Physical Therapist's Guide to
Cerebral Palsy (CP) is a general term used to describe a group of disorders that affect the normal development of movement and posture. CP is caused by an injury to the brain—such as infection, stroke, trauma, or the loss of oxygen to the brain—that occur before, during, or after birth or within the first 2 years of life. The injury to the brain is "nonprogressive," meaning that it does not get worse after the initial injury. However, the day-to-day activities that can be affected by the injury during an individual's childhood can worsen throughout the individual's life.
Difficulties from CP can range from mild to severe. Individuals with CP may have trouble seeing, hearing, feeling touch, thinking, or communicating. They may also experience seizures.
CP affects approximately 3.6 infants per each 1,000 born in the United States. The number of children diagnosed with CP has grown in recent years as a result of the increased survival rates of premature babies and those born with low birth weights. The average life expectancy of adults with CP has increased as well. People with CP can benefit from physical therapy throughout all the stages of their lives.
Physical therapists are experts in helping people with CP improve their physical functions. They can help them stay active, and healthy, and perform day-to-day tasks such as walking, operating a wheelchair, and getting in or out of a wheelchair to and from a bathtub, bed, or car.
What is Cerebral Palsy?
Cerebral palsy is a broad term used to describe the effects on the development of motor skills caused by nonprogressive injuries to the developing brain. Types of CP are given different names based on the type of movement problem and the areas of the body affected:
- Spastic involves increasing spasm of the muscles as the person moves faster.
- Ataxic involves decreased coordination and unsteadiness throughout the body.
- Dyskinetic involves unpredictable changes in muscle tone and movement that create unstable posture.
- Mixed describes a combination of the movement problems noted above (spastic, dyskinetic, or ataxic).
- Quadriplegia describes CP that affects both arms and legs, the neck, and the trunk.
- Diplegia affects either both legs (the most common form of the disorder) or both arms (less common).
- Hemiplegia affects just one side of the body.
Signs and Symptoms
Symptoms of CP differ from one person to the next. Symptoms might appear as early as 2 months of age and are usually seen before a child is 2 years old. Parents usually notice early signs that their child is not able to hold his or her head up as well as other babies, or easily reach, roll, sit, crawl, or walk.
Other symptoms of CP related to movement can include:
- Tight muscles that worsen with stress, illness, and time
- Tight joints that do not bend or stretch all the way, especially in the hands, elbows, hips, knees, or ankles
- Muscle weakness, or a decline in movements that the child had already been performing
- Lack of efficient movement of the legs, arms, trunk, or neck
- Lack of coordination
- "Floppy" muscles, especially in the neck or trunk
- Muscle tremors
Other symptoms of CP can include:
- Difficulty speaking or being understood
- Learning disorders (even though the child has normal intelligence)
- Vision problems
- Hearing problems
- Pain in joints that is often caused by tight muscles or poor posture
- Decreased mouth muscle strength or coordination leading to problems with eating and/or increased drooling
- Difficulty holding urine
- Slower-than-normal growth
How Is It Diagnosed?
Although a child's pediatrician may identify a delay in movement development and refer the child to a physical therapist, physical therapists are often the first medical professionals to identify signs and symptoms of CP. The therapist will:
- Conduct a medical history, asking questions about the parents' concerns, the pregnancy, birth, and the general health of the child
- Perform a thorough evaluation that includes:
- observing the child in different positions to assess movement patterns
- hands-on assessment of the child's muscle tone, strength, flexibility, and reflexes
- determining developmental milestones (how well he or she can sit, stand, or grasp objects)
Your therapist will collaborate with your child’s physician, who may order further tests—such as blood work, magnetic resonance imaging (MRI), or computerized tomography (a CT Scan)—to reach a final diagnosis.
How Can a Physical Therapist Help?
A physical therapist is an important partner in health care and fitness for anyone diagnosed with CP. Therapists help people with CP gain strength and movement to function at their best throughout all the stages of life.
The physical therapist will provide care at different stages in the individual's development, depending on his or her unique needs. Therapy may be provided in your home or at another location such as a community center, school, or a physical therapy outpatient clinic. The physical therapist will work with other health care professionals, such as speech/language pathologists or occupational therapists, to address all the individual's needs as treatment priorities shift.
Physical Therapy in the Early Years: Birth to Age 4
Physical therapists can help caregivers support their child's movement development by providing hands-on training for positioning, movement, feeding, play, and self-calming. Your therapist will also suggest changes at home to encourage movement development, as well as communication, hearing, vision, and play skills. It is important to remember that it is through play that young children learn many skills. Your therapist will develop an individual program of play activities that match your child's specific needs—to improve strength, movement, and function. At this age, physical therapy is generally provided at home, in a daycare center, or in an outpatient clinic.
