occupational therapy for children with cerebral palsy

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Occupational therapists (OTs) treat a wide range of conditions in children. This post focuses on occupational therapy for children with cerebral palsy and treatment. One of the more common neurological diagnoses that OTs treat is cerebral palsy. This post breaks down what cerebral palsy is, and how an occupational therapist can provide interventions and services to address the functional deficits caused by this condition. Some families may need to start with this post: What is Occupational Therapy?

Occupational therapy and cerebral palsy


Cerebral Palsy (CP) is a group of disorders that can affect the body in different ways, depending on the type and severity. According to the CDC, it is the most common motor disorder among children in the United States.

The broad condition is better understood by breaking down the meaning of the words: “cerebral” meaning brain, and “palsy” meaning muscle weakness. In the case of CP, the muscles of the body become weak due to an injury to the brain. 

This injury in the brain can happen during the brain’s development in utero, or early on in an infant’s life. The neural pathways get interrupted or damaged, causing a dysfunction in the way that the brain communicates to the muscles of the body. 

types of cerebral palsy

It’s important to cover the various types of cerebral palsy because each type can involve differing occupational therapy interventions. The most common types are spastic, ataxic, dyskinetic, and mixed cerebral palsy.

Spastic Cerebral Palsy- The most common type of Cerebral palsy is spastic CP. The term”Spastic” refers to the presentation of the musculature affected by the condition. The muscles are spastic, or stiff and tight. The stiffness in the affected muscles, or increased muscle tone, causes difficulties with movement. They may be too “stuck” to move properly. 

Occupational Therapy for Spastic Cerebral Palsy

Occupational therapy for spastic Cerebral Palsy can include:

  • Self care interventions
  • Participation in meaningful activities
  • Education on adaptive tools
  • Build on strengths
  • Manage sensory and emotional regulation needs
  • NDT interventions
  • Splinting
  • Positioning
  • Adaptive equipment
  • Compensatory techniques

Ataxic Cerebral Palsy- Results in balance and coordination deficit. This type of palsy results in abnormal gait patterns, decreased safety in mobility, low muscle tone, tremors, and generally reduced coordination for fine or gross motor activities. 

Occupational Therapy for Ataxic Cerebral Palsy

Occupational therapy for Ataxic Cerebral Palsy can include:

  • Environmental modifications
  • Weight Bearing
  • Self-Care
  • Participation in meaningful activities
  • Education on adaptive tools
  • Build on strengths
  • Manage sensory and emotional regulation needs
  • Positioning
  • Adaptive equipment
  • Functional mobility
  • Compensatory techniques

Dyskinetic Cerebral Palsy– This type of CP describes many different muscle deficits: dyskinetic means uncontrolled muscle movement. Those with dyskinetic CP may have too tight or loose muscles, uncontrollable movements that are fast or slow, or an ever-changing combination of any of these symptoms. In more severe cases, these uncontrollable movements occur often, resulting in requiring more assistance for daily activities. In milder cases, the involuntary movement may be smaller and infrequent, therefore the individual can be more independent. 

Occupational Therapy for Dyskinetic Cerebral Palsy

Occupational therapy for Dyskinetic Cerebral Palsy can include:

  • NDT interventions
  • Self-care interventions
  • Participation in meaningful activities
  • Education on adaptive tools
  • Build on strengths
  • Manage sensory and emotional regulation needs
  • Splinting
  • Positioning for safety and function
  • Adaptive equipment
  • Compensatory techniques

Mixed Cerebral Palsy– There is also a category of “mixed” cerebral palsy, meaning more than one type of palsy is present. The diagnosis of Mixed Cerebral Palsy is given when a child shows symptoms of multiple types of cerebral palsy. When this occurs, there may be differences in different areas of the brain. Mixed cerebral palsy type can present with a wider variety of physical and neurological symptoms.

Occupational Therapy for Mixed Cerebral Palsy

Occupational therapy for Mixed Cerebral Palsy can include:

  • Any of the occupational therapy interventions listed above, depending on the specific needs of the individual and based on symptoms.

