIGHT time

Giving Tom an opportunity to PARTICIPATE and create positive neuroplastic changes during the first window of abundant brain growth and development

In the RIGHT order

Alignment, Awareness, Activation and Strength

Tom feels much more stable in TheraTogs. We have noticed lately how his head control is coming along and he is really looking up and engaging with everyone, especially his sister. He has been a lot more vocal too. And he is being much more aggressive with telling me he is hungry by sticking his tongue out. He is so content in his new chair that I almost cannot believe it. We feel energized and grateful to have found you. Tom's mother

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occupational therapy cerebral palsy case study

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Occupational Therapy for Children with Cerebral Palsy: a Systematic Review

occupational therapy cerebral palsy case study

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Physical & Occupational Therapy In Pediatrics

The lower the physical function, the higher the quality of life in japanese adolescents with cerebral palsy.

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To investigate the factors that contribute to subjective quality of life (QOL) in adolescents with cerebral palsy (CP).

We evaluated the subjective QOL in 51 adolescents with CP through interviews using the Japanese version of KIDSCREEN-27 (J-KIDSCREEN-27) and compared the scores with those of 60 typically developing adolescents. Correlations of subjective QOL with age, sex, the levels of functions (gross motor, manipulation, and communication), intelligence, the level of activity of daily living (ADL), and the type of educational support were examined. Thereafter, we investigated the predictors of the subjective QOL by multiple regression analysis.

The total QOL scores and individual J-KIDSCREEN-27 domains were not significantly different from those of typically developing adolescents. Sex, manipulation and communication functions, and intelligence had no relationship with subjective QOL. Gross motor function and ADL level negatively correlated with satisfaction with the school environment. Multiple regression analysis revealed that higher age predicts lower psychological well-being, lower gross motor function predicts higher satisfaction with the school environment, and attending schools or classes for special needs predicts higher physical well-being.

Conclusions

Seeking adequate support for mildly affected adolescents attending regular classes will be the key to further improving subjective QOL in adolescents with CP.

Acknowledgments

We thank all the participants and medical staff members of Bobath Memorial Hospital of Omichikai Social Medical Corporation for their help with this research. We also thank Professor Yasuo Naito at Graduate School of Rehabilitation Science, Osaka Metropolitan University for his very helpful advice.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

MK, AH, and T N designed the study; AH, MK, and KK recruited participants and collected clinical data; MK, KT, and T N statistically analyzed the data. All authors discussed the results and wrote the manuscript.

Additional information

Notes on contributors, masako kato, hiroshi arai, koyu komatsu, kiyomi tateyama, takashi nishikawa, log in via your institution, log in to taylor & francis online, restore content access.

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Cerebral Palsy (CP)

, MD, Akron Children's Hospital

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occupational therapy cerebral palsy case study

Cerebral palsy refers to a group of nonprogressive conditions characterized by impaired voluntary movement or posture and resulting from prenatal developmental malformations or perinatal or postnatal central nervous system damage. Cerebral palsy manifests before age 2 years. Diagnosis is clinical. Treatment may include physical and occupational therapy, braces, medications or botulinum toxin injections, orthopedic surgery, intrathecal baclofen , or, in certain cases, dorsal rhizotomy.

Cerebral palsy (CP) is a group of conditions that causes nonprogressive spasticity, ataxia, or involuntary movements; it is not a specific disorder or single condition.

CP occurs in 2 to 3/1000 live births. The highest prevalence, 111.8/1000 live births, occurs in preterm infants < 28 weeks gestation ( 1 Reference Cerebral palsy refers to a group of nonprogressive conditions characterized by impaired voluntary movement or posture and resulting from prenatal developmental malformations or perinatal or... read more ).

occupational therapy cerebral palsy case study

1. Wimalasundera N, Stevenson VL : Cerebral palsy. Pract Neurol 16(3):184–194, 2016. doi: 10.1136/practneurol-2015-001184

Etiology of Cerebral Palsy

Intracranial Hemorrhage

Examples of types of CP are

Spastic diplegia after preterm birth

Spastic quadriparesis after perinatal asphyxia

Athetoid and dystonic forms after perinatal asphyxia or kernicterus

CNS trauma or a severe systemic disorder (eg, stroke, meningitis, sepsis, dehydration) during early childhood (before 2 years of age) may also cause CP.

