The document provides an extensive overview of cerebral palsy (CP), defining it as a group of permanent disorders affecting movement and posture due to non-progressive brain abnormalities. It elaborates on various classifications, types, associated conditions, and the complexities involved in diagnosing and managing CP, emphasizing the need for a multidisciplinary treatment approach. The document also highlights the importance of early intervention and therapeutic strategies to support children with CP in their development.

1. Mansoor Alam
Consultant Developmental Specialist
ICD, New Delhi, India

2. Cerebral Palsy
Latest Definition
Over the years, the definition of cerebral palsy has been
repeatedly changed. According to the current definition,
developed by an international team of experts
Cerebral palsy is a group of permanent, but not
unchanging, disorders of movement and/or posture and
of motor function, which are due to a non-progressive
interference, lesion, or abnormality of the developing/
immature brain.

3. Cerebral Palsy
The diagnosis of cerebral palsy is mainly based on motor function
and posture disorders
 That occur in early childhood and persist until the end of life
 They are non-progressive, but change with age.
 Motor function disorders, which are the core symptoms of
cerebral palsy, are frequently accompanied by other dysfunctions,
such as: sensation, perceptual, cognitive, communication and
behavioural disorders, epilepsy, and secondary musculoskeletal
disorders.

4. Cerebral Palsy
Three parts definition
 Disorder of postures and movements
 Non Progressive, but often changing
 Early in life (Conception to 3-8 Years)

5. Incidence
1 in 250-345 children (Worldwide)
Boys > Girls (Difference: 30%-Limited Studies)
Black Children > White Children (3.7 per 1000 black
children and 3.2 per 1000 white Children)

6. Types / Varieties
CP is classified in many ways to understand and deal the
condition
 Based on the site of insult to the brain
 Based on involvement of body parts
 Based on severity of the damage to the brain

7. Classification
Based on site of insult of the brain
 Spastic (Cerebral Cortex / Brainstem / Pyramidal Tract)
 Dyskinetic ( Basal Ganglia / Extra pyramidal)
 Ataxia (Cerebellum / spinal cord)
 Floppy ( cerebellum)
 Rigidity (Motor Cortex)
 Mixed (motor cortex, basal ganglia, thalamus, and cerebellum)

8. Classification
Based on involvement of body parts
Quadriplegia (All four extremities plus Truncal involvement)
Triplegia (Any three extremities plus truncal involvement)
Diplegia (Both Lower limbs plus truncal involvement, Upper limbs mildly affected )
Hemiplegia (One sided both limbs, upper limb is more affected)
Monoplegia (Mostly one leg, very rare)

9. Classification
Based on involvement of body parts
Newer Classification
 Unilateral Spastic CP
Right Sided / Left Sided
 Bilateral Spastic CP
Symmetrical / Asymmetrical

10. Classification
Based on extent of damage in the brain
 Mild
 Moderate
 Severe
 Profound
No longer used in practice.
Instead use: GMFCS, MACS, VFCS, CFCS, EDACS.
Five Level Functional Classification System

11. Different Forms of CP
 CP Spastic hemiplegia
 CP Spastic diplegia
 CP Spastic quadriplegia
 CP Spastic triplegia
 CP Spastic monoplegia

12. Different Forms of CP
 CP Dystonia / Dystonic CP
 CP Athetosis / Athetoid CP
 CP Ataxia / Ataxic CP
 CP Hypotonia / Hypotonic CP
 Mixed CP

13. CP Spastic Hemiplegia
Infantile hemiplegia is a movement defect of one side of
the body only, either the right side or the left.
The disability is not always uniform. In the typical spastic
form in the older child, the following patterns are seen.
 The upper limb is held with the arm adducted and
internally rotated
 The forearm flexed and pronated, the wrist flexed, and the
fingers flexed with the thumb pressed into the palm.

14. CP Spastic Hemiplegia
• 30 % of all CP
• One side affection
upper > lower extremity
• 50 % mentally retarded
• 33 % seizures

15. CP Spastic Hemiplegia

16. CP Spastic diplegia
 Symmetrical or near symmetrical involvement
 The legs are more involved that the arms.
 The hips knees and ankles may flex and the child can sit in
the tailor position on the base of his spine.
 The arms may be mildly or moderately affected.
 Very mild cases of spastic diplegia may walk in planter
flexion only.

