Pediatric Physical Therapy for Cerebral Palsy: An Overview

Pediatric physical therapy for cerebral palsy is designed to help children develop strength, coordination, and balance to maximize their functional abilities. It also works to improve posture, movement, and motor development, as well as enhance a child’s ability to interact with their environment. Additionally, physical therapy can help to reduce pain, prevent further decline in mobility, and minimize the risk of secondary medical conditions. In summary, the goal of pediatric physical therapy for cerebral palsy is to improve a child’s quality of life, and ability to participate in activities.

CP is a neurological disorder that affects movement and muscle coordination, primarily due to damage to the developing brain. It presents in multiple ways, from mild to severe. Physical therapy helps children with CP achieve their maximum potential.

Areas of Evaluation in Physical Therapy

A therapist will evaluate some or all of these areas, to help create a personalized therapy plan for the child:

• Gait
• Range of joint motion: children with cerebral palsy often have limited range of motion. Range of motion limitations impact their ability to carry out day to day activities. PTs work on improving range of motion through stretching and strengthening exercises, and joint mobilization. The goal is to alleviate muscle stiffness, improve flexibility, and enhance the overall functioning of joints that are impacted
• Physical strength
• Flexibility
• Balance
• Endurance
• Posture
• Neuromotor development
• Sensory integration
• Cognitive functioning
• Reflexes
• Breathing, respiration

Benefits of Physical Therapy for Children with CP

Some of the most common benefits to the kiddos are:

Improved Balance and Coordination: Strengthening muscles and improving range of motion allow the kiddos to develop improved balance and coordination.

Increased Independence: Empowering kiddos to move, increase their strength and see progress resulting from their efforts, allows them to experience increased self-confidence which translates to greater independence.

Improved Mobility: The work that kiddos do in their physical therapy sessions helps them achieve greater control over their movements, making it easier to move around space and participate in various important activities in their daily life.

Decreased Pain and Discomfort: Muscle tightness and joint stiffness can be alleviated through physical therapy which decreases pain and discomfort that is common for kiddos with CP.

What are the Goals for Physical Therapy for Kiddos with CP?

The main goals of pediatric physical therapy for cerebral palsy are:

1. Improving the kiddos’ functional mobility. This includes moving, sitting, standing and walking. In some cases, kiddos can’t do any or all of those movements. It is always the goal to try to improve from their baseline and build from there. If the child can’t walk or sit or stand on their own, there are adaptive devices that can help. 
2. Building muscle strength and endurance. The stronger the kiddo is and the more endurance they have, the better they can move and maintain good posture.
3. Improving balance and coordination, which helps kiddos be safer in their movements.
4. Preventing secondary complications that develop as a result of inactivity. Contractures and various other challenges may arise muscle tightness or joint stiffness that is not addressed.

What are the Expected Outcomes of Physical Therapy?

The expected outcomes vary based on the child’s unique needs and the severity of their cerebral palsy. Possible outcomes include (but aren’t limited to):

• The kiddo is better able to participate in daily activities and interact with family in friends
• Increased independence and confidence improve the kiddos quality of life
• The risk of falls and injuries are decreased
• Decrease in secondary health conditions and hospital stays

The Use of Assistive Devices in Pediatric Physical Therapy

Assistive devices often play a significant role in physical therapy for kiddos with CP. The devices are designed to provide support, and stability, and of course, improved functioning in daily activities.

Common assistive devices include:

Orthoses

Orthoses are commonly used in pediatric physiotherapy for children with CP. They provide support and stability to affected joints, which improves alignment and allows for promote proper movement patterns. Some common types of orthoses include:

Wrist-Hand Orthosis (WHO): WHO braces provide support to the wrist and hand of the kiddo, enabling them to have greater hand functionality and fine motor skills.

Ankle-Foot Orthosis (AFO): AFOs are used to support the ankle and foot, which improves stability for kiddos while they walk.

Knee-Ankle-Foot Orthosis (KAFO): KAFOs extend from the thigh to the foot and they offer support to the knee, ankle, and foot.

Seating

Seating systems can be customized for specific postural challenges, giving the proper support and alignment needed to prevent complications.

Gait Trainers and Walkers

Gait trainers and walkers offer support and stability to children with CP, promoting proper gait patterns. Gait trainers can be customized to a kiddo’s specific needs, and they can be adjusted as the child grows or has changing needs. These devices can be equipped with accessories, such as forearm supports, pelvic harnesses, or swivel wheels.

Robotic Gait Trainers

Robotic gait trainers, such as the Trexo, can be used to help get kiddos upright and walking, without requiring a PT to manually move the kiddo. Postural support is available to help children who have challenges with weight bearing, or trunk and neck control. Trexo offers kiddos the repetitive motion needed for neuroplasticity, and also ensure the child is walking with the correct gait pattern. The are various modes and features on the Trexo that help therapists who are focusing on ambulation.

Other Therapeutic Options

Some facilities will incorporate recreational activities into therapy. Kiddos may get to swim, dance and play games such as throwing and catching a ball. These activities help children develop muscles, balance, coordination and range of motion.

Swimming gives children an opportunity to do exercises they cannot do otherwise, because the child is almost entirely submerged in the water. Moving against the water, kicking and other beneficial exercises can be done in a pool. This gives the children an opportunity to play and have fun.

At Home

Often there are exercises that parents can do with their kiddo at home. PTs will communicate with the parents to get this going.

Physical therapy for kids is effective for rehabilitation from an injury, and is equally as important for children with CP.