How Physiotherapy Helps People With Cerebral Palsy
If you or your child has been diagnosed with cerebral palsy, it’s highly likely that physiotherapy will play an important part in your life. For people with cerebral palsy, physiotherapy funded through the NDIS can help with achieving developmental milestones (like the ability to crawl, sit, stand, and walk), gaining independence, and the ability to participate in family and community activities. NDIS physiotherapists work with people with cerebral palsy, and their formal and informal supports, to help them achieve their goals.
Boy with cerebral palsy seated in wheelchair with splints on his arms, playing a game of checkers.
What is cerebral palsyi?
Cerebral palsy (CP) is an umbrella term used to describe a group of disorders caused by damage to the developing brain. Most often, this damage occurs during pregnancy. For many people with CP, the cause is unknown. CP causes motor (movement) difficulties that result in physical disability. The degree of disability varies significantly from one person with CP to another. It can range from minimal (such as weakness in one hand) to profound (such as a total loss of voluntary movement). The most common movement problem experienced by people with CP is called spastic hemiplegia, in which voluntary movement is affected down one side of the body.
In addition to movement issues, people with CP can often experience other difficulties. One in two people with CP have an intellectual disability and one in four have epilepsy. Difficulties with speech, vision, behaviours of concern and feeding are also common.
In Australia, one in 700 babies is diagnosed with CP each year, and approximately 34,000 people are living with the condition. It is the most common physical disability in childhood.
CP is a lifelong condition and there is no cure, but treatment aims to support people with CP to achieve their potential and live rich and meaningful lives.
Cerebral palsy physiotherapy: an overview
As movement experts, NDIS physiotherapists work with children, teenagers and adults who have physical disability related to their CP to help them develop or maintain function, gain independence with daily activities, and even participate in sport and leisure activities.
For people with cerebral palsy, physiotherapy will typically involve:
- discussion about your health history, therapy goals and current circumstances (such as your home situation, availability of supports and other factors which may help to determine how therapy can best be delivered)
- an assessment that looks at how you move and explores potential barriers to achieving your goals
- advice about therapy, exercise and equipment to support you to achieve your goals
- therapeutic supports to assist development or maintenance of motor skills and abilities
- tailored exercise programs to strengthen muscles and improve posture
- stretches to maintain or improve range of movement
- pain management techniques.
If you or your child has CP, your NDIS physiotherapist will tailor a program for you. This means physiotherapy for cerebral palsy will look a bit different for each person. Depending on your needs and goals, physio for people with CP might also involve prescription of assistive technologies, such as walking aids and wheelchairs, that will help you achieve them.
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How physiotherapy can help children with cerebral palsy
If your child has been diagnosed with CP, physiotherapy is often a mainstay of management. Physiotherapists are highly trained in movement and function. They will support your child to achieve their potential for physical function, independence, and ability to participate in family and community life (such as school, social and recreational activities). They use therapies that aim to minimise the impact of your child’s physical impairments and improve quality of life for your child and family.
Because CP is not a single condition, physiotherapy may involve strategies to improve several aspects of movement function, including muscle tone, coordination, muscle control, posture, balance, and gross and fine motor skills.
Cerebral palsy physiotherapy management involves a wide range of techniques and approaches. Your NDIS physiotherapist will work alongside you to find the best approach for your child and family. Some common examples of physiotherapy for cerebral palsy include:
Strengthening exercises
These aim to increase the power of weak muscle groups to support better function, such as the achievement of developmental milestones and fine and gross motor skills.
Functional training
This involves therapeutic exercises and activities to enhance your child’s ability to complete functional tasks, such as walking, jumping, transferring, and climbing stairs.
Aerobic exercise
Exercises that raise the heart and breathing rate over a sustained period (such as walking, cycling and swimming) can help to improve your child’s fitness and ability to participate in sport and recreational activities.
Stretching
Muscle spasticity (increased tension) is a common characteristic of CP. Stretching techniques may be used to improve or maintain range of movement, reduce the risk of muscle shortening and contractures, and improve functional ability (e.g. walking ability).
Casting and splinting
These may be used to provide gentle stretching over a longer period, with a goal of reducing contracture and spasticity and increasing range of motion. Serial casting is a specialised technique which involves repeated applications of a cast, usually every one to two weeks, to gradually increase range of motion.
Pain management
Pain is another common feature of CP. In a 2020 study involving 3545 children and adolescents with the condition, 44% of participants reported experiencing pain, with 36% of these reporting that pain disturbed their sleep, and 61% their daily activities. Over time, physiotherapy may help to relieve pain as range of motion and joint alignment improve. Physiotherapy techniques such as hydrotherapy and heat and cold therapies may also help with pain management.
CP is a complex condition and discovering that your child has a disability can significantly impact your home and family life. This means a multidisciplinary approach to care is important. Physiotherapists work in conjunction with other healthcare professionals, such as doctors, psychologists, occupational therapists, speech pathologists, exercise physiologists, and dietitians, to help ensure your child achieves the best possible outcomes and to support a good quality of life for your child and family.
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How physiotherapy can help adults with cerebral palsy
While individuals with CP should ideally start physiotherapy as early as possible, it is also important for adults. In fact, people with CP can be increasingly affected by disability throughout their lives. Research indicates that people with CP are significantly more likely than those without it to develop several chronic health conditions, including diabetes, lung problems, high blood pressure, other heart conditions, stroke, and joint problems.
Pain is also often an issue for adults living with CP. A recent study, based on data from 1591 people, found two-thirds of adults with CP experienced pain, which the researchers note is likely to be underreported in individuals with communication difficulties. Pain strongly interfered with daily activities and sleep, emphasising the need to manage it more effectively.
Findings like these highlight the need for therapies that promote physical activity and help limit the effect of physical disability on function and overall health. Physiotherapy can help with these goals.
Some examples of physiotherapy interventions for adults with CP include:
Aerobic exercise training – exercises such as walking, cycling, rowing, swimming and boxing can help to improve and maintain healthy heart and lung function. Exercise also activates release of ‘feel good’ hormones which help to improve mood. For some people with CP, exercise may need to be adapted to suit their physical abilities. For example, they might use a modified stationary bike or participate in wheelchair sports.
Strengthening exercises – as the body grows, so does the need for muscle strength. Adequate muscle strength is important for performing everyday tasks, balance, and maintaining upright posture. Your physio might prescribe a variety of exercises to strengthen weak muscle groups. Resistance training exercises, especially those involving weight bearing, can also have benefits for bone health.
Functional task training – your physio might work with you to improve your ability to perform everyday activities, such as transferring from your bed to your wheelchair, maintaining your balance to stand and cut vegetables, or climbing the stairs in your home or workplace.
Stretching – various stretching techniques might be used to improve range of motion and function.
Pain management – as with children and adolescents, physio techniques may assist with managing pain.
It’s important to remember that even small increases in activity can achieve health benefits. A recent study of 40 children and adults with CP found that regular physical activity had enormous benefits for overall health and motor functions, regardless of the intensity and duration.
Your physio will tailor a therapy program aligned to your needs and goals and update it as you make progress.
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