17. CP Spastic Diplegia
 The most common type
 Speech / intellect: normal – slightly impaired
UL- Minimally Spastic
Minor incoordination of fine motor skills
LL : Spastic
Hips: flexion, adduction, int. rotation,
knees: flexor / extensor spasticity /or equal,
Ankles: equinus
Foot: pes valgus
 Most walk independently by 4 years

18. CP Spastic Diplegia

19. Cerebral Palsy Spastic diplegia

20. CP Spastic triplegia
 These children show asymmetrical involvement; and
the arms are more involved than the legs.
 The arms may be mildly, moderately or severely
affected.
 If the arms are moderately affected, one hand is better
than the other because the child will use one hand for
play.

21. Cerebral Palsy Spastic triplegia

22. CP Spastic quadriplegia
 These children show symmetrical or near symmetrical
involvement; and the arms are more involved than the
legs.
 Both hands are severely involved and he finds
difficulty in feeding himself and playing with toys.
 If a child with spastic quadriplegia is maintained in
one position for the greater part of the day, particularly
if it is a flexed posture, he may develop flexion
contracture in muscles and in the capsules of joints.
 Severe deformities and joints dislocations can result.

23. CP Spastic quadriplegia
• All four limbs involved and trunk
• Often mentally retarded
• With seizures
• Most ( 80 % ) non ambulatory

24. CP Spastic quadriplegia

25. CP Dystonia
 Dystonia is a movement disorder in which
involuntary sustained or intermittent muscle
contractions cause twisting and repetitive movements,
abnormal postures, or both.
 Dystonia in cerebral palsy (CP) presents as
hypertonia, involuntary postures and movements, or a
combination

26. Cerebral Palsy Dystonia

27. CP Athetosis
Athetoid cerebral palsy is a type of cerebral
palsy characterized by athetosis, or uncontrolled
movements.
This lack of control usually causes a person with
athetoid cerebral palsy to make erratic movements,
especially when the person is in motion.

28. Cerebral Palsy Athetosis

29. CP Ataxia
 Ataxia is the least common form of cerebral
palsy. Ataxia means 'without order' or
'incoordination'.
 Ataxic movements are characterized by clumsiness,
imprecision, or instability.
 Ataxia causes an interruption of muscle control in the
arms and legs, resulting in a lack of balance and
coordination.

30. Cerebral Palsy Ataxia

31. CP Hypotonia
 Hypotonia is diminished muscle tone. The infant or
child with hypotonic cerebral palsy appears floppy -
- like a rag doll.
 In early infancy, hypotonia can be easily seen by the
inability of the infant to gain any head control when
pulled by the arms to a sitting position (this symptom
is often referred to as head lag).

32. Cerebral Palsy Hypotonia

33. CP Rigidity
 Muscles that have rigidity feel heavy and like “a lead
pipe” when they are moved passively.
 Rigidity is a common feature in cerebral palsy caused
by anoxia, such as in near drowning.

34. Mixed CP
 Mixed cerebral palsy is a combination of any two
varieties of Cerebral Palsy.
Spastic + Dystonic (very common)
Spastic + Ataxic (very rare)
 Those diagnosed with mixed CP have damage to the
motor control centers in several parts of their brain.

35. Cerebral Palsy Mixed

36. Causes / Etiology
The exact cause is unknown but it is believed that CP
occurs during pregnancy when the brain gets damaged or
is underdeveloped
This disorder affects the Cerebrum which controls
voluntary movement such as thinking and emotions.
The cerebral motor cortex (at the back of the frontal
lobe) is usually damaged also.
Cerebral Palsy may occur due to the damage of white
matter (brain tissue).

37. Causes / Etiology
 Variety of perinatal, prenatal, and postnatal factors
contribute, either singly or multifactor to CP.
 Commonly thought to be due to birth asphyxia; now
known to be due to existing prenatal brain
abnormalities.
 Premature delivery is the single most important
determinant of CP.
 In 24% of cases, no cause is found.

