Therapies explained, and what the evidence says

The main therapies

Physical therapy

Large movements. Head control, rolling, sitting, crawling, standing, walking, balance and strength. Also positioning, stretching, and preventing contractures.

Ask: what is the goal, how will we measure it, and what should we do at home.

Occupational therapy

Hands and daily life. Reaching, grasping, releasing, feeding, dressing, play, and later writing and self-care. Also sensory processing and adaptive equipment.

Speech and language therapy

Two quite different jobs.

Communication. Understanding, expressing, speech sounds, and communication devices.

Feeding and swallowing. Sucking, chewing, and swallowing safely. A speech therapist is usually the person who assesses whether food is going the wrong way, which is called aspiration.

Vision services

A teacher of the visually impaired assesses functional vision, which is different from an eye examination. This matters greatly for cortical visual impairment, where the eye is normal and the brain is not. ⁵

Hearing services

Audiology, hearing technology, and teachers of the deaf. Language access comes first, whatever the technology decision. ⁶

Developmental instruction

Play-based teaching aimed at specific skills, usually through early intervention.

Specific approaches, and what the evidence says

Constraint-induced movement therapy

The stronger arm is gently limited so the child has to practise with the weaker one. A Cochrane review found it improves use of the affected arm in children with unilateral cerebral palsy. ²

It is one of the better supported interventions in this field. Ask about it if your child uses one side much more than the other.

Goal-directed and family-centred training

Practice aimed at a goal the family chose, in the setting where the skill is needed. Better evidence than general handling. ¹

Bimanual therapy

Training both hands together on real two-handed tasks. Used alongside or instead of constraint therapy.

AAC

Anything that supports communication without speech, from picture boards to eye-gaze devices. Introducing it does not slow speech, and waiting costs a child years of language access. ¹

hippotherapy

Therapy that uses a horse's movement, guided by a licensed therapist. Children usually enjoy it and it can support trunk control and balance. The evidence base is smaller than for the approaches above. ¹

Aquatic therapy

Water reduces the effect of gravity, so a child can move in ways they cannot on land. Useful for strength, endurance and enjoyment. As with hippotherapy, ask what specific goal it serves.

Treadmill and gait training

Used for children working on walking, often with partial body weight support.

Casting and bracing

Serial casting to lengthen a tight muscle, and braces to hold position. Usually combined with therapy or with botulinum toxin injection so the window is used.

Questions to ask before starting anything

These five questions work for any therapy, any provider, anywhere.

1. What specific outcome are we working toward?
2. How will we measure whether it is working?
3. What evidence supports this for a child like mine?
4. How long before we should expect to see a change?
5. What should we be doing at home between sessions?

A good provider welcomes these. A provider who is uncomfortable with them is telling you something.

On treatments that are marketed heavily

Some interventions are promoted to families of children with cerebral palsy that do not have evidence behind them, sometimes at very high cost and often abroad.

The systematic review of interventions is a useful reference before committing. ¹

That is not a reason to be closed to new things. It is a reason to ask what outcome is expected, what evidence supports it, and what happens if it does not work.

How much therapy is right

There is no single answer, and more is not automatically better.

What the evidence supports is practice that is frequent, specific to a goal, and embedded in daily life rather than confined to a clinic. ¹

Practically, that means:

A small number of goals at a time. A plan with twelve goals produces guilt and very little practice. A plan with two produces progress.

Practice in real situations. Working on grasping during snack time beats working on it at a table with blocks.

Home programs that fit your actual life. Tell your therapist plainly what you can do. A five minute programme that happens beats a thirty minute one that does not.

Watch for burnout, yours and your child's. A child who has three appointments a week plus exercises has a job. So do you.

Who pays for what

Under 3. Through early intervention. Evaluation is free, and services are at no cost or on a sliding scale depending on the state. ⁴

Age 3 and over. Therapy that a child needs in order to access education is provided by the school district through the IEP. That is education-based therapy and it is not the same as medical therapy. ⁷

Medical therapy is covered by insurance or Medicaid, often with visit limits. Many children have both school-based and medical therapy.

Medicaid waivers can cover therapy that insurance will not, and can qualify a child regardless of family income in many states. Waiting lists are long, so apply early. ⁸

See paying for care.