Physical Therapy in the School Years: Ages 5 to 12
Physical therapists train caregivers to help the child with CP accomplish functional goals and promote the highest quality of life through all stages of development. The treatment plan and goals will change as your child ages. Pre-school and school bring challenges for your child to navigate new environments each year. At this age, children also experience growth spurts, requiring adjustments to therapy and equipment used to help the child. Care priorities can focus on walking, transfers, personal hygiene, play, socialization, and adaptive equipment needs to meet the social and physical changes that occur during this time period. Physical therapy may be provided in outpatient and/or school settings. School-based therapy focuses on accommodations and modifications to ensure your child has the best possible learning environment.
Physical therapy benefits the adolescent with CP by focusing on prevention of posture problems and joint limitations. This is done by encouraging mobility and fitness, managing muscle and/or joint pain, and recommending braces and other helpful equipment to maintain health and function. The physical therapist will educate parents about self-care, maintaining daily routines, socialization, physical activity, and plans for the child's schooling and future careers.
It is important to note that lifelong health habits are formed at this age—and developing an individual fitness program can improve the person’s health and function for the remainder of his or her life. Children with CP are at a greater risk than the general youth population of not exercising enough and becoming sedentary, which can lead to weight issues and medical complications. These issues progress gradually but can have a significant impact on the quality of life of the child and of the caregivers. Physical therapists are skilled in developing individual exercise programs that use each child's strengths and abilities. For instance, a therapist might recommend adaptive sports such as bowling, swimming, cycling, volleyball, tennis, and basketball to promote physical fitness and socialization with peers.
Physical Therapy in Adulthood: Age 18+
Many individuals with CP live highly functional lives as adults. Many have careers and families. In adulthood, people with CP often focus on pain management, conserving energy, adaptive equipment, and environment modifications to promote independence at work and at home. Physical therapists can help with managing these concerns. Like many adults, individuals with CP have muscle and joint pain in adulthood. Physical therapists can prescribe an exercise routine that enables the individual to stay strong and minimize joint issues.
Physical therapists are skilled in all of these areas, and they partner with people with CP and their caregivers to address their individual goals for realistic, positive outcomes.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat patients with cerebral palsy. However, you may want to consider:
- A physical therapist who is experienced in treating people with CP
- A physical therapist who focuses on treating infants and children
- A physical therapist who is a board-certified clinical specialist or who has completed training in pediatric or neurologic physical therapy, meaning he or she has advanced knowledge, experience, and skills
You can find physical therapists that have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have cerebral palsy.
- During your first visit with the physical therapist, be prepared to describe the symptoms in as much detail as possible, identify what makes the symptoms worse or better, and discuss your goals.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of cerebral palsy. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free access of the full article, so that you can read it or print out a copy to bring with you to your health care provider.
Bax M, Goldstein M, Rosenbaum P, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. 2005;47:571–576. Article Summary on PubMed.
Yeargin-Allsopp M, Van Naarden Braun K, Doernberg NS, et al.Prevalence of cerebral palsy in 8-year-old children in three areas of the United States in 2002: a multisite collaboration. Pediatrics. 2008;121;547–554. Free Article.
Ustad T, Sorsdahl AB, Ljunggren AE. Effects of intensive physiotherapy in infants newly diagnosed with cerebral palsy. Pediatr Phys Ther. 2009;21:140–149. Article Summary on PubMed.
Dumas HM, Watson K, Fragala-Pinkham MA, et al. Using cognitive interviewing for test items to assess physical function in children with cerebral palsy. Pediatr Phys Ther. 2008;20:356–362. Article Summary on PubMed.
Mockford M, Caulton JM. Systematic review of progressive strength training in children and adolescents with cerebral palsy who are ambulatory. Pediatr Phys Ther. 2008;20:318–333. Article Summary on PubMed.
Darrah J, Wiart L, Magill-Evans J. Do therapists’ goals and interventions for children with cerebral palsy reflect principles in contemporary literature? Pediatr Phys Ther. 2008;20:334–339. Article Summary on PubMed.
Horsman M, Suto M, Dudgeon B, Harris SR. Growing older with cerebral palsy: insider’s perspectives. Pediatr Phys Ther. 2010;22:296–303. Article Summary on PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.
Authored by Judy Lindsay, PT. Reviewed by the editorial board.