38. Causes / Etiology
Multifactorial but in most cases is unknown.
Sometime, neuro-imaging may be entirely normal.
Prenatal factors play a significant role in the etiology of
CP.

39. Associated Conditions
All children with CP have some or the other associated problems.
There are three types of co morbidities have been identified.
 Cocausal
Disorders caused by the same injury to the developing brain that caused CP (i.e.
epilepsy and cognitive impairment)
 Complications
Disorders that are complications of the main CP condition (i.e. scoliosis and hip
dislocation)
 Co‐occurring
Disorders not caused by the injury to the developing brain, nor are complications
of the main CP condition (Autism, ADHD, Down Syndrome-Dual Diagnosis)

40. Associated Conditions
In actual sense these associated factors are considered the
basis of prognosis (outcomes from the treatment).
Coping with these disabilities may be even more of a
challenge than coping with the motor impairments of
cerebral palsy.
There is a common saying “Lesser the number of
associated problems-more the chances of better future”.

41. Associated Conditions
1. Epilepsy
2. Hearing Disorder
3. Visual Disorder
4. Cognitive Impairment
5. Speech Impairment
6. Feeding Difficulties
7. Excessive Drooling
8. Poor Bowel Control / Incontinence
9. Power Bladder Control / Incontinence

42. Associated Conditions
10. Dental Problems
11. Malnutrition
12. Constipation
13. Obesity
14. Sensory Loss
15. Sensory Processing Dysfunction
16. Behavioral Disorders
17. Poor Immunity
18. Hormonal Imbalance

43. Associated Conditions
19. Excessive Sweating
20. Pain Syndrome
21. Sleep disturbance
22. Heart Defects
23. Psychological disorder
24. Allergy
25. Hydrocephaly
26. Microcephaly
27. Skin Disorder

44. Associated Conditions
28. Bone Health
29. Muscle Atrophy
30. Appetite Disorder
31. Issues with Secondary Sexual Development

45. Diagnosis Making
Cerebral Palsy is a complex disorder so diagnosis making
is always difficult. There is no specific test which can
confirm the presence of CP.
CP is diagnosed through observations, assessments and
clinical investigations.

46. Diagnosis Making
Delayed milestones, mostly with gross motors and fine
motors
Persistence of primitive reflexes
No evidence of progressive disease / No loss of
milestones achieved previously

47. Diagnosis Making
There is motor delay- variation by more than 50% with
abnormal movements and poor postural control
A child with CP may have a combination of associated
disorders such as Epilepsy, Visual deficits, Hearing
Deficits, Drooling, Feeding problems, Poor Cognition,
Poor speech, etc

48. Diagnosis Making
 GMA- Prechtl’s Method
 Observation and Videography of the child while the
child is in static, dynamic and transitory postures
during play, ADLs
 Documenting medical history starting from
pregnancy. Medical issues related to prenatal,
perinatal and postnatal to establish a good scientific
basis of the diagnosis

49. Diagnosis Making
 Getting X-rays or Ultrasound (Skull / Hips / Spine),
 Getting MRI / CT scan of the Brain / Spine
 Getting EEG -to rule out epileptic syndrome

50. Diagnosis Making
 Getting Blood Tests -to rule out other diseases
 Getting Genetic Study -to rule out genetic disorder
 Getting Vision Test, Hearing Test, etc to have a
baseline

51. Treating Team
Advance Cerebral Palsy Management Team should have
the expertise of
 Neonatologist
 Developmental/Behavioural Paediatrician
 Pediatric Neurologist (Physician)
 Pediatric Neurosurgeon
 Pediatric Orthopedic Surgeon
 Pediatric Ophthalmologist
 Pediatric Otolaryngologist
 Pediatric Geneticist

52. Treating Team
 Pediatric Cardiologist
 Pediatric Endocrinologist
 Pediatric Gastroenterologist
 Pediatric Immunologist
 Pediatric Nephrologists
 Pediatric Pulmonologist
 Pediatric Rheumatologist
 Pediatric Dietician
 Early Intervention Specialist
 Developmental Specialist / Developmental Therapist