Symptoms and Signs of Cerebral Palsy

Before a specific type develops, symptoms include lagging motor development and often persistent infantile reflex patterns, hyperreflexia, and altered muscle tone.

Types of cerebral palsy

CP is categorized mainly as one of the following, depending on which parts of the CNS are malformed or damaged ( 1 Symptoms and signs references Cerebral palsy refers to a group of nonprogressive conditions characterized by impaired voluntary movement or posture and resulting from prenatal developmental malformations or perinatal or... read more , 2 Symptoms and signs references Cerebral palsy refers to a group of nonprogressive conditions characterized by impaired voluntary movement or posture and resulting from prenatal developmental malformations or perinatal or... read more ):

Spastic CP is the most common type and occurs in > 80% of cases ( 2 Symptoms and signs references Cerebral palsy refers to a group of nonprogressive conditions characterized by impaired voluntary movement or posture and resulting from prenatal developmental malformations or perinatal or... read more ). Spasticity is a state of resistance to passive range of motion; resistance increases with increasing speed of that motion. It is due to upper motor neuron involvement and may mildly or severely affect motor function. Spastic CP may cause hemiplegia, quadriplegia, diplegia, or paraplegia. Usually, deep tendon reflexes in affected limbs are increased, muscles are hypertonic, and voluntary movements are weak and poorly coordinated. Joint contractures develop, and joints may become misaligned. A scissors gait and toe walking are typical. In mild cases, impairment may occur only during certain activities (eg, running). Corticobulbar impairment of oral, lingual, and palatal movement, with consequent dysarthria or dysphagia, commonly occurs with quadriplegia.

Athetoid CP or dyskinetic CP is the second most common type. It occurs in about 15% of cases and results from basal ganglia involvement. Athetoid or dyskinetic CP is defined by slow, writhing, involuntary movements of the proximal extremities and trunk (athetoid movements), often activated by attempts at voluntary movement or by excitement. Abrupt, jerky, distal (choreic) movements may also occur. Movements increase with emotional tension and disappear during sleep. Dysarthria occurs and is often severe.

Ataxic CP is rare and results from involvement of the cerebellum or its pathways. Weakness, incoordination, and intention tremor cause unsteadiness, a wide-based gait, and difficulty with rapid or fine movements.

Mixed CP is common—most often with spasticity and athetosis.

A tool called the Gross Motor Function Classification System–Expanded and Revised (GMFCS–E&R) can be used to describe the gross motor function of children with CP. The system categorizes gross motor function into 5 different groups. It provides a description of current motor function that helps identify current and future needs for mobility aids.

Findings associated with cerebral palsy

Strabismus

Many children with spastic hemiplegia or diplegia have normal intelligence; children with spastic quadriplegia or mixed CP may have severe intellectual disability Intellectual Disability Intellectual disability is characterized by significantly subaverage intellectual functioning (often expressed as an intelligence quotient < 70 to 75) combined with limitations of adaptive... read more .

Symptoms and signs references

2. Monbaliu E, Himmelmann K, Lin JP, et al : Clinical presentation and management of dyskinetic cerebral palsy. Lancet Neurol 16(9):741–749, 2017. doi: 10.1016/S1474-4422(17)30252-1

Diagnosis of Cerebral Palsy

Sometimes testing to exclude hereditary metabolic or neurologic disorders

If CP is suspected, identifying the underlying disorder is important. History may suggest a cause. A brain MRI can detect abnormalities in most cases.

CP can rarely be confirmed during early infancy, and the specific type often cannot be characterized until 2 years of age. High-risk children (eg, those with evidence of asphyxia, stroke, periventricular abnormalities seen on cranial ultrasonography in preterm infants, jaundice, meningitis, neonatal seizures, hypertonia, hypotonia, or reflex suppression) should be followed closely.

Differential diagnosis

CP should be differentiated from progressive hereditary neurologic disorders and disorders requiring surgical or other specific neurologic treatments.

Ataxic CP is particularly hard to distinguish, and in many children with persistent ataxia, a progressive cerebellar degenerative disorder is ultimately identified as the cause.

