How Occupational Therapists Approach Assessing People with Cerebral Palsy
Cerebral palsy (CP) is a neurological disorder that affects an individual's ability to control their muscles, maintain balance, and coordinate their movements. Some common challenges faced by individuals with CP include difficulty with fine and gross motor skills, muscle stiffness or spasticity, involuntary movements, and problems with balance and coordination. These challenges can make it difficult for individuals with CP to perform everyday tasks, such as dressing, eating, and personal care. They may also impact their communication skills and cognitive abilities.
This article explores the relationship between CP and occupational therapy (OT), highlighting the importance of OT in managing and improving the quality of life for individuals with CP. The article begins by explaining CP, its types, causes, and symptoms, and how it affects daily living for individuals with the condition. It then delves into the role of OT for individuals with CP, including its goals, benefits, and various interventions.
Exploring the Types of CP
CP is categorized based on the primary movement disorder present. There are four primary types of CP:
Spastic Cerebral Palsy: The most prevalent form, affecting around 80% of individuals with CP. Characterized by increased muscle tone and stiff muscles, resulting in awkward movements.
Dyskinetic Cerebral Palsy: This type involves difficulty controlling hand, arm, foot, and leg movements, making sitting and walking challenging. Muscle tone can vary drastically throughout the day.
Ataxic Cerebral Palsy: Individuals with ataxic CP struggle with balance and coordination, which may impact walking or tasks requiring precise control, like writing.
Mixed Cerebral Palsy: Some people display symptoms of multiple CP types, most commonly spastic-dyskinetic CP.
(Centers for Disease Control and Prevention, 2021)
Cerebral palsy is the most common motor disability in childhood.
How Cerebral Palsy Affects Daily Living
Cerebral palsy affects daily living in various ways, depending on the type and severity of the condition. The challenges individuals with CP face can impact their ability to perform everyday tasks and participate in social activities. Some of the ways CP affects daily living include:
Mobility: Individuals with CP may experience difficulty with walking, balancing, and coordinating their movements due to muscle stiffness, weakness, or involuntary movements. This can limit their ability to move independently and participate in physical activities.
Fine motor skills: CP can affect an individual's fine motor skills, making it challenging to perform tasks that require precise hand and finger movements, such as writing, buttoning clothes, or using utensils.
Gross motor skills: CP can also impact gross motor skills, making it difficult for individuals to engage in activities that involve larger muscle groups, such as climbing stairs or playing sports.
Communication: Speech and language difficulties are common in individuals with CP, which can hinder their ability to express themselves and understand others. This can lead to social isolation and frustration.
Cognitive abilities: Some individuals with CP may experience cognitive challenges, such as difficulties with attention, memory, or problem-solving. This can affect their ability to learn, work, and engage in daily activities.
Self-care: CP can make it challenging for individuals to perform essential self-care tasks, such as bathing, dressing, grooming, and eating independently.
Social interactions: Physical, communication, and cognitive challenges faced by individuals with CP can affect their ability to form and maintain relationships, participate in group activities, and engage in community life.
Emotional well-being: The challenges associated with CP can lead to frustration, low self-esteem, and depression. Individuals with CP may also experience social isolation due to difficulties in communication and mobility.
Occupational Therapy for Cerebral Palsy
Occupational therapy is a healthcare profession that aims to improve individuals' quality of life and independence with cerebral palsy. Occupational therapists work with people of all ages with cerebral palsy and face physical, cognitive, or sensory challenges affecting their ability to perform everyday tasks and engage in meaningful activities.
The primary goal of occupational therapy for cerebral palsy is to help individuals achieve their maximum potential in daily living activities, work, education, and leisure pursuits. Occupational therapists comprehensively assess a person's unique needs and develop personalized treatment plans that may include therapeutic exercises, adaptive strategies, and assistive devices or technologies. Through occupational therapy, individuals with cerebral palsy can learn to overcome challenges related to mobility, fine and gross motor skills, communication, cognitive abilities, self-care, social interactions, and emotional well-being. With the support of an occupational therapist, individuals with cerebral palsy can improve their independence, quality of life, and overall well-being.
How Occupational Therapists Approach Assessing People with Cerebral Palsy
The assessment process for individuals with CP is crucial for understanding their needs, challenges, and goals. Occupational therapists conduct a thorough assessment that may include the following components:
Medical history: Gather information on the individual's medical history, including the type and severity of CP, previous treatments, and any co-existing conditions.
Physical assessment: Examining the individuals' muscle tone, strength, range of motion, fine and gross motor skills, balance, and coordination.
Cognitive assessment: Evaluating the individual cognitive abilities, such as attention, memory, problem-solving, and executive functioning skills.
Sensory assessment: Assessing the individual sensory processing abilities, including their response to touch, sound, and visual stimuli.
Daily living skills assessment: Observing the individual's ability to perform everyday tasks, such as dressing, eating, grooming, and mobility.
Social and emotional assessment: Evaluating the individual's social skills, communication abilities, and emotional well-being.
