Introduction

Cerebral Palsy
Nisrin Alqatarneh MSc OT
Thanks to Dr. Sumaya Malkawi
 What is CP?
 A non-progressive neurological disorder,
characterized by abnormalities in the developing
brain that create a group of neurologic, motor,
and postural deficits in the developing child.
 Caused by brain insults or injuries during
prenatal, perinatal or infant period
 Diagnosis is matter of clinical judgment
 The defining feature is motor and postural deficit
 Secondary disorders also compound motor
impairment such as; cognitive, sensory, and
psychosocial deficits
 We can see:
› Impairments in motor and postural control
› Coordination of muscle action
› Sensory impairment
› All typically classified according to the type and
distribution of motor impairment
 The incidence
 1.4 to 2.4 per 1000, this remained constant in past 30 years or
so
 The causes have changed:
› Rise in spastic diaplegia which is associated with prematurity and low
birth rate
› Decrease in athetoid CP which is attributed to fetal asphyxia and
hyperbilirubinemia
 Incidence in general population has remained relatively stable
over past 30 years
• Declined with advances in medical care and technology
• Increased in premature births
 The two factors balance each other out
 Diagnosis

Some factors on which a diagnosis is based

 Delays in development
 Abnormal movement
 Variable tone
 Retention of primitive reflexes
 Hyperresponsive tendon reflexes
 Asymmetry in the use of extremeties
 Poor sucking
 Delays in motor as well as in other areas
 Causes of CP
 Prenatal and perinatal causes
(~80%)
› Infections during pregnancy
› Severe oxygen shortage during
labor and delivery
› Nervous system
malformations

 Postnatal causes (~15%)

› Brain infections
› Head injury
› Prolonged anoxia
 The child with CP shows impaired ability to
maintain normal posture due to lack of muscle
co-contraction (co-activation)
 And the development of abnormal movement
compensations
 Hyperactive responses to tactile, visual, or
auditory stimuli may result in fluctuations of
muscle tone which affect postural control
Classification of CP
 Lesion in motor cortex cause spasticity
 Lesions in basal ganglia cause fluctuations in
muscle tone (athetosis, diakinesis, dystonia)
 Lesions in the cerebellum produce unstable
movements (ataxia)
 So...
 Classification of CP:
› Distribution; according to which limbs are
affected
› The quality of muscle tone
› Locale of brain lesions
› Severity of spasticity (i,e: severe, moderate,
mild)
 Classification of CP (Current)

