Occupational therapy for cerebral palsy

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.

Occupational therapy can help children by:

• Increasing their chance for independence
• Improving their ability to play and learn
• Boosting their self-esteem and confidence
• Helping them develop a workable routine
• Giving them a sense of accomplishment
• Improving their quality of life

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:

• Reducing demands on them
• Reducing stress
• Providing a sense of security
• Improving their quality of life
• Allowing them to watch their child improve and become independent

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:

• Spastic -  Muscle stiffness in the upper and/or lower limbs and jerky movements characterize spastic cerebral palsy. Among other things, this can lead to difficulty getting dressed, bathing, using the bathroom, eating, drinking, writing, and holding objects.
• Athetoid - Children with athetoid cerebral palsy are unable to regulate muscle tone, which makes it difficult to control their movements. Trouble with grasping objects, posture, drooling, swallowing, and speaking are common among children with athetoid CP.
• Ataxic - Problems with balance and coordination are common among children with ataxic cerebral palsy. These children often struggle with precise movements and have tremors or shakiness. This makes it difficult to perform tasks like writing or eating that require precise finger movements or repetitive movements like clapping.

What to expect in occupational therapy

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 conduct a complete evaluation. They will test your child's fine motor skills, perceptual development, and oral-motor abilities. The therapist will observe how your child responds to touch and movement and interview you about your child’s strengths, weaknesses, and specific goals for therapy.

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:

• Fine Motor Control - Improves hand dexterity by working on hand muscle strength, finger isolations, in-hand manipulations, arching the palm of the hand, thumb opposition, and pincer grasp. Activities include squeezing a clothespin, playing with water squirt toys, and pushing coins into the slot of a piggy bank.
• Bilateral Coordination - Play/movements teach the child to control both sides of the body at the same time, like drumming, pushing a rolling pin and pulling apart construction toys (Legos).
• Upper Body Strength and Stability - Play focuses on strengthening and stabilizing the trunk (core), shoulder, and wrist muscles through exercises, such as crawling, lying on the tummy while reading, playing catch in a kneeling position, and pouring water from a pitcher into a cup.
• Crossing the Midline - These activities, like making figure eights with streamers and throwing balls at a target to the right or left of center, teach the child to reach across the middle of their body with their arms and legs to the opposite side.
• Visual Motor Skills - Improves hand-eye coordination through activities like drawing, stringing beads or macaroni, and catching and throwing a ball.
• Visual Perception - These activities improve the ability to understand, evaluate, and interpret what’s being seen. Activities include alphabet puzzles, playing with different shapes, and matching games.
• Self-Care - Improves the ability to perform activities of daily living and prepares the child to be more independent at home, at school, and in the community. Exercises can be as simple as practicing these ADLs, like brushing their teeth, getting dressed, and self-feeding.

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

• Pediatric Constraint Induced Movement Therapy (CIMT) - Improves the ability to move weaker parts of the body by restraining their stronger counterparts. For a child who has difficulty moving one of their arms, the stronger arm will be completely restrained for a period of time while the weaker arm is strengthened and trained.
• Sensory Integration Therapy - Improves the ability to receive, register, interpret and act on information that comes to the brain through sensory receptors. These activities provide the child with different sensory experiences and can include playing with balls, play dough, silly putty, sand and water, walking on different carpet textures and finger painting.

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.

Tools

• Everyday household items (straws, clothes pins, tweezers, sponges, etc.)
• Books
• Adaptive scissors (with spring closures or grips for easier use)
• Writing utensils
• Splints
• Adaptations to clothing (zipper pulls, button hooks, reachers)
• Toys to help with the development of motor skills
• Games and toys that help with motor and cognitive development

Assistive Devices

• Pencil grips
• Specialized feeding utensils
• Seating and positioning equipment
• Computer software and accessibility
• Household aids and equipment
• School chairs and tables
• Toilet and bathing aids
• Tablets

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.

• Toddlers - Treatment for toddlers revolves around play and learning. Games and toys are used to improve the child’s cognitive and physical development.
• Young Children - Therapy for young children works on improving cognitive and physical development, as well as the child’s ability to perform daily living activities. Occupational therapy can also improve the child’s performance in school and their socialization skills.

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 therapist, 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.