53. Treating Team
 Pediatric Physiotherapist
 Pediatric Occupational Therapist
 Speech and Language Therapist
 Special Educator
 Clinical Psychologist / Behavior Therapist
 Orthotic Specialist (POE)
 Assistive Aids Technicians
 Pediatric Audiologist and Hearing Aids Technician
 Pediatric Vision Therapist(Optometrist / Refractionist)

54. Treatment / Management
 Management Versus Treatment
 Management Plan Versus Management Program
 Holistic Management Plan / Integrated Treatment /
Combination Therapy
 Individualized Management Program ( IMP)

55. Components of Holistic Management Plan
 Habilitation Services
 Medications
 Chemo denervation
 Orthopedic Interventions
 Neurosurgical Interventions
 Regenerative Medicines
 Complementary and Alternative Medicines

56. Habilitation Services
 Infant Stimulation
 Early Intervention
 Play Therapy
 Developmental Therapy
 Physiotherapy
 Occupational Therapy
 Speech Therapy
 Cognitive Therapy / Special Education

57. Habilitation Services
 Behaviour Modification Therapy (BMT/ ABA)
 Assistive Technology / Equipment Oriented Therapy
 Electrotherapy
 Hippo therapy (Real / Robotic)
 Hydrotherapy
 TAL –Technology Assisted Learning
(Computer oriented Games and learning apps)
Nutritional Support / Nutriceutical Therapy

58. Medications
Pharmacological Therapy / Drugs therapy
 Medications for primary Disorders
Spasticity Management
Movements Management (Dystonia and Ataxia)
 Medications for Associated Conditions
Epilepsy
Drooling
GERD
Constipation
Osteoporosis
Hormonal imbalance
Nutritional Support / Nutriceutical Therapy
Cogni-enhancer

59. Chemo denervation
Nerve Block
Phenol
Alcohol
Bonta A ( Botulinum Toxin Type-A)
Botox
Dysport
Nobota
Xeomin

60. Orthopedic Intervention
 Soft Tissue Release
 Osteotomy
 SESLS
 SEMLS
 SEMLLARS
 OSSCS
 Ilizarov

61. Neurosurgical Intervention
Implant
Intrathecal baclofen pump therapy
Deep brain stimulation
Rhizotomy
SDR / SPR
Fasciculotomy

62. Regenerative Medicines
 Hyperbaric Oxygen Therapy-HBOT
 Stem Cell Therapy
 Gene Therapy

63. Complimentary and Alternative Medicines
 Homeopathy
 Ayurveda
 Unani
 Acupuncture
 Yoga

64. Habilitation Services
 Habilitation Therapy
 Pediatric Therapy
 Rehabilitation Therapy (Need Based))

65. Infant Stimulation
 Infant stimulation is a process of providing supplemental
sensory stimulation in any or all of the sensory modalities
to an infant as a therapeutic intervention
Visual
Auditory
Tactile
Vestibular
Olfactory
Gustatory
 Begins at NICU
 Mostly continues till 1 year of age

66. Infant Stimulation
Providing the Right Stimulation at the Right time is
the Key for Brain Development
Infant Stimulation improves not only medical outcome
but also neurodevelopment outcome by preventing
active inhibition of the central nervous system pathways
due to inappropriate input, and supporting the use of
modulating pathways during a highly-sensitive period of
brain development.

67. Infant Stimulation
 The stimuli used vary based on the patient and the
sense involved.
 The stimulation is usually presented on a regular
schedule for specific amounts of time (e.g., 30 minutes
per day for 20 days).

68. Infant Stimulation
 Stimulation in NICU via tactile, vestibular, and auditory
channel; similar to stimulation received in the womb.
 Visual stimulation may be added, and the program may be
modified to approximate the typical sensory environment
of the home.
 In the first years of a baby’s life, the brain is busy building
its wiring system. The amount of stimulation the baby
receives has a direct affect on how many synapses are
formed. Repetitive stimulation strengthens these
connections and makes them permanent, whereas young
connections that don’t used eventually die out.