 Spastic
 Hypotonia
 Ataxia
 Dyskinesia
1) Spastic CP
 Hypertonicity
 Increased contractures
 No isolated movements
 Excessive Muscle Tone
 No variety (stereotyped
 Hyperreactive to
Stretch movements)
 Poor dissociation of
 Children need mobility
(Too little movement; movement
fixed in patterns)
 Children have
decreased stability
 1) Spastic CP
 Have generalized hypotonia from birth to 2-12
months when spasticity gradually appears and
increases until a plateau is reached
 Movement confined to mid-ranges
 Constant excitation of spastic muscles
 Persistent primitive reflexes
 Absent or delayed equilibrium reactions
 1) Spastic CP
 Hand fisted, thumb in palm of hand
 Elbow tightly flexed, humerus adducted
 Head/neck hyperextended, mouth open
 Head back, shoulder and arms back (scapular
retraction)
 Legs extended and tightly crossed at ankles, toes
tightly curled under
Classification of CP by Number of
Limbs Involved
› Hemiplegia
› Diplegia
› Quadriplegia
› Monoplegia
 Associated Reactions
 Associated reactions- “abnormal reflex activities
which may occur in the absence of voluntary
movements”
Dislocated Hip Common in Cerebral
Palsy Due to Spasticity
 Because the increased
muscle tone in the legs When
acts to pulls the femur changing
out of the hip joint diaper, you
may notice
one leg looks
turned out and
shorter than
other
 Guidelines of Treatment- spastic
1. Normalization of tone:
 weight bearing.
 NDT- Bobath: (joint compression, massage, tone
influencing techniques).
 stretching.
2. Facilitation of the movement:
 bilateral activities
 Constrained Induced Movement Therapy (CIMT)
 Guidelines of Treatment- spastic
3. Motor learning :
 practice of skills.
 Repetition.
4. prevention of contractures:
 splinting.
 positioning (also during activity).
5. Reduce the effect of associated reactions.
6. Maintain Range of motion
• Exercise
• Activities (eg. By reaching)
 2) Hypotonic
 Hypo tonicity is considered a transient stage in a
spastic child.
 Difficulty maintaining position against gravity.
 “laxity” – can’t sustain weight bearing
 Sensory intake is low.
 Contractures and deformities may appear.
 Low muscle tone in his extremity.
 Guidelines of Treatment-
hypotonic
 Bobath facilitative techniques: taping on
muscles , weight bearing, fast irrythmic activities
 Over head activities.
 Bilateral activities.
 Selective isolated movements
 Balance training
 3) Athetoid CP
 Alternating muscle tone from low to normal (to high
if combined with spasticity)
 Have increased tone at birth, hypotonia at 2-3
months, athetoid movements seen around 18 months
 Little control in mid-ranges of movement
 Writhing movements, especially distally
 Moves in and out of reflex patterns
 Equilibrium present, but uncoordinated or
exaggerated
 3) Athetoid CP
 Choreo-athetotic CP is characterized by
involuntary movements most predominantly
found in the face and extremities (brief and rapid)
 Dystonic CP is characterized by slow, strong
contractions, which may occur locally or
encompass the whole body (sustained posture)
 Guidelines of treatment - Athetoid
 Control trunk to enhance distal movement
 Weight bearing.
 Stretching
 Bobath.
 Control spasm and the writhing movements.
 working toward midline by using bilateral
activities.
 Increase proprioceptive control
 4) Ataxic CP
 Fluctuating muscle tone from low to normal
 Hypotonic at birth and stay that way
 Uncoordinated and clumsy; poor timing of movement
 Use primitive rather than abnormal patterns
 Intention tremors common
 Slow movements
 Decreased proximal control
 Nystagmus
 Reduced coordination rhythm and accuracy
 Guidelines of treatment - Ataxic
 Normalize the tone ( eg. Weight bearing ,
stretching)
 Postural control. “proximal stability for distal
mobility”
 Active involvement of the upper limbs.
 Motivate selective dissociative movements
(differentiate different muscle group , uses every
muscle group solely).
 Guidelines of treatment - Ataxic
 Bobath techniques : facilitation techniques :
( taping on the muscle , weight bearing , pushing
or pulling ).
 Eye-hand coordination.
 Challenging their balance by swinging and
rocking .
 5) Mixed CP
 spasticity and athetosis is most common
 Cerebral Palsy Classification
Level Gross Motor Classification System (GMFCS)
I Walks without restrictions, limitations in more advanced gross
motor skills
II Walks without restrictions, limitations walking outdoors and in
the community
III Walks with assistive mobility devices, limitations walking
outdoors and in community
IV Self mobility with limitations, children are transported or use
power mobility outdoors and in the community
V Self mobility is severely limited, even with use of assistive
technology