(Cerebra Palsy Guidance, 2022)
Creating a Personalized Treatment Plan
Based on the assessment and evaluation findings, the occupational therapist develops a personalized treatment plan tailored to the individual's unique needs, goals, and abilities. The treatment plan may include the following:
Occupational therapists utilize a range of therapeutic interventions to address the specific challenges individuals face with CP. These interventions aim to improve fine and gross motor skills, enhance balance and coordination, and support cognitive development.
It is estimated that one out of every 400 individuals in Canada are diagnosed with cerebral palsy.
For example, occupational therapists may design exercises targeting muscle strength and flexibility or develop activities stimulating problem-solving and decision-making skills. An example of such an activity is the "Box Tower Challenge." In this activity, the therapist and the individual work together to build a tower using various-sized cardboard boxes or foam blocks. The boxes should be lightweight and safe for the individual to handle. The therapist encourages the individual to plan the tower's structure by considering the size and weight of the boxes and determining the best order to stack them. This process engages the individual's problem-solving and decision-making skills.
While constructing the tower, the individual must reach, grasp, and lift the boxes, which helps improve their fine and gross motor skills. The activity also involves bending, stretching, and balancing as the individual places boxes at different heights and positions. This encourages muscle strength, coordination and flexibility development. The therapist can further adjust the difficulty of the activity by changing the size or weight of the boxes, adding obstacles, or setting a time limit.
Assistive Devices and Technology
Assistive devices and technology support individuals with CP to perform daily tasks more independently. Occupational therapists may recommend various tools, such as splints to support joint alignment, adaptive utensils for self-feeding, or communication aids like speech-generating devices to enhance communication.
To further expand, by providing individuals with adaptive utensils that are easier to manipulate, they can gain more control over their eating process, promoting independence for easier self-feeding. These specially designed utensils often feature modifications such as larger, easy-to-grip handles, non-slip surfaces, or angled designs that cater to the specific needs and abilities of the individual.
As individuals learn to feed themselves using adaptive utensils, they become less reliant on caregivers for assistance during mealtimes, fostering a sense of autonomy and self-sufficiency. Regular use of adaptive utensils can help individuals develop their fine motor skills, hand-eye coordination, and dexterity as they practice grasping, lifting, and maneuvering the utensil to bring food to their mouths. Furthermore, gaining the ability to self-feed can boost an individual's self-esteem and confidence, as they experience a sense of accomplishment and pride in independently performing an essential daily living activity.
Environmental modifications involve changing an individual's home, school, or work environment to improve safety and accessibility and promote independence. Occupational therapists assess the individual's surroundings and recommend adjustments that may include:
Installing grab bars in bathrooms and other areas where extra support is needed
Adding ramps or stairlifts to improve accessibility in multi-level homes
Widening doorways to accommodate wheelchairs or walkers
Adjusting the height of countertops or tables for easier access
Using non-slip flooring or mats to reduce the risk of falls
Organizing and decluttering spaces to create clear pathways and minimize tripping hazards
Incorporating adaptive furniture, such as chairs with armrests or adjustable-height desks
Installing lever-style door handles and faucets for more effortless operation
Placing frequently used items within easy reach to minimize strain and effort
Using visual cues, such as colour-coded labels or contrasting colours, to improve navigation and organization
Implementing appropriate lighting and acoustics to reduce sensory overload and improve overall comfort
(Cerebra Palsy Guidance, 2022c)
By creating a more supportive and accessible environment, individuals with CP can experience increased autonomy and participation in daily activities.
Family and Caregiver Training
Family and caregiver training is essential for providing a supportive network to individuals with CP. Occupational therapists educate family members and caregivers on the specific needs of the individual and teach them strategies to assist with daily activities and manage challenges. This training may include guidance on handling mobility issues, addressing communication difficulties, and supporting the individual's emotional well-being. Let's look at an example.
Cerebral palsy is not life-threatening. Individuals with cerebral palsy have a normal life expectancy.
In this example, an occupational therapist works with a family with a child affected by CP. This individual has difficulty dressing independently. The therapist begins by observing the individual's current dressing routine, identifying their specific challenges, such as limited range of motion, difficulty with fine motor tasks like buttoning, or challenges with balance and coordination.
After assessing the individual's needs, the therapist educates the family members and caregivers on the individual's specific difficulties and explains the underlying factors contributing to these challenges, such as muscle tightness, weakness, or impaired motor control. The therapist also discusses the importance of promoting independence in dressing to enhance the individual's self-esteem and sense of autonomy.
Next, the therapist introduces and teaches the individual and his/her/their family practical strategies and techniques to assist the individual in dressing. These might include:
Encouraging adaptive clothing, such as garments with Velcro closures, magnetic buttons, or elastic waistbands, to simplify dressing tasks.
Teaching caregivers and family members how to break down the dressing process into smaller, more manageable steps, providing support and guidance as needed.
Demonstrating effective techniques for helping the individual put on and remove clothing items, such as rolling up sleeves or pant legs, using a "hook" method for pulling garments over the head, or stabilizing the individual's body while they dress.
Suggesting dressing aid