Therapies explained, and what the evidence says
The short answer
Different therapies do different jobs. Physical therapy works on large movements. Occupational therapy works on hands and daily life. Speech therapy works on communication and on safe eating.
The evidence for interventions in cerebral palsy has been mapped systematically, and it is worth knowing that some widely marketed treatments are not supported by it. 1 Ask any provider what evidence supports what they are offering and what outcome they expect to change.
The numbers, up front
- The evidence is mapped
- A systematic review of interventions for cerebral palsy classified treatments by the strength of evidence supporting them, which is a useful reference before committing time or money 1
- Goal-directed practice works better
- Practice aimed at a specific goal the family chose has better evidence than general handling 1
- Constraint therapy
- A Cochrane review found constraint-induced movement therapy improves use of the affected arm in children with unilateral cerebral palsy 2
- Start early
- Evidence supports starting intervention as soon as a child is identified as at high risk, rather than waiting for a confirmed diagnosis 3
- Communication does not wait for speech
- Introducing augmentative and alternative communication does not slow speech development, and waiting costs a child access to language 1
- Who pays
- Therapy for a child under 3 is provided through early intervention at no cost for evaluation, and school-age therapy that supports education is provided by the school district 4
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.
- What specific outcome are we working toward?
- How will we measure whether it is working?
- What evidence supports this for a child like mine?
- How long before we should expect to see a change?
- 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.
Questions parents ask
What is the difference between school therapy and medical therapy?
School-based therapy exists to help a child access their education, and is provided through the IEP. 7 Medical therapy addresses the child's medical needs more broadly and is billed to insurance or Medicaid. They have different goals, and many children need both. A school district can decline medical goals that do not affect education.
Is more therapy always better?
No. What the evidence supports is practice that is specific to a goal and embedded in daily life, rather than volume for its own sake. 1 A small number of goals practised often in real situations beats a long list practised rarely.
Should we try a treatment we saw online?
Ask the five questions in this guide: what outcome, how measured, what evidence, what timeframe, and what if it does not work. The systematic review of interventions for cerebral palsy is a useful reference. 1 Be especially careful with expensive treatments abroad that require large upfront payment.
Words on this page, in plain English
- physical therapy
- Therapy for large movements: head control, rolling, sitting, crawling, standing, and walking.
- contracture
- A muscle or joint that has become permanently shortened and can no longer move through its full range.
- occupational therapy
- Therapy for hands and daily life: reaching, grasping, feeding, dressing, and play.
- speech-language pathology
- Therapy for communication and for safe eating and drinking.
- AAC
- Augmentative and alternative communication. Anything that helps a person communicate without speech, from picture boards to eye-gaze computers.
- aspiration
- Food, liquid or stomach contents going into the airway instead of the stomach.
- cortical visual impairment
- Vision loss caused by the brain, not the eye. The eye may look and work normally while the brain cannot make sense of what it sees.
- constraint-induced movement therapy
- Therapy that gently limits the stronger arm so the child has to practice with the weaker one.
- hippotherapy
- Therapy that uses a horse's movement to work on balance and trunk control, guided by a licensed therapist.
- AFO
- Ankle-foot orthosis. A brace that holds the ankle and foot in position for standing and walking.
- botulinum toxin injection
- A medicine injected into a tight muscle to relax it for a few months.
- early intervention
- The public program that provides therapy and support to children under 3 with delays or diagnosed conditions. It is required by federal law.
- IEP
- Individualized Education Program. The written special education plan for a school-age child, with goals, services, and minutes.
Where these facts come from
- Current Neurology and Neuroscience Reports. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. 2020. pubmed.ncbi.nlm.nih.gov/32086598/. Link checked September 3, 2026.
- Cochrane Database of Systematic Reviews. Constraint-induced movement therapy in children with unilateral cerebral palsy. 2019. www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004149.p. Link checked September 3, 2026.
- JAMA Pediatrics. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy. 2017. jamanetwork.com/journals/jamapediatrics/fullarticle/2636588. Link checked September 3, 2026.
- U.S. Government Publishing Office, Electronic Code of Federal Regulations. 34 CFR Part 303, Early Intervention Program for Infants and Toddlers with Disabilities. 2025. www.ecfr.gov/current/title-34/subtitle-B/chapter-III/part-30. Link checked September 3, 2026.
- National Eye Institute. Cortical or Cerebral Visual Impairment. 2024. www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-di. Link checked September 3, 2026.
- National Institute on Deafness and Other Communication Disorders. Newborn Hearing Screening. 2024. www.nidcd.nih.gov/health/your-babys-hearing-screening. Link checked September 3, 2026.
- U.S. Government Publishing Office, Electronic Code of Federal Regulations. 34 CFR Part 300, Assistance to States for the Education of Children with Disabilities. 2025. www.ecfr.gov/current/title-34/subtitle-B/chapter-III/part-30. Link checked September 3, 2026.
- Centers for Medicare and Medicaid Services, Medicaid.gov. Home and Community Based Services. 2025. www.medicaid.gov/medicaid/home-community-based-services/inde. Link checked September 3, 2026.