Cerebral palsy treatment

Question 1

Impaired Trunk Control and Sitting Balance

Answer 1

*Evidence: Can only sit unsupported for ~15 minutes; needs moulded wheelchair seat.
*Physiotherapy Plan:
>Core Strengthening:
- Anterior/posterior pelvic tilts in sitting or on a therapy ball.
- Bridging exercises (double and single leg) to activate glutes and core.
>Functional reaching in seated: e.g. reaching for cones across midline.
>Dynamic Sitting Activities:
- Reaching outside base of support while seated to improve reactive balance.
- Lateral weight shifts in supported sitting (progress to unsupported).
>Endurance Training:
- Gradually increase unsupported sitting time with postural corrections.
>Functional Integration:
- Practice seated ADLs (e.g. brushing hair, dressing upper body) in supported → less supported environments.

Question 2

Lower Limb Spasticity and Contractures

Answer 2

*Evidence: Hip flexion/adduction, hamstring/calf tightness, ankle inversion; walking aid use.
*Physiotherapy Plan:
>Stretching and ROM:
- Passive and active-assisted stretching of hip flexors, adductors, hamstrings, and calves.
- Standing frames or prolonged stretches in half-kneeling or long sitting to manage tone.
>Spasticity Management:
- Serial casting or night splints if indicated to reduce contracture risk.
- Liaise with MDT for Botulinum toxin injections if tone limits functional movement.
>Functional Strengthening:
- Squats to a box, sit-to-stand with focus on hip/knee control.
- Use TheraBands to strengthen hip abductors and external rotators.
>Gait Re-education:
- Practice supported walking (e.g. with posterior walker).
- Side-stepping, backwards walking, toe taps to promote symmetry and reduce scissoring gait.

Question 3

Ataxia and Poor Coordination in Upper Limbs

Answer 3

*Evidence: Difficulty using cutlery, writing, grooming.
*Physiotherapy Plan:
>Proprioceptive Training:
- Weighted utensils or wrist weights during fine motor tasks to dampen tremor.
- Closed-chain tasks (e.g., pushing on therapy ball, wall push-ups).
>Motor Control Exercises:
- Practice functional tasks like stacking blocks, threading beads, or guided writing patterns.
>Stabilisation Techniques:
- Use of forearm supports or trunk straps during seated tasks to stabilise proximal control.
>Coordination Practice:
- Ball catching, target reaching, or “nose-finger” tasks to enhance cerebellar engagement.

Question 4

Mobility Limitation and Fatigue

Answer 4

*Evidence: Walks short distances with walking aid; relies on wheelchair when fatigued.
*Physiotherapy Plan:
>Energy Conservation Education:
- Teach activity pacing, rest breaks, and using wheelchair strategically for longer distances.
>Endurance Training:
- Low-impact aerobic activities (e.g., cycling, overground walking in intervals).
- Step-ups, supported treadmill walking, or mini-circuit tasks with frequent rests.
>Gait Training:
- Practice transitions: sit ↔ stand, step ups, forward/backward walking.
- Encourage symmetrical stepping with visual/auditory cues for rhythm.
>Orthotics Review:
- Consider AFOs or SMOs to improve foot alignment and reduce fatigue during walking.

Question 5

Reduced Functional Independence in ADLs

Answer 5

*Evidence: Needs help with bathing, dressing, transfers.
*Physiotherapy Plan:
>Task-Specific Training:
- Practise dressing, grooming, and washing in therapy settings.
- Break tasks into manageable steps (task simplification).
>Transfer Training:
- Practise bed ↔ chair and toilet transfers using grab bars, transfer boards, or supervision.
>Core/Lower Limb Integration:
- Combine core control with reaching and stepping to simulate real-world movements.
- Sit-to-stand with progression to reaching while standing.
>Collaboration with OT:
- Optimise home and school ADL performance via equipment adaptation and fine motor development.
>Assistive Technology:
- Explore adaptive cutlery, grooming aids, and communication support tools.