Athetosis, self-mutilation, and hyperuricemia in boys indicate Lesch-Nyhan syndrome Lesch-Nyhan syndrome Purines are key components of cellular energy systems (eg, ATP, NAD), signaling (eg, GTP, cAMP, cGMP), and, along with pyrimidines, RNA and DNA production. Purines may be synthesized de novo... read more .

Tuberous Sclerosis Complex (TSC)

Infantile spinal muscular atrophy, muscular dystrophies, and neuromuscular junction disorders associated with hypotonia and hyporeflexia usually lack signs of cerebral disease.

Adrenoleukodystrophy X-linked adrenoleukodystrophy Peroxisomes are intracellular organelles that contain enzymes for beta-oxidation. These enzymes overlap in function with those in mitochondria, with the exception that mitochondria lack enzymes... read more begins later in childhood, but other leukodystrophies begin earlier and may be mistaken for CP at first.

Identification of a cause

Tay-Sachs Disease and Sandhoff Disease

Other progressive disorders (eg, infantile neuroaxonal dystrophy) may be suggested by nerve conduction studies and electromyography. These and many other brain disorders that cause CP (and other manifestations) are being increasingly identified with genetic testing (eg, microarray analysis, CP spectrum disorders gene panel, whole exome sequencing analysis), which may be done to check for a specific disorder or to screen for many disorders.

Treatment of Cerebral Palsy

Physical and occupational therapy

Braces, constraint therapy, medications, or surgery to treat spasticity

Botulinum toxin injections

Intrathecal baclofen

Assistive devices

Physical therapy and occupational therapy for stretching, strengthening, and facilitating good movement patterns are usually used first and are continued. Bracing, constraint therapy, and medications may be added.

Botulinum toxin may be injected into muscles to decrease their uneven pull at joints and to prevent fixed contractures.

Baclofen , benzodiazepines (eg, diazepam ), tizanidine , and sometimes dantrolene may diminish spasticity. Intrathecal baclofen (via subcutaneous pump and catheter) is the most effective treatment for severe spasticity.

Orthopedic surgery (eg, muscle-tendon release or transfer) may help reduce restricted joint motion or misalignment. Selective dorsal rhizotomy, done by neurosurgeons, may help a few children if spasticity affects primarily the legs and if cognitive abilities are good.

When intellectual limitations are not severe, children may attend mainstream classes and take part in adapted exercise programs and even competition. Speech training or other forms of facilitated communication may be needed to enhance interactions.

Some severely affected children can benefit from training in activities of daily living (eg, washing, dressing, feeding), which increases their independence and self-esteem and greatly reduces the burden for family members or other caregivers. Assistive devices may increase mobility and communication, help maintain range of motion, and help with activities of daily living. Some children require varying degrees of lifelong supervision and assistance.

Many children's facilities are establishing transition programs for patients as they become adults and have fewer supports to help with special needs.

Parents of a child with chronic limitations need assistance and guidance in understanding the child’s status and potential and in dealing with their own feelings of guilt, anger, denial, and sadness (see Effects on the family Effects on the family Chronic health conditions (both chronic illnesses and chronic physical disabilities) are generally defined as those conditions that last > 12 months and are severe enough to create some limitations... read more ). These children reach their maximal potential only with stable, consistent parental care and the assistance of public and private agencies (eg, community health agencies, vocational rehabilitation organizations, lay health organizations such as United Cerebral Palsy ).

Prognosis for Cerebral Palsy

Most children survive to adulthood. Severe limitations in sucking and swallowing, which may require feeding by gastrostomy tube, decrease life expectancy.

The goal is for children to develop maximal independence within the limits of their motor and associated deficits. With appropriate management, many children, especially those with spastic diplegia or hemiplegia, can lead near-normal lives.

Cerebral palsy (CP) is a group of conditions (not a specific disorder) that involve nonprogressive spasticity, ataxia, and/or involuntary movements.

Etiology is often multifactorial and sometimes unclear but involves prenatal and perinatal factors that are associated with central nervous system (CNS) malformation or damage (eg, genetic and in utero disorders, prematurity, kernicterus, perinatal asphyxia, stroke, CNS infections).

