Professional Roles in Mental Health and Cerebral Palsy

Original Editor -Ewa Jaraczewska based on the course by Pradeep Gunarathne

Top Contributors - Ewa Jaraczewska and Jess Bell  

Introduction[edit | edit source]

The association between motor impairment, sleep disorders, pain and fatigue, and mental health disorders in children, adolescents, and adults with cerebral palsy is well documented.[1][2] A team of professionals is needed to address the many complex factors affecting mental health to achieve the best possible outcome. However, services that support mental health care within rehabilitation systems and attempt to address the unique mental health needs of individuals with cerebral palsy can be limited.[3] This article highlights the roles of different healthcare professionals within the rehabilitation team. 

Physiotherapists[edit | edit source]

Goals:[4]

  1. To address the physical aspects of care
  2. To promote mental health and emotional well-being
  3. To identify ways to help children and their families to cope in daily life

Physical Aspects of Care[edit | edit source]

  • At least sixty minutes of moderate-to-vigorous intensity, mostly aerobic, physical activity each day across the week is recommended for children aged 5 to 17 years, regardless of disability.
  • Adults aged 18–64 years, including those living with chronic conditions and disability, should complete "at least 150–300 min of moderate-intensity aerobic physical activity, or at least 75–150 min of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate-intensity and vigorous-intensity activity throughout the week for substantial health benefits."[5]

If you would like to learn more about the physiotherapy management of cerebral palsy, please see: Physiotherapy Treatment Approaches for Individuals with Cerebral Palsy.

Mental Health and Emotional Well-Being[edit | edit source]

  • Pain can lead to depression and anxiety. Physiotherapy can positively affect mental health by helping individuals with cerebral palsy manage pain.[6]
  • Regular physical activity can help to reduce symptoms of depression and anxiety. Physiotherapists can promote physical activity by developing exercise programmes tailored to a child's and caregiver's abilities and goals.[6]
  • Physiotherapy should address an individual's physical abilities and help them regain/improve their sense of control over their bodies. This can help improve self-esteem and body image.[6]

Coping in Daily Life[edit | edit source]

  • There are various programmes that aim to help individuals and their caregivers cope in daily life (e.g. COPing with and CAring for infants with special needs (COPCA). Find out more about COPCA here)
  • These programmes offer families the autonomy to choose activities and areas of participation for children with cerebral palsy.[7]
  • The family is encouraged to make decisions about the child's care. This family‐specific approach focuses on working with the child, giving them responsibility and independence.[7]
  • These programmes aim to provide the family with tools to solve daily care problems using the family's resources.[7]
  • The physiotherapist's role is to coach the family, listen to them, make observations and suggestions, and inform and support them.[7]

Occupational Therapists[edit | edit source]

Goals:[4]

  1. To instruct individuals in daily life skills
  2. To improve occupational performance
  3. To facilitate social participation

Daily Life Skills[edit | edit source]

The ability to perform activities of daily living effectively and independently demands skills in multiple areas, including:

  • gross motor skills: examples include lifting an arm to put on a shirt
  • fine motor skills: examples include holding a fork and bringing it to the mouth without dropping food
  • visual skills
  • cognitive skills
  • sensorial skills
  • communication skills

The occupational therapist's role in engaging the child with daily life skills is to:

  • help the child participate to the best of their ability and potential
  • develop new skills
  • engage in communication, cognitive, and play activities with the child
  • give the child options
  • create a bond between a child and their caregiver

Please read more about activities of daily living and cerebral palsy here.

Occupational Performance[edit | edit source]

Occupational performance includes self-care, productivity and leisure activities. Occupational therapy aims to "use all capacities and abilities of people throughout their lives so that the person can perform activities and roles that are beneficial for life with satisfaction."[8]

  • The Canadian Occupational Performance Measure (COPM) allows the clinician to determine an individual's occupational performance. This scale facilitates the assessment of an individual's roles and role expectations in the areas of personal care, productivity, and leisure. It is standardised for all developmental stages and all disability groups.[9]
  • Occupational therapy interventions geared towards improving occupational performance bolster self-confidence and empower clients to pursue vocational skills or employment opportunities tailored to their functional capabilities:[4]
    • occupation-focus interventions where "occupation is the immediate focus of the evaluation or intervention."[10] These are "goal-directed activities delivered therapeutically to lead to an occupation."[11]
    • component-focused interventions where the intervention focuses on “components underlying occupation.”[12] It may include strength training, range of motion exercises, coordination, visual perception, problem-solving, balance, and attention.

Social Participation[edit | edit source]

  • Communication skills significantly impact a child's participation in social activities. Communication enables interaction with peers and the enjoyment of participation.[13]
  • Self-care is the most important determinant of participation in children with cerebral palsy aged two to four. For children aged five through thirteen, the most important determinants are self-care and mobility.[14]

Speech Language Pathologists[edit | edit source]

Goals:[4]

  1. To enhance speech and communication abilities to effectively interact with peers and express needs, thoughts, and emotions
  2. To address swallowing difficulties to enhance the overall quality of life
  3. To promote emotional well-being and mental health

Speech and Communication Abilities[edit | edit source]

Speech: Interventions might focus on:

  • Therapy to help individuals regulate breathing to support speech.[15]
  • Therapy to improve coordination of exhalation and phonation.
  • Therapy to improve articulation and production of individual speech sounds.

