Cerebral Palsy: Change the environment, not the child

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A successful new rehabilitation approach to treating children with cerebral palsy puts its focus on where a child lives and plays, not just improving the child’s balance, posture and movement skills.

In the child-focused approach, therapists identified the underlying impairment – tone, posture, range of motion – and provided therapy to improve the child’s skills and abilities.

Emphasis in the context therapy approach was on changing the task or environment. For example, one parent’s goal was for their child to finger-feed himself Cheerios independently. The therapist experimented with putting peanut butter on the tips of his fingers so that the Cheerios would stick to it. The child was successful in one intervention session, even though he did not have the fine grasp to pick them up without it. Having experienced success, the child went on to be able to finger feed Cheerios by himself.

Some researchers found this approach was more challenging with children who have a severe disability, as some therapists felt that by not providing hands-on treatment, the approach is not true therapy. However, the study found that the context approach was equally effective for children with mild or severe cerebral palsy.

The McMaster study, in conjunction with researchers at the University of Alberta’s Faculty of Rehabilitation Medicine and Alberta Health Services in Calgary, is the first randomized trial to examine the effects of therapy focused on changing a child’s task or environment, not the child. It appeared in the July issue of the medical journal Developmental Medicine and Child Neurology.

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