69. Infant Stimulation
 Kangaroo Care
 Need based ROM Exercises
 Need Based Joint Compression
 Positioning for weight bearing
 Positioning for Milestones development
 Hand Function Development
 Feeding Development

70. Early Intervention
Early intervention means intervening as soon as possible to tackle
problems that have already emerged for children and young people
Any time during the first year of life
Till 3 years of age ( In some countries till 6 Years of age)
Based on child developmental Profile / Domain
Gross Motor
Fine Motor
Cognition / Receptive Language
Expressive Language / Speech
Social-Emotional/ Behaviour
Self Help

71. Early Intervention
 Early intervention and prevention often overlap in practice.
 Early intervention can help children from pregnancy to 18
years, not only when they are very young.
 Neuroscience is showing that the healthy growth of very
young children’s brains can be impaired by poor early life
experiences.
 In that early period, interactions and experiences
determine whether a child’s developing brain architecture
provides a strong or a weak foundation for their future
health, wellbeing and development.

72. Early Intervention
 Early intervention is a process not an event
 For early intervention to be successful, each stage of
the process must be carried out well and followed
through
 A key ingredient is the capacity of professionals to win
the trust of children, young people and families

73. Play therapy
Many children lack skills that they need to survive in the
world. One method of teaching children social skills,
problem-solving skills, negotiation skills, and assertiveness
skills uses toys, art, and play materials to provide them with
direct instruction in a fun way that optimizes their learning
Play therapy is a powerful medium for young children to
build adult-child relationship and social skills
The intense sensory and physical stimulation that comes
with play therapy helps to form the brain circuits and
prevents loss of neurons

74. Play Therapy
 Play is nearly as important as food and sleep
 Throughout the life
 Based on Developmental Domains
Gross Motor
Fine Motor
Cognition
Speech
Behaviour
ADL

75. Importance of Play Therapy
1. Helps in physical development
2. Helps child to learn language and speech
3. helps in learning and development of intelligence
4. Improves child’s ability to socialize
5. Helps children develop emotionally
6. Serves as a means of alleviate fear

76. Types of Play
 Exploratory Play
 Manipulative Play
 Combinatorial Play
 Symbolic Play
 Pretend Play
 Constructive Play

77. Developmental Therapy
Developmental Therapy is a service provided by
professionals with a specialized knowledge of infant /
toddler development.
The DT looks at the whole child and the impact of the
child’s development on the family and care givers

78. Developmental Therapy
Domains under DT
 Physiotherapy
 Occupational Therapy
 Speech Therapy
 Cognitive Therapy

79. Developmental Therapy
Developmental Therapy differs from PT / OT in many
ways:
1. DT- Exclusively for pediatric populations
(Birth to 18 Years)
2. DT- Primarily a combinations of PT and OT
- Need based intervention for Communication and Cognition
3. DT- Functional Therapy
4. DT-ICF Oriented
5. DT- Holistic in nature

80. Developmental Therapy
Focuses Components
Reflex Integration
1. Preventive Sequential-Milestones oriented
2. Functional Task Analysis based intervention
3. Developmental Postural Management
4. Muscles and Joints Care
5. Use of Assistive Technology
6. Equipment based Therapy
7. Home Management Program


81. Developmental Therapy
 Developmental Profile
Gross Motor Development
Fine Motor Development
Cognitive Development
Expressive Language Development
Social emotional Development
Self Help Development
 Use of Developmental Checklists
HELP
Denver
Trivandrum Developmental Checklist

82. Physiotherapy
Physiotherapists, viewed as the 'movement expert', play
a key role within MDT.
The main aim of Physiotherapy, as identified by Gunel
(2011), is to support the child with Cerebral Palsy to
achieve their potential for physical independence and
fitness levels within their community, by minimizing the
effect of their physical impairments, and to improve the
quality of life of the child and their family who have
major role to play in the process.

