The document discusses child-focused and context-focused therapy approaches for treating children with cerebral palsy, emphasizing the importance of modifying tasks and environments rather than directly addressing the child's impairments. It outlines how therapists collaborate with families to identify goals and strategies that enhance children's functional abilities while encouraging child engagement in preferred activities. Both therapy modalities offer distinct benefits, and integrating them can lead to improved outcomes in rehabilitation.

1. Context verses
child focused therapy
in cerebral palsy
Dr Amit Pandey, BPt
Senior therapist
Samvedna
www.samvednatrust.com
FB: samvednatrust.cerebralpalsy
You tube: jjain999
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2. Cont.
A unique aspect of the context therapy approach is that
therapists were explicitly trained to change only the
characteristics of the task and/or environment and not to
try to change the child’s impairments.

3. CHILD FOCUSED THERAPY
1.Therapists identified problems such
as body posture, mobility, etc. which
were restricting the child’s function.
They gave therapy to change these
problems and practice specific
movements and activities.
2. Therapists focused on changing the
child’s mobility, body alignment,
muscle strength and coordination.
3. Therapy also focused on improving
a child’s skills through practicing
movements and activities.
CONTEXT FOCUSED
THERAPY
1. Parents and therapists
identified activities which the
child likes to do, but has
difficulty doing.
2. Therapists focused on
changing the
activity to make it easier to do
by reducing the restricting
factors in the environment.
Children also practiced the
activities.

4. Context Therapy shares
concepts
Functional
Task-oriented
 Activity-focused interventions,
such as involvement of parents, identification of functional goals,
and a ‘top-down’ activity-based approach to assessment and
intervention,

5. Dynamic systems theory stresses the
importance of trying to encourage new motor
behaviors when a child starts to experiment with
different motor skills; this is referred to in
dynamic systems theory as being ‘in transition’
for new motor skills.
Dynamic system theory

6. Cont.
Dynamic systems theory posits that motor
behaviors are organized around functional tasks or
goals and that the specific motor solution is influenced
by the spontaneous interaction of variables from three
sources.
Child characteristics
Task demands
Environmental influences.

7. Cont.
Child characteristics represent not only the
traditional physical impairments considered
in the rehabilitation of children with CP (e.g.
muscle tone, range of motion, balance) but
also non-physical characteristics such as
motivation, attention, and cognition.

8. Theory Principles Implementation in
context therapy
Dynamic systems Success at functional goal
depends on interaction of factors
within child, task and environment
subsystems
Emphasis on changing task and
environment rather than child
Family centered Collaborative relationship between
family and health-care providers to
identify goals and intervention
strategies
Family involvement
incorporated into assessment
and intervention protocol and
not left to individual therapist
discretion
Service delivery model
Primary therapist
One therapist provides
intervention (other therapists
available for consultation)
Natural environment
Assessment and intervention
ideally occurs in natural
environment directly related to
identified goal or task
Goal/task Parent involvement Functionally
relevant goals
Therapists trained to use the
Canadian Occupational
Performance Measure

9. Identification Principles Implementation in
context therapy
Assessment
Include families Strength-based Focus on
identifying constraints and facilitators related to
task and environment
With family, observe and videotape child’s
current performance of each identified goal
With family, identify factors in
task/environment that are supporting or
hindering child’s success at goal
Include families
Families identify strategies with therapists
Families demonstrate present strategies; build
from there
Work at functional goals Strategies target
task/environment, not remediation of child
Remediation of impairments not allowed (e.g.
passive stretching, specific muscle
strengthening, specific motor control
strategies)
Intervention
'Fail quickly’
Expect success quickly: if not successful in 2wks
re-evaluate strategies
Episodic interventions Think outside the box
Try short intense periods of intervention
followed by practice times for consolidation by
family and child Innovation encouraged
Do not assume hierarchical preference of
movement solutions Atypical (innovative)
patterns of movement accepted
Provide rationale and theory
Training included theory and research
background

10. Therapist training
Provide process
Three-step guidelines for goals,
assessment, and intervention
Provide support
Support from colleagues and
research team Conference calls
with therapists together, personal
telephone and e-mail follow-up
Evaluate process early
Therapists sent videotapes of
initial assessment to research
team
Intervention monitoring
Ensure fidelity of treatment
Therapist sent video of
intervention process; evaluated by
research team for fidelity of
treatment and feedback provided
Documentation of process
Therapists and families kept
logbooks of intervention process;
evaluated by research team to
ensure fidelity of treatment

11. CONTEXT FOCUSED
THERAPY
1.Parents and therapists identified activities which the
child likes to do, but has difficulty doing.
2. Therapists focused on changing the activity to make
it easier to do by reducing the restricting factors in the
environment. Children also practiced the activities

12. Cont.
Examples of task characteristics (what the child
is trying to do) are the shape, size, and weight of a ball
for the task of throwing, or the choice of the size,
shape, or texture of a writing instrument for the task of
printing, or consideration of alternative solutions such
as a computer or label maker.

13. Cont.
Environmental considerations are the identification of physical,
social, and attitudinal influences that represent barriers to or
facilitators of successful completion of the identified task or goal.
Examples include physical accessibility, availability of assistants,
and the attitudes of persons within the child’s environment.

14. Context therapy emphasizes changing the
parameters of the task or environment rather than
a focus on remediation of a child’s abilities. The
assumption of this approach is that changes to the
task and/or environment will enable the child to
perform an activity that they were unable to do
previously.

15. Intervention protocol
Three-step process for the context therapy intervention:
Goal identification
Assessment
 Intervention strategies.

16. BENEFITS OF CONTEXT
THERAPY
a) able to participate more independently in their self-
care activities,
b) able to move more independently,
c) more engaged in general skill activities,
d) able to participate more intensely in play activities,
e) more physically active and participated in more
games.

17. Cont.
Therapists identified innovative solutions to
parents’ concerns that resulted in a quick
resolution and achievement of the goal.
One child had difficulty independently stepping onto her school bus because
of the height of the steps. Instead of working on improving the child’s
quadriceps muscle strength to climb the steps, the therapist phoned
administrators in the school district, explained the problem, and requested a
bus with steps that were less steep.

18. CHILD FOCUSED
THERAPY
1.Therapists identified problems such as body posture, mobility,
etc. which were restricting the child’s function. They gave
therapy to change these problems and practice specific
movements and activities.
2. Therapists focused on changing the child’s mobility,
body alignment, muscle strength and coordination.
3. Therapy also focused on improving a child’s skills through
practicing movements and activities

19. Method
Therapist identified the problem of a child such as body posture,
mobility ,body alignment,muscle strength and coordination.The
Therapy focused on improving the child skills through practicing
Movement and activities.

20. Message
 Both modality has its own benefit & draw back
 By utilizing both method we can have good
recovery in most of the children affected with
cerebral palsy
 We can divide period of rehabilitation in two part