29
 Cerebral Palsy Classification
Level Manual Ability Classification System (MACS)

I Handles objects easily and successfully

II Handles most objects but with somewhat reduced quality and/
or speed of achievement
III Handles objects with difficulty, needs help to prepare and/or
modify activities
IV Handles a limited selection of easily managed objects in
adapted situations
V Does not handle objects and has very limited ability to
perform even simple actions
30
 Sever sp. Quad.
Supine No head lifting tonic labyrinthine reflex (TLR)
Prone No head lifting/rotation (TLR), difficult breathing
P to S Complete head lag because of extensor thrust
(TLR)
Roll Use TNR- no dissociation
Sit Supported only, sit on sacrum (ext. spasticity)
Sit to Supported only, spasticity increases with effort,
stand +ve support reaction
Walk Not possible
Hand Primitive grasp persist, Contractures of
function shoulder, flexion of elbow
Speech Tongue thrust, poor jaw closure, difficult sound
&feeding production
Psycho. Fearful, insecure
 Diplegia
Supine Symmetry of ULs (STNR), hands in midline, hand to mouth-
extensor spasticity increases in LLs
Prone Head lifting- extensor spasticity increases in LLs
P to S Gains head control at 6 mths, associated reactions
Roll initiated at head and arms- legs follow passively
Sit Poor hip flexion, sit on sacrum, kyphosis, W sitting, Prot Rxn
develop forward and sideways
Sit to stand Bunny hopping, over use of UL (grasp and drag body
behind), excessive lordosis and ant. pelvic tilt
Walk Hips and knees flexed(if extended planter flexion), +ve
support, no cruising
Hand Clumsy, need good sitting posture
function
Speech Good, independent feeding
&feeding
Psycho. Naughty, demanding
 Hemiplegia

Supine One hand fisted, arm flexed and retracted- reach out
normally with sound side
Prone Dislikes this position, might develop asymmetric creeping
(sideways or in circle)
P to S Head control
Roll Only to hemi side
Sit Late, weight bearing on sound side, use bottom shuffling
to move around
Sit to stand Affected leg goes forward through ½ kneeling- +ve
support of affected side
Walk Late, drags retracted hemi leg, +ve support, associated
reactions- no PR or ER on hemi side
Hand Hemi side: grasp reflex
function
Speech Normal
&feeding
Psycho. Problems appear late with schooling
 Athetoid
Supine TLR, ATNR, frog pattern, no kicking, dystonic attacks at 2
yrs
Prone TLR- child dislikes it
P to S No head control, neck retraction
Roll Very late, initiates rolling by hips
Sit Galant reflex if sits on chair he falls- no PR or ER
Sit to stand May achieve it if have strong arms
Walk Use ATNR
Hand Use one hand at a time, can grasp (weak) but can’t
function release voluntarily (when he looks at hand  release)
Speech Excessive opening of the mouth, jaw dislocation
&feeding
Psycho. Frustrated
High risk for hip dislocation
 Attaxic
Supine Frog posture
Prone Content to relax, not do anything
P to S Sever head lag
Roll Needs a lot of motivation
Sit Wide base, needs support, may collapse
Sit to stand Excessive use of hands to help
Walk Late, wide base, fast movement, no Eq. Rxn
Hand Intention tremor
function
Speech Poor coordination
&feeding
Psycho. Sociable and happy
 Cerebral Palsy Effects

 Involuntary movements
 Abnormal Muscle tone
 Sensory impairments
 Cognitive impairment
 Social and emotional impairments

How does this affect play?

Children with CP are “being done to” rather than
“doing with” (Blanche, 2008. p. 278)
 Associated Handicaps
 Mental retardation (50%-75%)

 Visual deficits (40%-50%)

 Deafness or hearing loss (25%)

 Seizures (50%)
 Functional Disabilities
 Daily living tasks

 Language

 Learning

 Psychosocial
 Prognosis
 Live into adulthood
• Associated problems may decrease quality and
longevity of life
• Life expectancy is less than that of the "normal"
population
 Can live in the community
• 25%-45% in competitive employment:
• Those with hemiplegia or athetosis most likely to be
employed
Prognosis

Employment outcome correlates to the following

 IQ
 Hand use
 Mobility
 Ability to communicate
 Personality attributes
 Presence of supportive people
 Also influencing outcome is availability of training
areas, financial aid, medical care, access to the
community, community attitudes
 Programming & Treatment
 Early
intervention

 Education
programs

 Hospitals and
clinics
 Programming & Treatment

Drugs
 Seizures: Most children with CP and seizures will be
on seizure medications

