Physical Rehabilitation in Cerebral Palsy

Physical Rehabilitation

One of the most important methods of treating cerebral palsy is physical rehabilitation, which usually begins in the first years of a child’s life, immediately after the diagnosis is established. Exercise programs are used, aimed at two important goals: preventing muscle weakness and atrophy due to insufficient use, and avoiding contractures, in which tense muscles become less mobile and fixed in a pathological position.

Contractures as a Complication of Cerebral Palsy

Contractures are one of the most common and most serious complications of cerebral palsy. In a healthy child, muscles and tendons are regularly stretched during walking, running, and other physical activities. This allows the muscles to grow at the same rate as the bones. In children with cerebral palsy, spasticity prevents such stretching of the muscles; as a result, they do not grow quickly enough and lag behind the bones in length.

The development of contractures in patients with cerebral palsy may lead to worsening balance skills and cause loss of already acquired abilities. The physical rehabilitation program should focus efforts on avoiding this undesirable consequence of the disease by stretching spastic muscles.

Motor Development and the Bobath Method

The third important goal of physical rehabilitation is to promote the child’s motor development. A well-known physical rehabilitation program aimed at developing movements is neurodevelopmental therapy (the Bobath method), which was developed by Dr. Karel Bobath and his wife, Berta. This program is based on the idea that primitive reflexes, which do not disappear but persist and intensify in children with cerebral palsy, are the main obstacle to mastering voluntary control of movement. Rehabilitation specialists who apply the Bobath method try to counteract these reflexes through positioning the child, that is, giving the correct body position necessary to perform certain movements.

Physical Rehabilitation in Older Children

As the child grows older and approaches school age, the focus of treatment shifts away from early motor development. Now, the efforts of physical rehabilitation are directed toward developing daily living skills, improving communication abilities, and preparing the child for life in a group setting.

Physical rehabilitation should now focus more on improving the child’s ability to sit independently and move with the help of canes or in a wheelchair, as well as perform precise and complex actions such as writing.

It is also important to focus efforts on teaching the child to eat independently, dress, and use the bathroom and toilet. Mastering these skills can significantly reduce the burden on caregivers and greatly improve the child’s self-confidence and self-esteem.

About the author

Halyna Lun

Deputy Director of the Elita Rehabilitation Center, pediatrician, and mentor with over 30 years of practice. She leads the medical department, consults families, and trains future doctors.