83. Physiotherapy
 Backbone of a habilitation program
 Traditional Physiotherapy Versus Advance
Physiotherapy
 Overlapping with Occupational Therapy
 Overemphasized
 Require Multifaceted, Specialized and Exclusive
Training

84. Physiotherapy Approaches
 Bobath Approach / NDT
 Rood Approach
 Kabat, Knot and Vass Approach / PNF
 Doman-Delacto Approach (Patterning)
 Ayres Approach (SIT)
 Peto Approach ( Conductive Education)
 Vojta Approach ( Reflex Integration)
 Brunnstorm Approach
 Carr and Shepherd Approach
 Feldenkrais Approach
 MNRI Approach
 Total Motion Release Approach
 Eclectic Approach

85. Physiotherapy
 No Passive ROM Exercises
 Active ROM / Stretching-Stretch and Hold Technique
How much is too much
 Sustained Stretching-Use of Night Splint / More than
6 hours sustained stretching(increase muscle length)
 Joint compression-Combined stretch and strength
technique
 Strengthening Versus Stretching
 Alignment- New essence of Physiotherapy
 Spasticity / SMC

86. Physiotherapy
Sequential therapy- Developmental Profile
Positioning-NEP / TRP
Promoting Postural Milestones
Static Positioning
Dynamic Positioning
Transitory Positioning
Promoting Mobility
Floor Mobility
Off Floor Mobility

87. Occupational Therapy
 Occupational therapy is a practice that uses goal-
directed activity to promote independence in function.
 The goal of occupational therapy intervention is to
increase the ability of the client to participate in
everyday activities, including feeding, dressing, bathing,
leisure, work, education, and social participation.

88. Occupational Therapy Approaches
HABIT
BMIT
CIMT
Hand Writing Task Practice
SIT
Goal Directed Training

89. Occupational Therapy Approaches
 Create, promote (health promotion)
 Establish, restore (remediation, restoration)
 Maintain
 Modify (compensation, adaptation)
 Prevent (disability prevention)

90. Speech Therapy
Speech and language therapy can help improve
communication, eating and swallowing. It can also encourage
confidence, learning and socialization.
Speech therapy can help with the following:
 Articulation – Pronunciation - Fluency/stuttering
 Sound and word formation – Listening - Pitch
 Language and vocabulary development- Speech volume
 Word comprehension- Word-object association
 Breath support and control- Chewing- Swallowing
 Speech muscle coordination and strength

91. Speech Therapy
Exercises Used in Speech Therapy
 Articulation Therapy
 Blowing Exercises
 Breathing Exercises
 Jaw Exercises
 Language and Word Association
 Lip Exercises
 Swallowing Exercises
 Tongue Exercises

92. Cognitive Therapy
Bloom's Classification of Cognitive Skills
 Remember – Retrieve relevant knowledge from long-term
memory
 Understand – Construct meaning from instructional messages,
including oral, written, and graphic communication
 Apply – Carry out or use a procedure in a given situation
 Analyze – Break material into its constituent parts and
determine how the parts relate to one another and to an overall
structure or purpose
 Evaluate - Make judgments based on criteria and standards
 Create - Put elements together to form a coherent or functional
whole; reorganize elements into a new pattern or structure

93. Cognitive Therapy
 Cognitive development and the effect of interventions should
therefore take the complex interplay over time between body,
brain, and mind into account.
 Tests need to be adapted, for example using eye gaze
technologies, so that cognitive functioning can be reliably
assessed, and not only assumed, in the most severely motor-
impaired children.
 In the future, brain–computer interfaces might gain importance
both for assessment and interventions.
 Furthermore, it might be that not only traditional
neuropsychological tests and computerized training tasks, but
more naturalistic tests and tasks increasing real-life abilities,
such as goal-setting and planning abilities, are needed.

94. Behaviour Therapy
 Behaviour Modification Therapy-BMT
 Behavioral Interventions
 Applied Behaviour Analysis-ABA

95. CCBT
 Communication (Speech),Cognition and Behaviour Therapy
 Special Educator
 Speech Therapist
 Clinical Psychologist

96. Assistive Technology-AT
 Equipment Assisted Therapy (EAT)
 Aids Oriented Therapy(AOT)
 Postural Aids
 Orthotic Aids
 Mobility Aids
 Adaptive Aids