Intellectual disability and other neurologic manifestations (eg, strabismus, deafness) are not part of CP but may be present depending on the cause.

Symptoms manifest before 2 years of age; later onset of similar symptoms suggests another neurologic disorder.

Do brain MRI and, if needed, testing for hereditary metabolic and neurologic disorders.

Treatment depends on the nature and degree of disability, but physical therapy and occupational therapy are typically used; some children benefit from bracing, botulinum toxin, benzodiazepines, other muscle relaxants, intrathecal baclofen , and/or surgery (eg, muscle-tendon release or transfer, rarely dorsal rhizotomy).

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

CanChild: Gross Motor Function Classification System–Expanded and Revised (GMFCS–E&R) : A tool for describing the gross motor function of children with CP (available in many languages)

United Cerebral Palsy: Provides information about therapy, early intervention programs, and support services for people who have cerebral palsy and other disabilities

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Mirror therapy and action observation therapy to increase the affected upper limb functionality in children with hemiplegia: a randomized controlled trial protocol.

occupational therapy cerebral palsy case study

1. Introduction

2. materials and methods, 2.1. study design, 2.2. sample size, 2.3. participants.

2.4. Procedures and Interventions

2.5. outcome measures, 2.5.1. spontaneous use, 2.5.2. manual ability, 2.5.3. surface electromyography (emg) of extensors and flexors muscles of the wrist, 2.5.4. grasp strength, 2.6. data analysis, 2.7. ethical aspects, 3. discussion, 4. conclusions, author contributions, institutional review board statement, informed consent statement, acknowledgments, conflicts of interest.

Share and Cite

Palomo-Carrión, R.; Zuil-Escobar, J.C.; Cabrera-Guerra, M.; Barreda-Martínez, P.; Martínez-Cepa, C.B. Mirror Therapy and Action Observation Therapy to Increase the Affected Upper Limb Functionality in Children with Hemiplegia: A Randomized Controlled Trial Protocol. Int. J. Environ. Res. Public Health 2021 , 18 , 1051. https://doi.org/10.3390/ijerph18031051

Palomo-Carrión R, Zuil-Escobar JC, Cabrera-Guerra M, Barreda-Martínez P, Martínez-Cepa CB. Mirror Therapy and Action Observation Therapy to Increase the Affected Upper Limb Functionality in Children with Hemiplegia: A Randomized Controlled Trial Protocol. International Journal of Environmental Research and Public Health . 2021; 18(3):1051. https://doi.org/10.3390/ijerph18031051

Palomo-Carrión, Rocío, Juan Carlos Zuil-Escobar, Myriam Cabrera-Guerra, Paloma Barreda-Martínez, and Carmen Belén Martínez-Cepa. 2021. "Mirror Therapy and Action Observation Therapy to Increase the Affected Upper Limb Functionality in Children with Hemiplegia: A Randomized Controlled Trial Protocol" International Journal of Environmental Research and Public Health 18, no. 3: 1051. https://doi.org/10.3390/ijerph18031051

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IMAGES

  1. Children With Cerebral Palsy

    occupational therapy cerebral palsy case study

  2. Cerebral Palsy And Occupational Therapy

    occupational therapy cerebral palsy case study

  3. The Impact Of Occupational Therapy And Cerebral Palsy

    occupational therapy cerebral palsy case study

  4. Ways Physical Therapy Helps Children with Cerebral Palsy

    occupational therapy cerebral palsy case study

  5. Occupational therapy in cerebral palsy

    occupational therapy cerebral palsy case study

  6. Occupational Therapist in Mumbai, India

    occupational therapy cerebral palsy case study

VIDEO

  1. Jasmine meets Alex and gets a special surprise!

  2. Joint Compression Therapy । Occupational Therapy । Autism ।ADSD। Cerebral Palsy

  3. Improving physiotherapy services for adults with cerebral palsy #BSL #englishsubtitles

  4. Join Blue Bird Day's Multidisciplinary Therapy Team!

  5. Learning to Adapt with Cerebral Palsy

  6. Christina Using Stander

COMMENTS

  1. Occupational therapy for children with cerebral palsy: a systematic

    Occupational therapy for children with cerebral palsy: a systematic review Despite the reasonable number of studies identified, the inconclusive findings regarding the efficacy of occupational therapy for children with cerebral palsy may be a reflection of the difficulties in efficacy research in OT for children with CP.