Communication:

Effective communication depends on the sending and receiving of messages between at least two individuals. Communication uses speech, vocalisation, facial expressions, gestures, and whole-body movements - these can be affected by the motor abilities of a child with cerebral palsy.

  • It is important to teach caregivers to become more responsive to the child’s communication.
  • Investigate the use of augmentative and alternative systems of communication (AAC) to supplement a child's natural modes of communication.[16]

Swallowing[edit | edit source]

  • Dysphagia in cerebral palsy "is often characterized by problems in both the volitional oral movements and the more reflexive pharyngeal phase of swallowing"[17]
  • Drooling is caused by swallowing disorders, and it occurs in 10 to 58% of children with cerebral palsy.[17]
  • It is necessary to evaluate swallowing function and establish a treatment plan as dysphagia affects an individual's quality of life and the following functions: meal duration, communication, burden, fatigue, sleep, and eating desire.

Emotional Well-Being[edit | edit source]

  • The emotional well-being of children with communication impairments can be affected.[18]
  • Children with severe motor impairments have lower mental health scores compared to children with moderate motor impairments.[18]
  • Children and youth with communication problems and language delays are at an increased risk of abuse, neglect, and social isolation.[18]

Nursing[edit | edit source]

Goals:

  1. To develop and implement a family-centred care plan[19]
  2. To offer stress and coping strategies to the parents of the children with cerebral palsy[20]
  3. To help strengthen family support to create a more nurturing and conducive environment[4]

Family-Centered Care Plan[edit | edit source]

The family-centred approach is based on the following principles:[21]

  • dignity and respect for families
  • provision of information for informed decision-making
  • consideration of the family’s preferences and priorities
  • collaborative partnerships between the provider and family

Stress and Coping Strategies[edit | edit source]

  • Interventions should focus on self-efficacy to empower the family and improve its well-being.[22]
  • Informational support: providing education sessions on the characteristics of children with cerebral palsy and on why it is important to meet with other parents of children with cerebral palsy.[23]
  • Emotional support: sharing stressful situations associated with parenting children with cerebral palsy, finding the causes of stress and self-understanding, meditating and stretching, relaxation and breathing.[23]
  • Appraisal support: listening, empathy, acceptance, and encouragement.[23]

Psychologists, Counsellors, and Social Workers[edit | edit source]

  • The primary role of the psychologist is to diagnose mental health issues, provide psychotherapy, and conduct psychometric tests. Psychotherapy may be conducted in a format of dialectical behaviour therapy (DBT) and cognitive-behavioural therapy (CBT) (DBT).[24]
  • Counsellors offer guidance and help to clients with particular issues.[24]
  • Social workers support each person's rights and welfare. Social workers can help people with mental health issues or provide case management services. They can be trained to assess a person's emotional well-being and offer psychotherapy or assist patients in reintegrating into the community upon discharge from a rehabilitation facility.[24]

