In general, we as physiotherapists are the experts in movement, and we can help your child work towards improving their independence and mobility in a variety of areas! More specifically, regarding cerebral palsy, physiotherapists utilise a variety of methods to work on decreasing the effects of their hypertonia to be able to work within their means and compensations to work on strengthening their muscles and improving their balance and motor planning skills.
What we try to emphasise here at NAPA in our physiotherapy programs are good mechanics that can carry over through meaningful activities to improve the independence and participation of our kids within their daily lives.
Some of the common types of activities utilised in our patient population with cerebral palsy are whole body vibration, balance or weight shifting activities, strengthening activities, and neuromuscular electrical stimulation (NMES). Let’s dive into an overview of these tools and techniques!
Typically, whole body vibration is a modality that we utilise to help “break up” or modulate a patient’s tone, especially for our patients with hypertonia. This essentially provides input to the child’s brain that can be interpreted appropriately and limits any of the signals for the increased muscle tone.
While on here, we can do more stationary positions to work more on tone modulation, or we can work on specific transitions or activities to be able to more appropriately utilise specific muscle groups and limit the amount that the child’s muscle tone may try to “help”. You can have your child sit, stand, lay down, or be on their hands and knees here! It depends on what muscles and activities you want to work on.
Most of our kids with cerebral palsy tend to find the most stability when they are in one stationary position; however, throughout our day there’s constant movement and shifting that occurs whether to be comfortable or needing to grab a necessary item. Needing to complete a weight shift requires muscle control as well as inherent balance reactions that are difficult for our children to multi-task with.
Practicing this in a controlled setting with whatever level of support that is needed, is very helpful to give them the opportunity to practice this necessary skill. Usually, you will see this play out as standing on a “squishy” surface or the child is standing on a platform that will move either side to side or forward and backward as they are walking across.
We always want to incorporate some strengthening exercises either for the whole body or specific muscle groups to assist in a specific activity. Usually, we will highlight the abdominals and bottom muscles. When we work on strengthening the abdominals, that will assist with general balance and trunk/postural stability. When we work on strengthening the gluteal or bottom muscles, that will help with general pelvis stability when working on standing.
Because there is so much carryover between strengthening these abdominal and gluteal or bottom muscles and making some of the everyday tasks easier, this is why these areas tend to be the focus. However, based on how the child presents and what their specific needs are, we may incorporate strengthening other muscles to help promote whatever their goals are.
It may be easy to think that with the increased tone in a specific muscle, that muscle must be strong. However, the utilisation of that muscle is either all on or all off due to that tone, not the actual muscle strength. We may use NMES to these muscles that normally have the increased tone to be able to strengthen the muscle in what we call a mid-range type of motion, or what would be a more functional range.
Think of it this way: say that you can do a squat, but it can only be really fast all the way down and then all the way up. That wouldn’t be very controlled, but if you were to do the same squat in that middle range slow and controlled, we would consider that to show more strength compared to the first example. That same concept applies to our children when we are working on strengthening in that mid-range and sometimes the NMES can help us achieve that ability.
Here at NAPA we have the resources to utilise everything listed above as well as different suit wear therapies, such as the NeuroSuit, Theratog, and SPIO. All of these provide various levels of support from being more postural/alignment based (Theratog and SPIO), to providing loading, alignment and compression (NeuroSuit) and can really be beneficial to provide increased body awareness and improving strength. We also incorporate the intensive model into our therapy program which is starting to become more widely researched due to the effectiveness of this model within a short period of time.
There is the beginning of more research into other therapies such as aquatic therapy and hippotherapy (horse riding). We highly recommend talking to your weekly therapist or MD about the possibility of these programs before starting one to make sure it is medically safe and appropriate for your child. There are other medical options for kids to help manage cerebral palsy from muscle relaxants to procedures such as Botox and while we can help provide some options and talk about those options on a case-by-case basis, this is definitely a topic that your medical doctor is the expert of and we highly recommend talking to them first.
At NAPA, we try to incorporate parents into our weekly sessions as much as we can so that you can take home one to two activities to work on throughout the week to keep your child’s progression moving forward. We love to problem-solve with our parents on how to make various activities easy to complete at home and find a fun way to make it part of your daily routine so that exercise becomes fun and enjoyable! The more fun it is, the easier it is to complete at home and the more new and different activities we can complete here!
Kayla Darden received her DPT from USC and is based at the NAPA Centre in Los Angeles. She’s always had a heart for working with kids and loves figuring out the best way to motivate the little ones! When not at the clinic, she is either reading a book, snuggling with her cats, or trying a new cooking recipe with her husband.
NAPA Centre is a world-renowned paediatric therapy clinic, offering weekly and intensive therapy for children with cerebral palsy at our multiple clinic locations throughout the Australia, the US, and the UK. NAPA is committed to helping children lead their happiest, healthiest lives by providing the best and most innovative paediatric therapy methods from around the world all under one roof. Let your child’s journey begin today by contacting us to learn more.