Treatment of Cerebral Palsy and Motor Delay

Treatment of Cerebral Palsy and Motor Delay is a highly practical, easy-to-read resource for all paediatric practitioners and students working with the developmental abilities and difficulties of children, providing a thorough overview of cerebral palsy and its treatment.

The sixth edition has been thoroughly revised and updated to integrate the latest evidence-base on motor control and motor learning, whilst still retaining Sophie Levitt's eclectic, holistic and functional approach. It includes greater detail on paediatric occupational therapy, classification systems, the latest systematic reviews of research, as well as an expanded chapter on adolescents and adults with cerebral palsy. The chapter on equipment has also been increased so as to be of further relevance to occupational therapists.

Supported by clear diagrams and photographs, as well as summaries to consolidate learning, it outlines therapeutic approaches and suggests treatment and management options, providing a wealth of practical information. The book promotes positive relationships between therapists, people with cerebral palsy and their families.

Sophie Levitt is a Specialist Physiotherapist and Tutor in Developmental Paediatrics and Paediatric Neurology. Her career has encompassed high profile therapy posts in London. She currently consults to a variety of professionals involved in the field of cerebral palsy internationally.

Anne Addison is a Clinical Lead Occupational Therapist working with children and young people with cerebral palsy and other neurodevelopmental disabilities.??She has worked across community, educational and acute hospital settings and currently has a specialist role supporting children with communication difficulties.

Foreword ix

Preface xi

Acknowledgements xvii

1 The clinical picture for therapy and management 1

Incidence of cerebral palsy 1

Motor dysfunction 1

Associated impairments and disabilities 3

Broad framework for therapy and management 4

Aetiology of cerebral palsy 7

Genetic causes 7

Causes in later childhood 7

Neuroimaging 7

Clinical picture and development 8

Change at different ages 9

Classification systems 11

Topographical classifications 14

Classification of motor types of cerebral palsies 15

Common features observed in all presenting types of cerebral palsies 21

Motor delay 22

Summary 23

2 A collaborative learning approach 25

Working with parents within a family framework 25

Emotional support 26

Parents vary 27

Other adults 28

Family‐centred services 28

Research on home and school visits 30

Collaborative learning approach 30

Opportunities to discover what the parents and child want to achieve 31

Opportunities to clarify what is needed for these achievements, to recognize what parents and children already know and can do, and to find out what they still need to learn and do 32

Involvement in the selection and use of methods 34

Involvement in the evaluation of progress 37

Parent–child interaction 38

Helping a child to learn motor control (body function) and motor function (activity) 39

Observation of parent and child interaction 40

Social needs 41

Parents’ health 41

Teamwork with parents 42

Siblings 43

Alternative and complementary treatments 44

Summary 46

3 Learning motor function 49

Learning methods 50

Development of a child’s attention and learning 52

Practical ideas to promote attention and learning 53

A child’s own strategies for a chosen goal 54

Task analysis 55

Cues for learning 56

Verbal guidance 58

Rewards 58

Practice and experience 59

Summary 60

4 Adolescents and adults 61

Studies of function in adolescents and adults 62

Activity goals 63

Issues of concern for adolescents and adults 64

Adolescents 65

Adults 66

Healthy lifestyle 67

Develop appropriate community mobility 68

Training of self‐care and cosmetic appearance 69

Knowledge about the condition 69

Therapeutic activities 70

Measures 70

Summary 70

5 Outline of treatment approaches 71

History 71

Muscle education and braces 71

Progressive pattern movements 73

Proprioceptive neuromuscular facilitations (PNF) 74

Neuromotor development 75

Neurodevelopmental treatment (NDT) (Bobath approach) 75

Sensory stimulation for activation and inhibition 77

Reflex creeping and other reflex reactions 78

Conductive education 79

Sensory integration 81

Context therapy 82

Strength training 82

Systems‐based task‐oriented approach 87

Mobility Opportunities via Education (MOVE) 88

Contemporary theories 89

6 Evidence‐based practice 93

Research and clinical studies 93

Research on treatment approaches 93

Theoretical grounds 94

Research studies 94

Reviews of research studies 94

Research on specific procedures 95

Other research 95

Clinical experience with evidence‐based practice 96

Definitions 97

The appraisal of research studies for therapy 98

Examples of qualitative research methods (Greenhalgh and Taylor 1997) 102

7 Synthesis of treatment approaches 103

The eclectic viewpoint in therapy 103

Synthesis of treatment systems 104

The postural mechanisms 105

Trunk control 108

Voluntary motion 108

Perceptual–motor function 110

Principles for a synthesis of therapy and management 110

Developmental training 111

Some advantages and disadvantages of modifications of developmental sequences 114

Treatment of atypical tone 116

Training of movement patterns 117

Use of afferent stimuli 118

Management of deformity 120

8 Assessment for therapy and management 121

Approach to assessment 121

Assessment and measurements 125

Examples of atypically persistent postures, movements, and functions 132

Functional measures 133

Specific functional items 135

Measures of upper extremity and hand function 137

Measures of daily activity and participation 138

Quality of life and health‐related quality of life measures 142

Norm‐referenced measures of stages of child development 143

Neonatal assessments 144

Methods of observation of gait 145

Additional assessment required 154

Records 155

Summary 156

9 Treatment procedures and management 157

Motor training 157

Development of the child with severe visual impairment 161

Developmental Training 168

Prone development 168

Supine development 193

Development of sitting 208

Development of standing and walking 230

Lower limb orthoses for standing and walking 263

Development of hand function 277

Techniques for carrying the child correctly 307

10 Function and the child’s daily life 309

Motor function in communication 310

Motor function in self‐care activities 313

Motor function for leisure 326

11 Therapeutic group work 329

General management of groups 331

Selection of children 332

The programme 333

Summary 335

12 Management of deformities 337

Causes of deformities 338

Therapy goals 343

Deformities and gait 344

General considerations related to surgery 348

Therapy and daily care 351

Dynamic arm deformity 365

Deformities of trunk and neck 365

13 Assessment, prescription, and provision of equipment 367

Equipment for self‐care tasks 368

Postural management equipment 370

Sleep systems 381

Other equipment for positioning 383

Mobility equipment 383

Adaptations and the built environment 391

Appendix 1 Developmental levels 393

Physical ability assessment guide 393

Wheelchair use 397

Appendix 2 Useful organisations 399

References 401

Index 429

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