  2. Occupational Therapy and Cerebral Palsy

    Occupational therapy (OT) is an integral part of a Cerebral Palsy patient's overall treatment program. The goal of occupational therapy is to promote a child's ability to perform daily rituals and activities in a way that will enhance their quality of life and make possible the enjoyment of independent living.

  3. Description of self-care training in occupational therapy: Case studies

    The purpose of this prospective case study design was to describe the changes in dressing skills for five Kenyan children with cerebral palsy who participated in a 10-week occupational therapy intervention programme. The training sessions were individually designed to meet the needs of the child.

  4. Cerebral Palsy- Young Adult Case Study

    Introduction This case study involves Nathanial, an adult male living with Cerebral Palsy (CP). He is an active, 24 year old male who presents to physiotherapy with hip pain. Nathaniel was diagnosed with CP when he was 5 years old and has experienced intermittent hip pain since his teenage years.

  5. Evidence-Based Occupational Therapy Practice for Cerebral Palsy

    CIMT. Constraint-induced movement therapy constrains the dominant hand in a mitt or a cast to enable intensive training in the hemiplegic hand. For children with CP, CIMT was found to improve hand function of the hemiplegic hand. This approach is supported by randomized-control trials including reviews that confirm its effectiveness.

  6. Case Study: Cerebral Palsy

    This case study focuses on the physical therapy management of Kayla, a young woman with spastic, diplegic cerebral palsy (CP). Kayla is now 20 years old and a sophomore in college. She was born prematurely and has received physical therapy services in a variety of settings since infancy.

  7. Case Study For Cerebral Palsy Treatment

    Post her cell therapy for cerebral palsy treatment in Mumbai, Baby AR showed major improvements in balance and neck holding. Her grip and hand movements showed improvements as compared to before and the rigidity in her legs also reduced. "Dealing with a child having cerebral palsy is a full time job. When my daughter was diagnosed with ...

  8. Case Study

    Case Study - Cerebral PalsY Case Studies: Looking at the different types of Cerebral Palsy Quadriplegia Spastic Cerebral Palsy (Quadriplegia) Abby is a four year old girl who has decreased trunk, shoulder, and pelvic girdle mobility. She has voluntary and involuntary movements in both upper and lower extremities. Her muscles are hypertonic.

  9. PDF Case Study

    Case Study: Preschool-Age Child with Cerebral Palsy / Diplegia / Constipation IF THE EXAMINER ASKS: "What therapies is he receiving?" Parent SP: "Physical therapy, occupational therapy and speech therapy 5 times a week! It wears both of us out." IF THE EXAMINER ASKS, PARENT SP RESPONDS TO THE FOLLOWING QUESTIONS: Belly pain:

  10. occupational therapy for children with cerebral palsy

    Occupational therapy for spastic Cerebral Palsy can include: Self care interventions Participation in meaningful activities Education on adaptive tools Build on strengths Manage sensory and emotional regulation needs NDT interventions Splinting Positioning Adaptive equipment Compensatory techniques

  11. Occupational Therapy for Cerebral Palsy

    Occupational therapy for cerebral palsy Occupational therapy can help with managing everyday activities and functions, like eating, getting dressed and using the bathroom. It does so by improving physical and cognitive ability and fine motor skills. Medically Reviewed by: Kristin Proctor, RN Registered Nurse (RN) Page highlights

  12. (PDF) Occupational therapy for children with cerebral palsy

    The management of a person with cerebral palsy, with the objective of optimizing the person's ability to function, typically includes the input of many disciplines, including medical, physical ...

  13. Comparison of Priority Occupational Performance of Children with

    Physiotherapy and occupational therapy for people with cerebral palsy: A problem-based approach to assessment and management. John Wiley & Sons; 2010. 32. Storvold GV, Jahnsen R. Intensive motor skills training program combining group and individual sessions for children with cerebral palsy. Pediatr Phys Ther. 2010;22(2):150-9.

