CP - Role of Physio

Question 1

What is the role of physio in CP?

Answer 1

• Early intervention
• Train motor control
• Minimise the development of deformity
• Strength training
• Promote fitness
• Assist in decision making (re orthotics, surgery,
  spasticity management)
• Support and teach families

Question 2

What is the role of physio in early intervention?

Answer 2

• Home programs
• Requires early referral
• Support and teach families
• Encourage motor development
• Minimise development of deformity (maintain muscle length)

Question 3

What does training motor control involve?

Answer 3

• Home programs
• Goal directed functional training
• Age appropriate
• Training motor skills during everyday activities beginning at a very young age
• Evidence supports task and context specificity
• Modifying the environment

Question 4

What does minimising the development of deformity involve?

Answer 4

• Promote development of movement skills
• Casting
• Hip surveillance
• Home programs
• Maintain muscle length
• Functional training in lengthened range
• Modifying habitual postures by altering
  environment or teaching a
  better posture
• Orthotics (AFOs, knee splints)
• Early standing

Question 5

What can contribute to the development of deformity?

Answer 5

• Spastic muscles can develop contracture
• Habitual postures can contribute to deformity
• Lack of ‘normal’ forces on muscles and bones can alter their development

Question 6

What does strength training for CP involve?

Answer 6

• Group or individual sessions with PRT
• Emphasis on functional gains (however evidence describes effectiveness in improving muscle strength without gains in function)
• Groups with circuits (step ups, treadmill STS, climbing activities, obstacle course)

Question 7

What is the evidence for promoting fitness in patients with CP?

Answer 7

• Promote activities according to individual
  capabilities
• Demonstrated effectiveness in those that
  have sufficient motor skills & while training continues
• No evidence for gains in participation
• Need to address participation as well

Question 8

How can physio assist in decision making?

Answer 8

• Use a biomechanical & movement analysis approach to assess possible impact of intervention
• Timing of intervention can be vital (child’s movement issues, age & growth, family needs)
• Families often value discussion with the physiotherapist

Question 9

What is the current approach to therapy for CP?

Answer 9

• Training of motor function beginning at a very young age using FCP framework
• Emphasis on maintaining musculoskeletal flexibility & preventing fixed deformity
• Task & context specificity (function)
• Regular monitoring with CPUP, MDT approach
• Appropriate & timely referral to tertiary level services

Question 10

What is the intervention framework for CP?

Answer 10

• FCP
• Use ICF framework in clinical reasoning
• Train movement skills
• Alter environment
• Address habitual postures
• Address impairments

Question 11

What is involved in educating & supporting families?

Answer 11

• Infants: How to handle/play with baby to encourage optimal motor development
• Evidence for FCP & motor learning through home programs
• Emphasis on functional gains in line with family goals
• Understanding child’s specific needs