 Phenobarbital, Dilantin, Tegretol, Depakene

 Programming & Treatment
Drugs:
• Diazepam = general relaxant
• Baclofen = blocks signals sent from spinal cord to contract
muscles
• Dantrolene = interferes with process of muscle contraction
so muscles can’t tighten as much
• Effectiveness
 Reduce spasticity for short periods, but long term control of
spasticity has not been demonstrated
 Produce side effects such as drowsiness
 BOTULINUM TOXIN (BOTOX)
INJECTION FOR SPASTICITY
 Botox is a nerve impulse ''blocker.'' It attaches to
nerve endings and prevents the release of chemical
transmitters, which activate muscles. 
 Small amounts of Botox are injected into several
locations along the muscle group determined by the
EMG test
 Nerve endings usually grow new connections to
muscles that have not yet been exposed to Botox.
So, treatment may be repeated as often as every
three months
 What to Assess?
 Daily living skills
 Play and leisure skills
 Reflex development and maturation
 Gross and fine motor skills
 Hand functions
 Postural control
 Sensory processing, discrimination and
registration
 What to Assess?
 Praxis skills
 Cognitive skills
 Attention
 Visual perceptual skills
 Psychosocial skills and behaviors
 Language and communication skills
 Self-help skills
 Environmental barriers
 Instruments
 Quality of upper extremities skills Test (QUEST)
 Sensory Integration and Praxis Test
 Wee Functional Independence Measure
(WeeFIM)
 Pediatric Evaluation of Disability Inventory
(PEDI)
 Play Interest Profiles
 Instruments
 Test of Visual Motor Integration (VMI)
 Milani_Camparetti Motor Development
Screening Test
 Peabody Developmental Motor Scales
 Treatment Approaches
 Neurodevelopmental therapy
 Developmental approach
 Sensory integration
 Occupational behavioral
 Model of human occupation
 Biomechanical approach
 OT Intervention Strategy
 In treating a child with C.P., a blend of strategies is
appropriate:
 1. Remediation-
› Establish skills to gain maximal independence
 2. Compensation-
› Assistive technology to aid child
 3. Education-
› Parent and child education and to advocate for patient
 OT Activities in Treatment
Sessions
 Preparatory-
› Using modalities, stretching, massaging, to enable the child to
perform.
 Purposeful-
› To engage in tasks which are aimed to help the child reach
goals.
 Occupational-
› To engage in tasks which are meaningful and done in the
child’s natural context
 Treatment of Cerebral Palsy
• Splinting
• ROM and stretching exercises
• Bilateral Task Practice
• CIMT
• Weight bearing
• Use of equipments
• Adaptations
• NDT/ Handling techniques
• Developmental treatment
• Occupation based therapy (play)
 Treatment of Cerebral Palsy
 Splints may be used to reduce tone or increase
mobility and functional skills.
 Common C.P. splints
› Wrist Cock-Up Splint/Thumb Spica with wrist
support- for children with excessive wrist flexion to
promote functional hand use.
 Splints may be used to address
› Sustained abnormal posturing
› Limitations in movement of hand
› Limitations in functional skills
› Increased tone or decreased tone
 Treatment of Cerebral Palsy
 Daily Range of Motion Activities
› By therapist or family to prevent contractures
 Bilateral Task Practice
› To integrate both affected and unaffected upper extremities
 Weight Bearing Activities to break tone
 Treatment of Cerebral Palsy
 Constraint-Induced Movement Therapy
› There is evidence which suggests that CIMT may be
an appropriate strategy to encourage bilateral hand
use.
› Restraint of the less involved hand by splinting or
casting.
› All children in the studies showed improvement in
musculoskeletal and movement functions.
› Authors noted parental concern regarding the initial
loss of independence in CIMT.
› Parents noted substantial improvements in their
child’s functioning.
 Treatment of Cerebral Palsy
Why CIMT work
 Cortical Reorganization
 Dendrite branching
 Connections
 Synaptic strength
 the goal is to (re)wire (new paths, dendritic
branching) the hardwiring (synaptic
intensity) of the motor and sensory centers
of the brain
 Treatment of Cerebral Palsy
 Constraint-Induced Movement Therapy
 constraint of the non-affected upper
extremity, combined with repetitive use of
the affected upper extremity, works to
improve motor recovery and subsequently
function and performance. PCIMT helps a
child overcome developmental disregard
and at the same time helps the child train
the affected upper extremity.
 Treatment of Cerebral Palsy
 Constraint-Induced Movement Therapy
 Key terms:
 Learned non-use
 Developmental Disregard
 Naturalistic Forced Use
 Massed Practice
 Treatment of Cerebral Palsy
 Credit must be given to Edward Taub, PH.D.
 Dr. Taub is the Director of the Taub Therapy Clinic and
the “originator” in the 1980’s of this model which
incorporates traditional motor recovery therapies. Dr.
Taub’s contention is, based on his extensive research,
that anyone with long standing weakness on one side of
the body nearly always benefits from this approach
 He is a psychologist with the University of
Alabama/Birmingham
 Treatment of Cerebral Palsy
 All studies suggested that CIMT is effective in treating
kids with chronic hemiplegia. There is no clear
evidence to support a specific protocol
 Benefit of CIMT from research studies:
 Increased spontaneous use of the affected arm
 Parental reports of increased activity of daily living
independence
 Improved quality, speed, and dexterity of UE use
 Improved use of impaired hand as an assist in bilateral
activities.
 Protocol

