Cerebral Palsy and Occupational Therapy

We are here to walk you through occupational therapy for cerebral palsy. Our hope is to help you find the best OT care, at the right time—whether that is for yourself, your child or, or a loved one.

Settings where cerebral palsy occupational therapy occurs

If you have CP, hopefully occupational therapy becomes a touch point of assistance and guidance—starting as early as possible.

Occupational therapy will look different in all of the settings listed below, but our goal remains the same: to help our clients participate fully in their day to day in a way that is meaningful to them.

Here are common settings where OT for CP occurs::

• NICU

• Early Intervention

• School-based OT

• Outpatient OT

• Home Health

• Acute Care

• Skilled Nursing Facilities

How do OTs support individuals with cerebral palsy?

Every OT plan of care is different, because every client is different. We want to understand not only your challenges, but your strengths, and the supports you have to leverage.

Overall, OT is most successful when our clients set their own goals, and then we undertake real-life practice of your desired goal area.

Typically, a high amount of repetition is needed, because we are trying to activate something called “experience-based neuroplasticity” which refers to how your brain learns and grows.

Below are some typical areas we help with in cerebral palsy care.

(If you click on the intervention type, it will jump you down the page to the associated treatments.)

• Motor Interventions

• Early Intervention

• Tone

• Contracture and Alignment

• Pain

• Sleep

• Pulmonary Function

• Drooling & Oral Health

• Communication

• Cognition

• Self Care/Function

• Parent Outcomes

Common OT assessment related to cerebral palsy

The goals of the patient guide our treatments. To help track these goals, we may use standardized assessments to measure progress.

These assessments can also be useful to insurance companies, health care teams, or your school team during the IEP (individualized education plan) planning process.

• 10-Meter Walk Test (10MWT)

• ABILHAND-Kids

• Assisting Hand Assessment (AHA)

• Brief Pain Inventory (BPI)

• Canadian Occupational Performance Measure (COPM)

• Disabilities of the Arm, Shoulder and Hand (DASH)

• Gross Motor Function Classification System (GMFCS)

• Gross Motor Function Measure (GMFM)

• Melbourne Assessment of Unilateral Upper Limb Function (MUUL)

• Modified Ashworth Scale (MAS)

• Non-Communicating Children’s Pain Checklist (NCCPC)

• Quality of Upper Extremity Skills Test (QUEST)

• Timed Up and Go Test (TUG)

The most effective OT interventions for cerebral palsy

There has been a massive increase in the amount of research done about therapy for cerebral palsy. So, we have an ever increasing understanding of what type of interventions are most effective.

Below you will find our OT interventions for children with cerebral palsy sorted into a “traffic light”, where green-light interventions have the strongest evidence support.

This traffic light comes from this important study. The information for this study was gathered in 2019, so information may have evolved since then.  But this is the most current, comprehensive overview available to date. The study was funded by the Cerebral Palsy Alliance. You can find their helpful guide: Identifying the right intervention for your child.

Ok, below are the most (and least!) effective interventions by area, according to research.

Here is a quick guide to the the traffic light: 

🟢 Green means “go”:
High-quality evidence supports effectiveness.

🟡 Yellow means “measure clinical outcomes”:
Either:
1.) Promising evidence suggests possible effectiveness, but more research is needed
2.) No research exists and therefore effects are unknown 
3.) Conflicting findings exist, and therefore it is unclear how a patient might respond

🔴 Red means “stop”:
High-quality evidence indicates ineffectiveness or harm.

Traffic light of OT interventions for CP: 

Motor Interventions

Do It:

🟢 Mobility Training – Walking Speed
🟢 CIMT – Hand Function, Activity & Participation
🟢 Treadmill Training – Walking Speed, Walking Endurance, Gross Motor
🟢 Partial Body Weight Support Treadmill Training – Walking Speed
🟢 Goal Directed Training – Hand Function, Gross Motor
🟢 Strength Training – Muscle Strength
🟢 Home Program – Hand Function
🟢 Task Specific Training – Gross Motor
🟢 Bimanual – Hand Function
🟢 BoNT + OT – Goal Achievement
🟢 Action Observation – Hand Function
🟢 Environmental Enrichment – Hand Function, Gross Motor
🟢 Umbilical Cord Blood – Gross Motor
🟢 Hippotherapy – Balance Symmetry

Probably Do It:

🟡 Physical Activity – Physical Activity, Walking, Fitness, Participation, Quality of Life
🟡 AT Virtual Reality + Gaming – Hand Function, Walking
🟡 Mobility Training – Gross Motor, Walking for GMFCS IV-V
🟡 Partial Body Weight Support Treadmill Training – Gross Motor, Walking Endurance
🟡 Acupuncture – Gross Motor
🟡 Taping – Gross Motor, Hand Function
🟡 Fitness Training – Gross Motor, Walking Speed
🟡 Orthotics Night Hand Splint – Hand Function
🟡 BoNT + Physiotherapy – Gross Motor, Walking
🟡 Strength Training – Gross Motor, Upper Limb Strength, Function
🟡 Animal Assisted Therapy – Gross Motor
🟡 tDCS – Walking, Mobility, Balance, Hand Function
🟡 AFOs – Walking Speed, Gross Motor, Stride Length, Kinematics
🟡 BoNT + Electrical Stimulation – Hand Function, Walking Speed
🟡 HABIT-ILE – Gross Motor, Hand Function
🟡 SEMLS – Gross Motor, Walking Speed, Walking
🟡 Context Focused – Function
🟡 AT Robotics – Hand Function
🟡 CO-OP – Activity Performance
🟡 Electrical Stimulation – Gait Parameters, Muscle Strength
🟡 BoNT + Resistance – Muscle Strength
🟡 BoNT + Orthotic – Hand Function
🟡 Casting – Gross Motor, Walking
🟡 Whole Body Vibration – Gross Motor
🟡 Coaching – Gross Motor
🟡 Hippotherapy – Gross Motor, Hand Function
🟡 Hydro Therapy – Gross Motor
🟡 Yoga – Muscle Strength, Flexibility
🟡 Motor Speech – Speech, Intelligibility
🟡 Mirror Therapy – Motor Function
🟡 Biofeedback – Hand Function, Walking
🟡 Focal Vibration – Gross Motor
🟡 AT Wii Fit – Balance
🟡 Hippotherapy Simulation – Gross Motor, Hand Function
🟡 AT Adaptive Equipment – Mobility
🟡 AT VR + Biofeedback – Balance
🟡 Modified Sport – Gross Motor, Walking
🟡 Seating – Hand Function
🟡 DBS – Gross Motor

Probably Don’t Do It:

🟡 Suit Therapy – Gross Motor
🟡 Conductive Education – Gross Motor
🟡 Massage – Gross Motor
🟡 Physical Activity – Gross Motor
🟡 Reflexology – Gross Motor
🟡 Sensory Processing – Function
🟡 Vestibular Stimulation Training – Gross Motor
🟡 Vojta – Gross Motor
🟡 Yoga – Gross Motor

Don’t Do It:

🔴 NDT [Original Passive Form] – Gross Motor
🔴 Sensory Integration – Motor Skills
🔴 Cranial Osteopathy – Gross Motor
🔴 Hyperbaric Oxygen – Gross Motor

Early Intervention

Probably Do It:

🟡 CIMT <2yrs – Hand Function
🟡 Motor Training – Gross Motor
🟡 GAME – Gross Motor, Cognition
🟡 CIMT or Bimanual – Hand Function
🟡 General Stimulation – Gross Motor, Cognition
🟡 COPCA – Gross Motor

Probably Don’t Do It:

🟡 NDT [Original Passive Form] – Gross Motor
🟡 Conductive Education – Gross Motor
🟡 Vojta – Gross Motor

Tone

Do It:

N/A

Probably Do It:

🟡 BoNT + Physiotherapy – ↓ Spasticity
🟡 Acupuncture – ↓ Spasticity
🟡 tDCS – ↓ Spasticity
🟡 Hippotherapy – ↓ Spasticity
🟡 Whole Body Vibration – ↓ Spasticity
🟡 NDT – ↓ Spasticity
🟡 tDCS – ↓ Dystonia
🟡 DBS – ↓ Dystonia

Probably Don’t Do It:

🟡 Massage – ↓ Spasticity
🟡 Reflexology – ↓ Spasticity
🟡 Stretching – ↓ Spasticity
🟡 SEMLS – ↓ Spasticity

Contracture and Alignment

Do It:

🟢 BoNT + Casting – Passive, Range
🟢 Lower Limb Casting – Passive, Range
🟢 Hip Surveillance – ↓ Displacement
🟢 Scoliosis Surgery – Scoliosis Correction

Probably Do It:

🟡 Biofeedback – Active Range
🟡 BoNT – Passive Range, Prevent Hip Displacement
🟡 BoNT + Hip Brace – Prevent Hip Displacement
🟡 SEMLS – Ankle/Knee Passive Range
🟡 Soft Tissue Crouch Surgery – Knee Passive Range
🟡 Soft Tissue Pelvis Surgery – ↓ Hip Internal Rotation
🟡 Equinus Correction – ↓ Foot Deformity
🟡 Femoral Osteotomy – ↓ Hip Rotation
🟡 Hand Surgery – ↓ Thumb Posture
🟡 Reconstructive Hip Surgery – ↓ Hip Displacement
🟡 Upper Limb Casting – Passive Range
🟡 AT Robots – Ankle Passive Range
🟡 Postural Management – Prevent Hip Displacement
🟡 Whole Body Vibration – Passive Rage

