Role of Occupational Therapy in

management of Cerebral Palsy

Mrs Sadhana P. Joshi

Head, O.T. Dept, C.O.H.
What is cerebral palsy

 Cerebral palsy is a disorder of posture and

locomotion due to the lesion in the immature
brain (It is non-progressive and non
unchanging disorder).It is a disorder of
sensory motor functions in which child is
having difficulty in controlling and carrying
out voluntary movements.
What is cerebral palsy cont…

 Thiscentral motor handicap is frequently

associated with impaired speech, vision,
hearing and various types of perceptual
disturbances and some degree of mental
retardation and/ or epilepsy.
Aim of treatment

 Aim of treatment will be to improve the

individuals possibility by re-educating the
movements and pattern through various
therapies. It is long term training
programme. Results of treatment are
more promising if begun at early stage.
Types of Cerebral palsy

 The nature extent and area of lesion

gives rise to many disorders affecting
one or several limbs.
 Spastic – Increased muscle tone.

• Quadriplegia – whole body affected

• Diplegia – legs affected > hands
• Hemiplegia – one hand and one leg affected
• Double hemiplegia – hands affected>legs
Types of Cerebral palsy cont…

 Athetoid
• Movements are uncoordinated, involuntary and are
carried by sudden unpredictable variation in muscle
tone.
 Ataxic
• Movements lack assurance and are awkward and
imbalanced. Mostly muscular tension is free.
• Child may be floppy (Low muscle tone) or mixed type
Therapies

 There are different non-surgical therapies

like
• Phelp,
• Fay,
• Knott,
• Vojta,
• Petto,
• Kabat
• Bobath
• S.I.
• N.D.T.
Neuro Developmental Therapy
 Neuro Developmental Therapy is a form of therapy utilized
with individuals who have C.N.S. disorders resulting in
abnormal movements.
 This treatment approach attempts to facilitate the normal
stages and process in the development of movements.
• CNS Controls movements not muscles
• The sensory systems affects motor functions
• Functional movements requires complex CNS process
• Abnormal tone resulting from CNS dysfunction affects movements
performance
• Acquisition of a functional skill in normal infants and children
provides a system of analysis of abnormal movements
• Dynamic postural controls is necessary for normal movements
Philosophy of N.D.T.
 To get optimum function
 To treat a child as a whole person who functions within family
and society
 Treatment is active movements, can be automatic or voluntary
but not cognitively controlled
 Treat in a frame work of normal development as well as
abnormal
 Team approach necessary to treat the CNS dysfunction
 Teach movements (not huge) constantly assess response
 Input to be constant
 Future – short term and long term goals
 Different treatment in different settings
Philosophy of N.D.T.
 Problem solving
 Helps restore functions
 Gets mobility through positioning
 Facilitate and inhibit
 You can develop your own style
Therapy cont…

 Fundamentals of various systems of

treatment is-
• To improve postural mechanism ( Parachute,
Righting, Equilibrium)
• To improve voluntary movements
• To improve perceptual motor activities
 Therapy cont…

 Occupational Therapists work with a goal to provide services

that enable patients to restore and improve their functional
capacity.

 To attend the above goal, the programme of occupational

therapy addresses the problems concerned with :

7. Posture and balance

8. Muscle tone and strength
9. Gross motor skills
10. Fine motor skills
11. Motor planning
12. Manipulation and constructive play
13. Eye hand coordination
14. Visual motor perception
15. Sensory integration
 .
 Intervention of above problems result in
enhancement of performances of skills like
 Activities of daily living
 Pre academics
 Pre vocational and vocational skills
 In C.O.H. patient is evaluated and assessed
for the motor development of the upper
extremities
Upper Extremity function

 Functionaldevelopment of the upper

extremity depends upon
• Postural adjustability – Child should have a
good head, neck and trunk control , good
righting and equilibrium reactions, good girdle
stability and scatpula humeral dissociation.
Dynamic postural control is necessary for
normal movement
Upper Extremity function cont…

• Neuro muscular status – Abnormal tone

resulting from C.N.S. dysfunction affects
movements performance. Spastic child is
having poverty of movements and athetoid
child is having a problem in stability and mid
range control.
• Perceptual motor ability and sensory
integration function – Organisation of
sensation is defective. Motor adaptive
response is not proper. cont….
Upper Extremity function cont…

cont…
Children are having lot of perceptual problem
like right, left , up down etc. Children are
having problem in visual perception and visio-
motor coordination.
• Sensory integration deficits that are most
likely to influence hand use are tactile
defensiveness, poor bilateral integration and
dyspraxia.
Upper Extremity function cont…

 Development of the motor pattern involved in

hand function as described by Jean Ayres –
• Control of neck and eye movements
• Trunk stability and balance
• Shoulder stability and movements
• Elbow movements
• Gross grasp
• Wrist positioning and movements
• Release of grasp
• Forearm supination and pronation
• Individual finger manipulation
Points for planning treatment

 Points to consider while planning programme –

• C.N.S.controls movements not just muscles
• Abnormal tone resulting from C.N.S. dysfunction
affects movement performance.
• Functional movements require complex C.N.S.
process.
• Sensory input plays an important role in motor
behaviour. Exteroceptor initiate the movements and
proprioceptors guide the movements.
Points for planning treatment cont..

• Pattern of motor output which are inherent and

have maturation sequence to each other have an
important role in motor behaviour.
• Muscles that function together facilitate each
other. Action of muscles of one side of the body is
greatly influenced by the muscles of the other
side of the body. It is called as cross education.
• Dynamic postural control is necessary for normal
movements
Sensory Integration

 Sensory integration is defined as a

neurological process that organizes sensation
from ones own body and the environment in
the brain to make adaptive response and
makes it possible to use the body efficiently
within the environment.
 Sensory integration functions will include the
awareness, discrimination & recognition of
sensory stimuli from the environment & from
C.N.S. to direct motor behaviour.
Sensory Integration cont…

Sensory
Input
Stimuli

Feedback/ Previous
CNS Integration
Experience

Adaptive
Output
Response
Sensory Integration cont…

Sensory CNS Adaptive Response

Input Integration 

Tactile Organisation
Visual Association Motor Concept
Auditory Past Experience Response Of Form
Olfactory Interpretation Space
Kinesthetic Time
Vestibular
Perceptual problems

 Perception is defined as a process of organizing and

interpreting sensations that individual receives from
internal and external stimuli.
 Children suffering from perceptual problems may
having difficulty in identifying and discriminating
shapes, colours, very poor concept of body in space,
slightly distracted, hyperactive, poor concentration,
lack of directionality, clumsy, poor bilateral
integration, unable to copy designs & figures.
Perceptual problems cont…

 Visual perceptual problems include

• Figure ground
• Position in shape
• Spatial relationship
• Perceptual constancy
• Eye hand coordination
Treatment

 “O.T. for Independence” is the prime motto of

Occupational Therapy. So training in self care
activities (ADLs) like feeding, dressing, undressing,
grooming, ambulation etc. is of utmost importance.
 Different tailor made adaptive devices and
equipments are made as per child’s requirements to
make him independent as far as possible.
 Theconcept of the above said role of
Occupational Therapy lies in the Chinese
proverb –
‘Give a man a fish and you feed him for a
day, teach a man to fish and you feed him for
a lifetime’
THANK YOU