  14. Occupational therapy for children with cerebral palsy: a systematic

    Conclusion: Despite the reasonable number of studies identified, the inconclusive findings regarding the efficacy of occupational therapy for children with cerebral palsy may be a reflection of the difficulties in efficacy research in OT for children with CP. Future research should critically reflect on methodological issues.

  15. When my son was born with cerebral palsy, I thought we'd never play

    When my son was diagnosed with cerebral palsy at a year old, I thought about the activities I'd done that I hoped to one day share with him — sports, especially baseball, and military service. Those seemed totally unobtainable. Of course, it wasn't just my hopes and dreams — cerebral palsy affected Archer daily. Once, the day care he went ...

  16. Physical And Occupational Therapy Case Study

    Occupational Therapy Case Study Essay ... demonstrating the results suit therapy can have on children who have cerebral palsy. The study concluded that suit therapy, when combined with other therapies, is an effective intervention for spastic diplegic cerebral palsy. This source is credible because it was published in the Online Journal of ...

  17. Case 7: Tom

    Tom is a 3 year old boy, born at 28 weeks. He has a diagnosis of evolving dyskinetic Cerebral Palsy, GMFCS V. Tom has a history of seizures. Pia met Tom while teaching a therapist course about the Key to CP approach. Tom was a demo child, meaning he only spent about an hour with Pia.

  18. The effect of the combination of active vestibular intervention and

    Abstract : Objective: This study aimed to examine the effect of the combination of active vestibular interventions and occupational therapy on balance, and the relationship between balance changes and Activity of Daily Living in school-aged children with cerebral palsy (CP). Materials & Methods: Twenty-four children with Spastic CP, at level I and II according to the "Gross Motor Function ...

  19. The Open Journal of Occupational Therapy

    The Open Journal of Occupational Therapy Volume 9 Issue 3 Summer 2021 Article 8 July 2021 Use of a Caregiver Coaching Model for Implementation of Intensive Motor Training for Hemiplegic Cerebral Palsy: A Case Study Sheryl Eckberg Zylstra University of Puget Sound - USA, [email protected] Aimee Sidhu

  20. Occupational Therapy for Children with Cerebral Palsy: a...

    Clinical Rehabilitation http://cre.sagepub.com Occupational therapy for children with cerebral palsy: a systematic review Esther MJ Steultjens, Joost Dekker,...

  21. Cerebral Palsy Case Study Occupational Therapy

    Cerebral Palsy Case Study Occupational Therapy Plagiarism report You are free to order a full plagiarism PDF report while placing the order or afterwards by contacting our Customer Support Team. 1513 Orders prepared Need a personal essay writer? Try EssayBot which is your professional essay typer.

  22. The Lower the Physical Function, the Higher the Quality of Life in

    Masako Kato is an occupational therapist, a lecturer in the Department of Occupational Therapy, Faculty of Rehabilitation at Kobe Gakuin University, and a doctoral student in the Department of Occupational Therapy, Graduate School of Rehabilitation Science at Osaka Metropolitan University. Her research focuses on support for children with ...

  23. Cerebral Palsy (CP)

    Cerebral palsy refers to a group of nonprogressive conditions characterized by impaired voluntary movement or posture and resulting from prenatal developmental malformations or perinatal or postnatal central nervous system damage. Cerebral palsy manifests before age 2 years. Diagnosis is clinical. Treatment may include physical and occupational ...

  24. Cerebral Palsy Awareness Teaching Resources

    Disability Awareness Cerebral Palsy Story l Intermediate. by. Deborah SLT. $4.00. PDF. Download a disability awareness book featuring a child with cerebral palsy (physical disability) who uses a wheelchair, plays adapted toys (toys with switches, large knobs and book fluffers/Ebooks) and uses a communication system to talk.

  25. Cerebral Palsy Case Study Occupational Therapy

    The first step in making your write my essay request is filling out a 10-minute order form. Submit the instructions, desired sources, and deadline. If you want us to mimic your writing style, feel free to send us your works. In case you need assistance, reach out to our 24/7 support team.

  26. IJERPH

    The movements of the affected upper limb in infantile hemiplegia are slower and clumsy. This leads to a decrease in the use of the affected hand. The visual effect obtained using the mirror box and the observation of actions in another individual can activate the same structural neuronal cells responsible for the execution of these actions. This research will study the affected upper limb ...