Probably Don’t Do It:

🟡 Stretching – Passive Rage
🟡 Orthotics – Passive Rage

Don’t Do It:

🔴 NDT [Original Form] – Prevent Contracture

Pain

Probably Do It:

🟡 Animal Assisted Therapy – Pain
🟡 Massage – Pain
🟡 Sleep System – Pain
🟡 DBS – Pain

Probably Don’t Do It:

🟡 Yoga – Pain

Sleep

Probably Do It:

🟡 Cranial Sacral Therapy – Sleep
🟡 Sleep Hygiene – Sleep
🟡 Melatonin – Sleep
🟡 Sleep System – Sleep
🟡 Massage – Sleep

Probably Don’t Do It:

🟡 Hyperbaric Oxygen – Sleep

Pulmonary

Probably Do It:

🟡 Exercise – Pulmonary
🟡 Airway Clearance Physiotherapy – ↓ Hospital Stay
🟡 AT Seating – Pulmonary
🟡 Vojta – Diaphragm, Inspiration

Mealtime

Do It:

🟢 Electrical Stimulation + Oral Motor – Feeding
🟢 Oral Sensory Motor – Oral Function, Chewing

Probably Do It:

🟡 Gastrostomy – Safety, Growth
🟡 Parent Education – Feeding, ↓ Stress
🟡 Dysphagia Compensation – Safe Swallow
🟡 Oral Sensory Motor – Diet Consistency, Safe Swallow, Feeding, ↓ Tongue Thrust

Drooling & Oral Health

Do It:

🟢 Electrical Stimulation + Oral Motor – ↓ Drooling
🟢 Dental – Dental Health

Probably Do It:

🟡 Behavioral Interventions – ↓ Drooling
🟡 Oral Sensory Motor – ↓ Drooling

Communication

Do It:

🟢 Literacy – Literacy

Probably Do It:

🟡 Language Therapy – Communication, Interactions
🟡 Augmentative & Alternative Communication – Communication, Peer Interactions, ↑ Partner Communication, Verbal Speech Supplement
🟡 Eye Gaze Augmentative & Alternative Communication – Communication
🟡 Social Stories – Communication, Behavior

Probably Don’t Do It:

🟡 Non-Speech Oral Motor – Verbal Speech
🟡 Oral Sensory Motor – Verbal Speech

Cognition

Do It:

🟢 Literacy – Literacy

Probably Do It:

🟡 AT Robotics – Cognition, Play
🟡 GAME – Cognition
🟡 General Early Stimulation – Cognition
🟡 Yoga – Attention, Mindfulness
🟡 Play Therapy – Play, Coping

Probably Don’t Do It:

🟡 Yoga – Executive Function

Self Care/Function

Do It:

🟢 Goal Directed Training – Self Care
🟢 Home Program – Self Care

Probably Do It:

🟡 Animal Assisted Therapy – Self Care, Socialization
🟡 CO-OP – Self Care
🟡 AT Adaptive Equipment – Independence
🟡 Context Focused – Self Care
🟡 Massage – Self Care
🟡 COPCA – Function

Probably Don’t Do It:

🟡 Conductive Education – Self Care
🟡 Hippotherapy – Self Care

Don’t Do It:

🔴 NDT [Original Passive Form] – Self Care
🔴 Hyperbaric Oxygen – Self Care

Parent Outcomes

Do It:

🟢 Acceptance & Commitment Therapy – ↓ Stress
🟢 Stepping Stones Triple P – ↓ Stress, Quality of Life, Child Behavior

Probably Do It:

🟡 Conductive Education – Quality of Life
🟡 Coaching – Parenting Skills, Coping
🟡 Parent Education – Parenting Skills
🟡 Dysphagia Management Parent Education – ↓ Stress
🟡 Solution Focused Therapy – Parent Skills
🟡 Respite – ↓ Stress
🟡 AT Adaptive Equipment – Decreased Burden

Tips on using the traffic light

The authors of this study recommend these steps for using the traffic light.

1. Ask the child and family to define their intervention goals

2. Match the goals to the outcome indicator headings and look up the intervention options

3. Select the intervention with the highest level of evidence, and offer that intervention

4. If the intervention is ineffective, unavailable, or if the family feels it is not the right fit, move on to the intervention with the next-highest level of evidence

Conclusion

We hope this has been a helpful guide into cerebral palsy and OT. If you found this page and read to the bottom, you probably either have cerebral palsy yourself or are an advocate for someone with cerebral palsy. We commend you for really digging into what works and what doesn’t.  And, we hope this helps find the right therapist to support you.