97. Postural Aids
Postural Ability and Postural Alignment Oriented
 Prone Wedge
 Side Lying board
 Corner Chair with tray cut out: High / Floor
 Arm Chair with tray cut out / Table
 Standing Frame: Supine Stander / Prone Stander
Supine stander are considered better
Long leg sitter with cut out table
Peto bar / Peto Chair / Peto Table
Creeper / Crawler
Aligners
Stretching Board

98. Orthoses
RIGHT ORTHOSIS can help a child with CP:
 Walk sooner (more stability)
 Walk better (better alignment)
 Perhaps walk more (if energy efficient)
Earlier it was only preventive in nature, now its almost
corrective and preventive both
3 C in orthoses
 1st C- Correction
 2nd C –Comfortable
 3rd C-Cosmetic

99. Orthoses
Spinal Orthoses
Spinal Jacket
Upper Limb Orthoses
Cock Up Splint
Use only in night as night splint
Elbow and arm band
Thumb abductor
Mid Arm Supinators
CIMT Band –Use with the unaffected / better hand during play only

100. Orthoses
Lower Limb Orthoses
Ankle Foot Orthoses (Solid / Hinged / Limited Joints)
Solid AFOs are always better than Hinged AFO
There is no scientific data available to support rubber pad below AFO soles, few
studies have shown negative impact on long term gait
Knee Immobilizers ( Corset / 3 Points)
Corset doesn’t work after 2 years of age
Knee gaiters can be modified to anti-torsion splint
Night splint is always better than using day time
Genu Recurvatum ( Knee Hyperextension) doesn’t require KAFO, it can easily be
controlled with 5-8 degree dorsiflexed AFO
HKAFOs are totally banned in practice in CP Management
Dynamic Hip Abductors are available in place of costly SWASH
SMO and Insole Arch Support never help to prevent or correct Equino-Valgus /
Varus. Both help Pes Planus only

101. Mobility Aids
 Use FMS (Functional Mobility Scale) for better gait
outcome

102. Mobility Aids
Scooter Board / Creeper
Crawler
Rollator / Walker
Posterior Rollator are considered better than Anterior Rollator
Elbow Crutches
Most Functional Mobility Aids
Tripods / Quadripods / Cane / Stick
Tripods are better than Quadripods due to optimal support
Wheel Chair: Ordinary / Self pushed / Motorized
Motorized: Sound oriented / head movement oriented / Switch oriented

103. Adaptive Aids
 Bent Spoon
 Pencil / Pen Holder
 Modified Straw
 Soap Net / Soap Stick
 Modified Computer Accessories
 Heavy Feeding Plate


104. Electrotherapy
 NMES / NEMS / EMS
 FES / Spinex
 TES
 EMG Biofeedback
 ?? TENS / Therapeutic Ultrasonic / IFT / Diathermy

105. Hippo therapy
 Horseback riding actively engages several of the body's
muscle groups with significant background work from
the joints and tendons that they are attached to. The
hip flexors are a group of muscles that help to provide
free range of motion allowing the body to bend in to
the hips, and the hips to be pulled in towards the torso
 Real Horse
 Robotic Horse

106. Hydrotherapy
 Aquatic physical activity may be significantly
beneficial for higher GMFCS levels, that is, those with
significant movement limitations for whom land-
based physical activity may be difficult and limited. It
should be noted that there are limited land based
programs for this population
 There is supportive evidence that aquatic exercise in a
group environment can provide a motivating and
socially stimulating environment for children

107. Technology Assisted Learning (TAL)
 VR is the use of technology to simulate a three-dimensional
environment. Those using it typically wear a helmet or goggles
with a screen as well as gloves and other equipment and sensors.
The user experiences an environment that seems real and that
can induce all the sensations and responses of a real
environment.
 The VR provides significant gains in functional motor skills by
increasing cortical reorganization and neuroplastic changes.
The biofeedback during VR therapy is multimodal, as it uses
sensory and cognitive functions simultaneously, and it is also
entertaining, interesting, motivating, and easy to understand

108. Thank you all for your attention
 All of the presented information are from the workshops and
Courses conducted by AHS-ICD, New Delhi, India
 To know details and get the e-brochure, please connect at
ahsicd@gmail.com
 Keep browsing our website to get updated news, happenings and
researches in Cerebral Palsy at www.icddelhi.org