No matter the type of CP, every case will be different, because each child comes with their own unique abilities. 

Cerebral palsy occupational therapy interventions

Occupational Therapy for children with Cerebral Palsy

Aspects of the occupational therapy interventions for cerebral palsy are listed below. Because each individual with cerebral palsy diagnosis is so different in the way of tone, musculature, abilities, difficulties, environmental considerations, family environment, and other aspects, there will be no two treatment plans that are exactly alike.

Neurodevelopmental Treatment (NDT): NDT is a holistic movement based approach, involved in handling and moving the child. In the most serious cases of cerebral palsy, an individual may require total assistance, or be dependent, for the majority of their activities of daily living.

An OT and a PT provides treatment to control the muscles, and reduce the likelihood of joint contractures. If a joint is bent for too long due to high spasticity, the bones of the joint may begin to “fuse” and a joint contracture is formed.

This happens often at the elbows, hips, and knees preventing that joint from moving.

In order to avoid joint contractures, therapists can provide skilled therapy, such as NDT, to correct the spasticity and promote functional movement in the affected muscles.

Splinting for Cerebral Palsy: In milder cases, a child with spastic CP may be able to perform most tasks independently, but benefit from a splint to guide their upper extremity posture.

A commonly used splint is a thumb splint with a supinator strap. Many children with cerebral palsy present with tightly closed fingers, and a pronated forearm.

A thumb splint with a supinator strap can help to position the thumb, wrist, and forearm in a more functional position. This splint is typically prefabricated, made of a soft fabric, attached with velcro. 

Environmental Modifications: Safety is the number one priority. Occupational Therapy and for children with cerebral palsy might involve an environmental assessment for safe mobility in the home.

Recommendations may include: non-slip mats, professional railings installed in bathroom/ hallways/stairs, lighting accommodations, removal of clutter/cords/rugs/other tripping hazards, depending on the unique needs of the child.  

Weight Bearing: Occupational therapy for children with cerebral palsy includes upper extremity weight bearing activities. These can be used on the affected arms to help increase muscle tone in a child with ataxic CP.

Weight bearing can also increase bone density, to reduce the chance of fractures. It can also improve sensory awareness and proprioception that sends information to the brain about where the body is in space.

Effective strength and sensory processing can increases safe, functional movements. To make weight bearing fun and playful, try placing the child prone over a physioball, having them reach for preferred toys with one hand, then the other.

Adaptive Equipment: Feeding tools like the ones in this article on adaptive feeding equipment from the OT Toolbox, may help increase independence, by compensating for shaky movements while feeding.

To increase coordination for handwriting skill, a variety of adaptations can be used (Amazon affiliate links):

It is important to make these activities as client-centered and motivating as possible. Having uncontrollable movement can be very frustrating, especially for small children who don’t understand what his happening to their body. Celebrate the little victories and find out what motivates your client to try, try again! 

Compensatory Techniques: Based on the unique movement needs of the child, occupational therapy for children with cerebral palsy may include alternative methods for the child to complete activities as independently as possible. One example; practice and identify the most functional order to get dressed and undressed.

Teach which arm to thread into a sleeve first, when to pull the shirt over their head, or how to orient the shirt to efficiently motor plan the following step. Create a song, social story, or picture book to help the child and their family learn.

A Final Note on occupational therapy and cerebral palsy

It is important to note that while some children with cerebral palsy may also have cognitive deficits, it is not a trademark of this diagnosis. Many children with CP meet their cognitive milestones.

A cerebral palsy diagnosis does not mean an individual can not learn, see, hear, and communicate as well as their peers. Seizure disorders, communication deficits, feeding, and swallowing disorders are common comorbidities for individuals with cerebral palsy.

Be sure to understand the medical needs of your clients in order to provide the best practice and occupational therapy for children with cerebral palsy.

As with any other patient, once you understand what their barriers and goals are, therapy can be meaningful and fun! 

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.

cerebral palsy occupational therapy interventions

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