Cerebral Palsy (CP) is a group of non-progressive disorders resulting from damage to the brain during development. These disorders impact movement, muscle tone and coordination. There are three types of CP including Spastic, Athetoid, and Ataxic.
Symptoms
Physical
- Changes in muscle tone (e.g. hypotonia and hypertonia)
- Changes in reflexes (i.e. clonus, hyperreflexia)
- Abnormal posture (i.e. misalignment, contractures)
- Delayed motor development
- Difficulty swallowing
- Potential changes in vision
- Greater potential for seizures
Cognitive
- Potential cognitive impairment
Affective
- Potential behaviour challenges
Assessments
Physical
- Seating Assessment
- Ashworth Scale (for Spasticity)
- Gross Motor Function Classification Scale
- Peabody Developmental Motor Scales
Cognitive
Affective
- Antecedent-Behaviour-Consequence (ABC) Chart
Function
- Canadian Occupational Performance Measure (COPM)
- Children Assessment of Participation and Enjoyment (CAPE)
Common Occupational Performance Issues (OPIs)
Self-Care
- Difficulty with functional mobility
- Difficulty with independent transfers to/from the toilet, bath, bed, car, furniture, wheelchair
- Difficulty managing orthotics and dressing
- Difficulty with independent bathing and perineal care
- Difficulty managing sleeping positions
- Difficulty chewing, swallowing, feeding, and speaking
Productivity
- Difficulty navigating community and school environment
- Difficulty reading and writing
- Difficulty engaging in classroom activities and keeping up with peers
- Potential learning difficulties
- Potential behavioural challenges in the school environment
Leisure
- Difficulty with independent positioning to effectively engage in play
- Barriers to play exploration due to changes in functional mobility and environmental barriers
Frames of Reference
- Biomechanical
- Neurodevelopmental
- Environmental
- Compensatory
- Behavioural
Interventions
Self-Care
Spasticity: orthotics to prevent contractures and facilitate mobility, education regarding orthotic care and use, exercise programs, Constraint-Induced Movement Therapy (CIMT), bolters for sleeping to prevent contractures
Mobility: assistive device prescription, education regarding safe use of assistive devices, education regarding safe transfer and mobility techniques, home modifications, education and coaching regarding energy conservation techniques
Dressing: forward / backward chaining, shaping, Cognitive Orientation to Occupational Performance (CO-OP), assistive dressing tools, education regarding safe and proper use of dressing tools
Toileting: adapted toileting devices to increase stability, education on perineal care techniques to facilitate independence
Bathing: assistive devices to increase safety in the bath/shower, education regarding the safe and proper use of assistive devices, home modifications
Eating: assistive devices to promote proper positioning while eating, education regarding safe and proper use of assistive devices, adapted eating utensils, education regarding safe and proper use of adapted eating utensils, education regarding care and proper use of enteral feeding tube
Productivity
Community Mobility: car adaptations (i.e. ramps, lifts), coordination of adapted public transport, education regarding safe community mobility, advocacy for accessible environments
School Engagement: advocate for accessible school environment, assist with the creation of an individualized education plan (IEP), provide recommendations for differentiated instruction and classroom organization, educate educational assistants about how to assist client with required transfers, motor skill development
Leisure
Play Exploration: facilitate proper positioning during play to enable client to explore play tools and environments, educate and coach parents on proper positioning during play, facilitate exposure to accessible leisure activities and environments
Play Participation: assistive technology to enable maximum engagement in play and leisure opportunities, education regarding safe and proper use of assistive technology