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Occupational therapy in the management of cerebral palsy
Occupational Therapy (OT) enables individuals with cerebral palsy to participate in activities of daily living that are meaningful to them. A family-centred philosophy is used with children who have CP. Occupational therapists work closely with families in order to address their concerns and priorities for their child.〔Mulligan S, Neistadt ME. Occupational therapy evaluation for children: a pocket guide. : Lippincott Williams & Wilkins; 2003.〕 Occupational therapists may address issues relating to sensory, cognitive, or motor impairments resulting from CP that affect the child's participation in self-care, productivity, or leisure. Parent counselling is also an important aspect of occupational therapy treatment with regard to optimizing the parent's skills in caring for and playing with their child to support improvement of their child's abilities to do things.〔Steultjens E, Dekker J, Bouter LM, JCM, Lambregts B, CHM. Occupational therapy for children with cerebral palsy: a systematic review. Clin.Rehabil. 2004 02;18(1):1-14.〕〔Neistadt ME. Occupational therapy evaluation for adults: a pocket guide. : Lippincott Williams & Wilkins; 2000.〕 The occupational therapist typically assesses the child to identify abilities and difficulties, and environmental conditions, such as physical and cultural influences, that affect participation in daily activities.〔Neistadt ME. Occupational therapy evaluation for adults: a pocket guide. : Lippincott Williams & Wilkins; 2000.〕 Occupational therapists may also recommend changes to the play space, changes to the structure of the room or building, and seating and positioning techniques to allow the child to play and learn effectively.〔Neistadt ME. Occupational therapy evaluation for adults: a pocket guide. : Lippincott Williams & Wilkins; 2000.〕〔Guidetti S, Söderback I. Description of self-care training in occupational therapy: case studies of five Kenyan children with cerebral palsy. OCCUP THER INT 2001 03;8(1):34-48.〕
==Effect of sensory and perceptual impairments==
Children with CP may experience decreased sensation or a limited understanding of how the brain interprets what it sees. Occupational therapists may plan and implement sensory-perceptual-motor (SPM) training for children with CP who have sensory impairments so that they learn to take in, understand, plan and produce organized behaviour.〔Bumin G, Kayihan H. Effectiveness of two different sensory-integration programmes for children with spastic diplegic cerebral palsy. Disabil.Rehabil. 2001 06/15;23(9):394-399.〕 The SPM training improves the daily, functional abilities of people with CP.〔Bumin G, Kayihan H. Effectiveness of two different sensory-integration programmes for children with spastic diplegic cerebral palsy. Disabil.Rehabil. 2001 06/15;23(9):394-399.〕 Occupational therapists may also use verbal instructions and supplementary visual input, such as visual cues, to help children with CP learn and carry out activities.
For children with CP with limited movement and sensation, the risk of pressure sores increases. Pressure sores often occur on bony parts of the body.〔Chin TYP, Duncan JA, Johnstone BR, Kerr Graham H. Management of the upper limb in cerebral palsy. Journal of Pediatric Orthopaedics B 2005;14(6):389.〕 For example, pressure sores may occur when a child has limited feeling and movement of their lower body and uses a wheelchair; the tailbone bears weight when seated and can become vulnerable to pressure sores. The occupational therapist can educate the child, family, and caregivers about how to prevent pressure sores by monitoring the skin for areas of irritation, changing positions frequently, or using a tilt-in-space wheelchair.〔Chin TYP, Duncan JA, Johnstone BR, Kerr Graham H. Management of the upper limb in cerebral palsy. Journal of Pediatric Orthopaedics B 2005;14(6):389.〕
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