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ Van Der Slot WM, Nieuwenhuijsen C, Van Den Berg-Emons RJ, Bergen MP, Hilberink SR, Stam HJ, Roebroeck ME. Chronic pain, fatigue, and depressive symptoms in adults with spastic bilateral cerebral palsy. Dev Med Child Neurol. 2012 Sep;54(9):836-42.
  2. ↑ Whitney DG, Warschausky SA, Whibley D, Kratz A, Murphy SL, Hurvitz EA, Peterson MD. Clinical factors associated with mood affective disorders among adults with cerebral palsy. Neurol Clin Pract. 2020 Jun;10(3):206-213.
  3. ↑ Eres R, Reddihough D, Coghill D. Addressing mental health problems in Australians with cerebral palsy: a need for specialist mental health services. Advances in Mental Health, 2022;20(3): 281-284.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Gunarathne P. Mental Health Considerations With Cerebral Palsy. Plus Course 2023
  5. ↑ Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC, DiPietro L, Ekelund U, Firth J, Friedenreich CM, Garcia L, Gichu M, Jago R, Katzmarzyk PT, Lambert E, Leitzmann M, Milton K, Ortega FB, Ranasinghe C, Stamatakis E, Tiedemann A, Troiano RP, van der Ploeg HP, Wari V, Willumsen JF. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020 Dec;54(24):1451-1462.
  6. ↑ 6.0 6.1 6.2 Grande A. Relationship between Physiotherapy and Mental Health. Available from https://www.focusphysiotherapy.com/relationship-between-physiotherapy-and-mental-health/ [last access 29.12.2023]
  7. ↑ 7.0 7.1 7.2 7.3 Çankaya Ö, Seyhan K.ICF‐CY‐Based Physiotherapy Management in Children with Cerebral Palsy. Chapter 4. IntechOpen, 2016. Available from https://www.intechopen.com/chapters/51530 [last access 29.12.2023]
  8. ↑ Gimeno H, Gordon A, Tustin K, Lin JP. Functional priorities in daily life for children and young people with dystonic movement disorders and their families. Eur J Paediatr Neurol. 2013 Mar;17(2):161-8.
  9. ↑ Torkan S, Khanjani M S , Abdi K, Vahedi M. Comparison of Priority Occupational Performance of Children with Cerebral Palsy from the Perspective of Children, Parents, and Occupational Therapists in Isfahan in 2021. Middle East J Rehabil Health Stud. 2023;10(3):e133218
  10. ↑ Fisher AG. Occupation-centred, occupation-based, occupation-focused: same, same or different? Scand J Occup Ther. 2013 May;20(3):162-73.
  11. ↑ Powell JM, Rich TJ, Wise EK. Effectiveness of Occupation- and Activity-Based Interventions to Improve Everyday Activities and Social Participation for People With Traumatic Brain Injury: A Systematic Review. Am J Occup Ther. 2016 May-Jun;70(3):7003180040p1-9.
  12. ↑ Wall G, Isbel S, Gustafsson L, Pearce C. Occupation-based interventions to improve occupational performance and participation in the hospital setting: a systematic review. Disabil Rehabil. 2023 Jul 31:1-22.
  13. ↑ Alghamdi MS, Chiarello LA, Palisano RJ, McCoy SW. Understanding participation of children with cerebral palsy in family and recreational activities. Res Dev Disabil. 2017 Oct;69:96-104.
  14. ↑ Kerem-Günel M, Arslan UE, Seyhan-Bıyık K, Özal C, Numanoğlu-Akbaş A, Üneş S, Tunçdemir M, Çankaya Ö, Özcebe H, Green D. Evaluation of daily and social participation of children with Cerebral Palsy across different age groups with a focus on the 'F'-words: Function, family, fitness, fun, friends and future. Res Dev Disabil. 2023 Sep;140:104588.
  15. ↑ Pennington L, Miller N, Robson S, Steen N. Intensive speech and language therapy for older children with cerebral palsy: a systems approach. Dev Med Child Neurol. 2010 Apr;52(4):337-44.
  16. ↑ Berenguer C, Martínez ER, De Stasio S, Baixauli I. Parents' Perceptions and Experiences with Their Children's Use of Augmentative/Alternative Communication: A Systematic Review and Qualitative Meta-Synthesis. Int J Environ Res Public Health. 2022 Jul 1;19(13):8091.
  17. ↑ 17.0 17.1 Erasmus CE, van Hulst K, Rotteveel JJ, Willemsen MA, Jongerius PH. Clinical practice: swallowing problems in cerebral palsy. Eur J Pediatr. 2012 Mar;171(3):409-14.
  18. ↑ 18.0 18.1 18.2 Noyek S, Davies C, Champagne M, Batorowicz B, Fayed N. Emotional Well-Being of Children and Youth with Severe Motor and Communication Impairment: A Conceptual Understanding. Developmental Neurorehabilitation, 2022; 25(8):554-575.
  19. ↑ Love L, Newmeyer A, Ryan-Wenger N, Noritz G, Skeens MA. Lessons learned in the development of a nurse-led family centered approach to developing a holistic comprehensive clinic and integrative holistic care plan for children with cerebral palsy. J Spec Pediatr Nurs. 2022 Jan;27(1):e12354.
  20. ↑ Hashem SF, Abd El Aziz MA. The Effect of Nursing Intervention on Stress and Coping Strategies among Mothers of Children with Cerebral Palsy. International journal of Nursing Didactics. 2018 Oct 19;8(10):01-17.
  21. ↑ Poojari DP, Umakanth S, Maiya GA, Rao BK, Khurana S, Kumaran SD, Attal R, Brien M. Effect of family-centered care interventions on well-being of caregivers of children with cerebral palsy: a systematic review [version 1; peer review: 1 approved with reservations]. F1000Research 2023, 12:790
  22. ↑ Guillamón N, Nieto R, Pousada M, Redolar D, Muñoz E, Hernández E, Boixadós M, Gómez-Zúñiga B. Quality of life and mental health among parents of children with cerebral palsy: the influence of self-efficacy and coping strategies. J Clin Nurs. 2013 Jun;22(11-12):1579-90.
  23. ↑ 23.0 23.1 23.2 Kim DJ, Kim YJ. Effects of the Parenting Efficacy Improvement Program for mothers as primary caregivers of children with cerebral palsy under rehabilitation. J Exerc Rehabil. 2019 Dec 31;15(6):763-768.
  24. ↑ 24.0 24.1 24.2 Bumra G, Srivastava AS. Psychological Difficulties Faced by Mental Health Professionals. International Journal of Research and Review 2022; 9(10).
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