 Eliasson, et al. (2005):

 2 hours day with caregiver, 1x per week with therapist x 8 weeks.

Constraint worn 2 hrs. daily.

 Willis (2002) Constraint is worn 90% of waking hours

 No definitive research stating that skilled in-clinic therapy is any

more effective than naturalistic forced use (w/children only).

 Constraints: Removable cast, splint (compliant child), mitt, ace wrap

(trial).
 Motor learning

 Involves 2 stages:

 • Acquisition or practice stage (relearning) and a retention

and transfer stage (information is stored for retrieval and
application to novel situations)

 • The acquisition stage may indicate performance but it is the

retention and transfer phase which is indicative of learning
(Magill, 1989; Sage, 1984; Schmidt, 1988, 1999)
 Examples of activities with CIMT

 10 mo – 3 y/o
 15-20 minute increments to include: breakfast,
ball play, water play, turning pages, toys to
bucket, snack, weight- bearing, keyboarding,
blocks – knock down, lunch, nap, snack, ball
play, finger paint
 Examples of activities with CIMT

 3-5 y/o & 6-10 y/o

 15-25 min. increments: dressing, eating breakfast,
stretching, coloring, stacking blocks, computer
game, snack, bean bucket, flash cards, weight
bearing, eating lunch. *Dressing, stretching, prepare
breakfast, eat, brush teeth, email family/friends,
arts/crafts, weight bear (push ups), pennies in bank,
games (i.e. sorry), ball task, build blocks, prepare
and eat lunch.
 Examples of activities with CIMT

 Adolescents:
 15-25 min. increments: dressing, eat breakfast,
brush teeth, fold clothes, put key in lock,
computer game, turn radio on & change stations,
open bottle and drink, buttoning, tying, puzzles,
prep lunch and eat, clean up, weight bearing.
 Treatment of Cerebral Palsy

 The use of equipments

 Positioning
› Examples: Head support, wheelchair pelvic straps, wedge
between legs to prevent excessive int. rot.
› Done by therapist or family to prevent contractures and
pressure ulcers
› To improve performance of activities
 The use of equipment
Why?
 To aid stability (e.g. standing, sitting)
 To aid mobility
 To facilitate ADL

Criteria for need:

