Overview of Occupational Therapy Assessment and Intervention in Cerebral Palsy

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Introduction

Occupational therapy enables people to participate in activities of everyday life. The occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want, need, or are expected to do by modifying the occupation or the environment to better support their occupational engagement.Paediatric occupational therapy programs that are family-centered, meet children’s needs, and focus on structured play and recreation enhance the development of children with cerebral palsy (CP) and can be delivered in hospitals, clinics,rehabilitation and daycare centres, home care programmes, special schools, community centres or private entreprises. Occupational therapy for client's with cerebral palsy addresses problems related to movement disorders, but also life long issues that include cognitive dysfunction and behavioural or emotional problems.This article provides an overview of the occupational therapy interventions appropriate for children with cerebral palsy.

Assessment

The occupational therapist can choose one from several client and family-centred models as a framework for the assessment and treatment when providing service to children with cerebral palsy. These models are:

1. 1. The Person-Environment-Occupation-Performance Model –it's main components are complex interactions between the person and the environment.
   2. The Person-Environment-Occupation Model- focusing on "occupational performance and its link to people, occupation, roles, the environment, work, and play as a dynamic, interwoven process".
   3. Occupational Adaptation Model-identifying occupations to allow the client to experience adaptation.
   4. The Model of Human Occupation-assisting with habits and roles that guide a person’s occupational choices.
   5. The Kawa Model- trying to enable, assist, restore and maximise clients’ life experiences.

Individual Evaluation

" The evaluation process is focused on finding out what the client wants and needs to do, how to determine what the client can do and has done, and also identify supports and barriers to participation in everyday life."--Teona Darchia

Client's Occupational Profile

"The occupational profile is a summary of a client’s (person’s, group’s, or population’s) occupational history and experi- ences, patterns of daily living, interests, values, needs, and relevant contexts.” --AOTA (2020)

The occupational profile includes the following:

• Occupational history/Experience
  • Semi-structured interview with the parent and/or child about the child's life experiences
• Information about daily living/interests (leisure)
  • Canadian Occupational Performance Measure (COPM) measures child’s perceived occupational performance in the areas of self-care, productivity, and leisure.
• Values
  • Semi-structured interview with the parent and/or child about child’s values and interests
• Contexts
  • Observation and semi-structured interview with the parent and/or child to define the different environmental and personal factors that are specific to each child.

Occupational Performance Analysis

• Occupational performance is an interaction and interdependence of a person, environment, and occupation components
• Include daily activities, work, productive activities, and play or leisure activities.

Formal interview techniques, casual conversation, observation and analysis of the client's performance in specific occupations and evaluation of specific aspects can be used to assess occupational performance.

Synthesis of the Evaluation

• Helps to establish goals, intervention plans, and desired outcomes
  • The ICF’s activities and participation domains offer a common language to assist with identifying important goals for the family and child

Intervention Planning

Intervention planning is conducted in collaboration with client, their family members, or other professionals and include the following three steps:

1. Intervention plan
2. Intervention implementation
3. Intervention review

Intervention can be direct or indirect and must consider the following two elements:

• Interactions with environment, including barriers
  • Physical barriers (stairs, uneven path)
  • Lack of access or availability of assistive technologies
  • Attitudinal barriers (stigmas around children with CP)
  • Governmental/policy barriers (limited access to hospital, clinic, specialised services)

• Person's participation in everyday activities

General rules for applying an intervention:

• Use simple and clear verbal instructions
• Show the person what you are asking him to do
• Carry out activities together and if necessary, use the hand-in-hand technique, which involves performing actions together, holding hands, and helping physically
• Give the person enough time to complete the activity
• Provide only as much help as the person needs
• Do not do part of the activities or tasks for the person if they cannot do it
• Use only handling strategies that do not have a negative effect on the person's muscle tone
• Choose assistive technologies that can increase client's participation in daily activities

Outcome Evaluation

• Goal Attainment Scaling (GAS) evaluates services or an individualised program based on the attainment of individualised goals.

Resources

• Rehabilitation Guideline for the Management of Children with Cerebral Palsy