Physiotherapy treatment for Cerebral palsy patient


Lifting and Carrying
The therapist needs to instruct the patient or caregivers to carry the child in special way in order to prevent worsening of deformities. 
Positioning
  • Lying Supine - a pillow placed under the head, or a pillow on both sides of the head and shoulders often promotes symmetry. 
  • Prone Children are often more symmetrical in this position, but a prone wedge board is used to raise the upper torso off the floor so that they use their hands to stabilize and heads to extend. 
  • W- Sitting Standing prevents the deformity at the ankle. While standing the hips and knees should be extended hips slightly externally rotated and abducted knees should be straight and feet should be plantigrade. 
Floor Sitting - Types
  • Corner sitting: the child sits supporting the back in a corner of the wall, chair or sofa with legs supported by gaiters. In India, where there is little furniture in many houses, and all activities are on the floor, the child is given a corner floor seat with legs extended. 
  • Side sitting
  • Long - leg sitting
  • W - sitting (rarely prescribed in  some patients as it promotes backward pelvic tilt but may lead to flexion contractures of the lower limb). 
Chair Sitting
The correct posture in chair sitting is ; head upright, the spinal curves supported, the person's weight distributed evenly through the buttocks and thighs, the knees at 90° and the foot planti-grade. 
Stages in Prone Development
  • Prone position placement
  • Head control - raising the head in prone, with postural fixation (holding it steady) 
  • Turning the head from side to side (counter poising) 
  • Raising the upper torso with the head and talking weight on forearms. This is a prelude to crawling. 
Supine Development
  • The head is stabilized with respect to the shoulder girdle. 
  • Next follows the shoulder girdle which is posturally fixed with relation to the head and pelvis
  • Postural fixation of the pelvis with respect to the shoulder girdle and lower limbs
  • Raising to sit and raising to stand. 
Development of Sitting
Supine rise to Sitting
  • First 0-6 months normal development level: Help the child to develop head control. 
  • From 6-10 months normal development level: Help the child come to sit on his own after it has attained fair head control, and developed balance and saving reactions. Of course the development age is more important than the chronological age.
  • Sitting is trained once the child has attained fair head control, and developing balance and saving reactions. The child is given exercises like
  1. Pull to sit
  2. Sitting with counterpoising. 
  3. Side lying to sit. 
  4. Spinal extension exercises. 

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