 Why, where, when, how, who by, and temporary or
permanent?
 The chosen equipment must be useful, used, liked
 Equipments
 Promotes skeletal alignment
 Reduces the effects of reflexes
 www.faqs.org/health/Sick-V1/Cerebral-Palsy.htm
l

 Improves muscle tone

 Encourages normal movement
 Provides developmentally appropriate positioning
Criteria for selection:
 Safe
 Inexpensive
 Adjustable (size, height…etc)
 Easy to use
 Light weight
 Water-proof, easily cleaned
 Cosmetically acceptable
 Close to normal (e.g. adapted chair)
 Why Choose a Sidelyer?
 Allows gravity to put UE’s in good position
 Used to manage muscle tone
 Used to diminish the effects of the ATNR
 An option for floor time
 Why Choose a Wedge?
 Promotes weight bearing
on forearms and hands
 Selected when children
don’t have mobility in
prone
 Alternative to seated
position
 Why Choose a Corner Seat?
 Used when children need support for floor sitting
 Help a forward reach and use of hands at midline
 Allows hip flexion BUT knee extension
Stability
 Sitting: chair, corner seat:
› Cause shoulder protraction
› if there is no head control, back support should be
high to support head
› Pelvis is the key to good posture firm support for
buttocks
› Correct height to get (90, 90,90)
› Attachable try/table (for play, feeding)
› May need pelvic strap
› May need head support
 Why Choose Adapted Seats?

 Provide additional support pieces for head, trunk,

arms and legs

 Used when you want children to be upright but

they lack postural control or endurance to sit in a
regular chair
 Why Choose Bolsters?

From: “Handling the Young Cerebral Palsied Child at Home”, Finnie

 Ambulation Aids
 Walker
www.noahsworldusa.c
om/CP.htm

 Crutches

 Canes

 Wheelchair
 Stability
 Standing: All children >12 months should be
standing
› Standing frame, prone stander
 Why use it?
› Body alignment
› To prevent osteoporosis
› Stimulate postural mechanisms
› Circulation
› Decrease pressure sores
› Good for visual awareness
› Normal milestones
 Why Choose a Wheelchair?
 Provide a stable, secure base
 Increase a child’s potential for participation in
education activities
 Mobility improves independence
 Mobility lessens “learned helplessness”
 Basics of Wheelchair Positioning:
Achieving a Good Fit
 Measurements taken of: pelvic/hip width, thigh
and leg lengths, heights of mid-back, mid-
scapula, and shoulder levels, elbow position

 Hip flexion, knee flexion, ankle flexion and

elbow flexion- depends on needs of child!!
 Maintenance
 Regular cleaning will go a long way
 Dirt will ruin a chair
 An unclean chair is a “roach motel”
 Cleaning should be a daily task
› Assign a “helper” to this task
 Never go on a field trip without a tire pump of can of
“air”
 At least once a week, check the brakes
 “Wiggle” the chair daily–is anything rattling or
moving? Can you see where? Use your
screwdriver or allen wrench.
 BUT never, never adjust the angles of the settings.
› Changing one angle changes position for the whole body
 Why Choose a Stander?
 Provides weight bearing
(which should be considered for any child over
12 months)
 Promotes visual-perceptual development
 ADL Positioners
 Toileting
 Bathing
 Feeding
 Mobility

 Scooter board
 Advice not to use baby walker (stimulate +ve
support)
 Adapted tricycle for children with diplegia/
hemiplegia: back support, wedge between knees,
adjusted handles to prevent internal rotation and
adduction of shoulder
Wheelchair:
 Firm support
 Correct width to prevent side flexion
 90, 90, 90
 Foot support
 May need head support
 May use mould inside the chair to correct position
and prevent pressure sores
 Self propel/ motorized or external help
 Recreation
 Horse riding (Hippotherapy): mobility,
excitement, equality, dynamic
› Therapeutic benefits:
 Facilitation of normal postural mechanisms
 Interaction with the environment
 Symmetry of posture
 Decrease fear of height and stimulation of spatial
orientation
 Development of self-confidence
 Recreation
 Swimming (floating):
› promotes relaxation of muscles, ease of movement,
and enjoyment
› NB:
 most children with CP are incontinent
 Take care of children with epilepsy
Encouraging Different Positions

