The document outlines the physiotherapy management strategies for children with cerebral palsy, focusing on rehabilitation goals such as improving mobility, strength, and social integration. It discusses various therapy methods including electrical stimulation, cryotherapy, hydrotherapy, and the use of bracing and mobility aids to enhance functional ambulation and reduce spasticity. Key challenges in neuromotor development are also addressed, along with the importance of parental involvement in home exercise programs.

1. PHYSIOTHERAPY
MANAGEMENT OF
CEREBRAL PALSY
BY MUHAMMAD SAQIB

2. GOALS OF REHABILITATION
Improve
mobility
• Teach the
child to use his
remaining
potential
• Teach the
child
functional
movement
• Gain muscle
strength
Prevent
deformity
• Decrease
spasticity
• Improve joint
alignment
Educate the
parents
• To set
reasonable
expectations
• Do the
exercises at
home
Teach daily
living skills
• Have the child
participate in
daily living
activities
Social
integration
• Provide
community
and social
support

3. THERAPY PROGRAM
• Stimulating advanced postural,
equilibrium and balance reactions to
provide head and trunk control
Infant
• Stretching the spastic muscles,
strengthening the weak ones, and
promoting mobility
Toddler &
preschooler
• Improving cardiovascular status
Adolescent

4. Basic problems in the neuromotor development of children with CP are:
◦ Difficulty with flexing and extending the body against gravity
◦ Sitting
◦ Functional ambulation
For functional ambulation a child needs:
◦ Motivation to move
◦ Enough muscle strength and control
◦ Able to shift his body weight (balance)
◦ Awareness of body position and movement (deep sensation)
◦ Sufficient visual and vestibular system
◦ No deformities interfering with joint function

5. THERAPY METHODS

6. FOR MAINTANENCE OF SOFT TISSUE LENGTH
◦ Active & passive ROM exercises
◦ Weight bearing exercises
◦ Positioning

7. POSITIONING

8. ELECTRICAL STIMULATION
◦ Vang et al, (1995) found electrical stimulation resulted in a measurable reduction
in spasticity in upper limb.
◦ O’Daniel & Krapfl, 1989 reported that the use of ES increases the effectiveness
of stretching spastic muscles by reciprocal inhibition.
◦ Shindo (1987), has reported a reduction of spasticity by clinical evaluation,
lasting 8 to 72 hours after each session of FES.
◦ Stefanovska (1988) measured decreased tone and increased voluntary strength in
ankle plantarflexors after peroneal nerve stimulation for 1 year.

9. CRYOTHERAPY
◦ Ice can be used as an adjunct to other treatment methods or as a means of
controlling tone in a specific area.
◦ Muscle cooling reduces phasic stretch reflex activity and clonus (Hartviksen. K,
1962; Giebler KB, 1990).
◦ Slow Icing reduces spasticity (Roods Approach)
◦ Ice can be used with static stretch to overcome hyperactive stretch reflexes
(Giebler KB, 1990).

10. HYDROTHERAPY
used as adjunct management for
CP Children
helps in stretching large muscle
groups & to help movements in
trunk.

12. HORSEBACK RIDING
◦ Hippotherapy, a form of Equine
Assisted Therapy, is gaining ground
as an effective way to increase the
physical and emotional health
of children with cerebral palsy (CP).
◦ It has the potential to help
the child develop physical strength
and endurance and increase balance.

13. BRACING
◦ Increase function
◦ Decrease spasticity
◦ Facilitate selective motor control
◦ Stabilize the trunk and extremities
◦ Keep joint in a functional position
◦ Prevent deformity

14. Posterior
leafspring AFO
(PLSO)
Antirecurvatum
AFO
Ground
Reaction AFO
(GRAFO)
Solid
AFO Hinged
GRAFO
Hinged
antirecurvatum
AFO
Hinged
AFO

15. MOBILITY AIDS
Types
◦ Standers
◦ Walkers
◦ Crutches
◦ Canes
Advantages
◦ Develop balance
◦ Improve posture
◦ Decrease energy expenditure
◦ Decrease loads on joints

16. Standers
Support erect posture
Enable weight bearing
Decrease muscle tone
Improve head and trunk control
Stretch muscles to prevent contractures

17. Walkers
Walkers provide the
greatest support during
gait
The anterior open (reverse) walker
provides the best gait pattern and is
less
energy consuming
Standard forward walkers lead to
increased
weight bearing on the walker and
increased
hip flexion during gait.

18. Canes, Crutches And Gait Poles
• necessary if the
child does not have
sufficient lateral
balance.
• provide sensory
input for gait and
facilitate a normal
gait pattern