From: “Handling the Young Cerebral Palsied Child at Home”, Finnie

Encouraging Different Positions

From: “Handling the Young Cerebral Palsied Child at Home”, Finnie

 Functional use in play

From: “Handling the Young Cerebral Palsied Child at Home”, Finnie

Functional Use in the Classroom

From: “Handling the Young Cerebral Palsied Child at Home”, Finnie

 Adaptations for Play

From: “Handling the Young Cerebral Palsied Child at Home”, Finnie

 Adaptations for Play

From: “Handling the Young Cerebral Palsied Child at Home”, Finnie

 Providing Stability to
Improve Mobility

From: “Handling the Young Cerebral Palsied Child at Home”, Finnie

 Providing Stability to
Improve Mobility

From: “Handling the Young Cerebral Palsied Child at Home”, Finnie

 Providing Stability to
Improve Mobility

From: “Handling the Young Cerebral Palsied Child at Home”, Finnie

Classroom Before
Classroom Before
 Adaptations
 Widened isles between tables.
 Removed items not currently being used.
 Added adaptive seating.
 Added adaptive switches for battery operated objects
 Added adaptive scissors for cut & paste activities.
 Added adaptive utensils for eating.
 Added adaptive communication device for interaction with
peers and teachers.
 Added adaptive hand weight for greater control while writing.
Adaptations & Modifications

Tumble Forms Corner Chair

Push Down Table Top Scissors

Oval Texture Switches

Self Help Skills

 
EasieEaters Curved Utensils
                   

    

Dressing Cube
Scooper Bowl
 Fine Motor Development
Weighted glove Therapatty
Gross Motor & Muscle Development

Anti-Burst Half Massage Ball

Social Interaction

Four-Tub Sensory Station

Cognitive Development

Magnetic Board Vehicle Magnet Blocks

Upper/Lower Case Letters
 Parent Advocacy
Things to keep in perspective:
› The parent is the expert on their child.

› They may spend the most time with their child.

› They may know daily obstacles better than anyone.

› They are the constant in their child’s life.

 Parent Advocacy
 Treat each parent with RESPECT and
DIGNITY.

 Choose goals which are important to

PARENT.

 This parent/clinician TEAM will ultimately

work to address the multidimensional needs
of the CP patient
 Parent advocacy
 Parents may go through an emotional process:
› shock, grief, denial, anger and acceptance.
 This emotional process may not always be linear, and
different feelings may arise as new developmental
challenges are posed.
› Accept your clients feelings and empathize.
 Help them work to maximize their child’s participation
throughout their developmental process. (9)
 Parent Advocacy
 Things to remember when working with
parents:
› It is difficult for some parents to let professionals
into their lives.
› Respect your client’s privacy.
› Encourage parents be active in their children’s
therapy.
› Be culturally sensitive to those with different
beliefs than your own.
› Include a home program that makes sense and is
feasible to the parent. (9)
 Parent Advocacy
 You can help parents learn to be advocates for their
child with CP.
› Let parents know that they are the most important
part of their child’s care.
› Educate parents about their child’s diagnosis and
occupational therapy.
› Give parents links to websites with information.
› Let parents know about local organizations and
support groups.
› Encourage parents to ask questions to their
physicians and healthcare providers.
› Address caregiver burnout and help parents find
ways to deal with stress.
 Parent Advocacy
 Other important information for our parents:
› Respite care and family counseling may be
available for parents.
› Parents can become involved in advocacy for
children with disabilities on the state and
national level.
› Parents may want to know about current
research. (Evidence based practice)
› Parents may want to become involved in
fundraising for their cause.