Overview of Occupational Therapy Assessment and Intervention in Cerebral Palsy

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Original Editor - Teona Darchia

Top Contributors - Ewa Jaraczewska  

Introduction

Occupational therapy enables people to participate in activities of everyday life. 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 support their occupational engagement better.Paediatric occupational therapy programs that are family-centred meet children’s needs and focus on structured play and recreation to 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 enterprises. Occupational therapy for clients with cerebral palsy addresses problems related to movement disorders but also lifelong 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 assessment and treatment when providing services to children with cerebral palsy. These models are

1. 1. The Person-Environment-Occupation-Performance Model – its main components are complex interactions between the person and the environment.
   2. The Person-Environment-Occupation Model- focuses on "occupational performance and its link to people, occupation, roles, the environment, work, and play as a dynamic, interwoven process".
   3. Occupational Adaptation Model- identifies occupations to allow the client to experience adaptation.
   4. The Model of Human Occupation- assists with habits and roles that guide a person’s occupational choices.
   5. The Kawa Model- tries 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 experiences, patterns of daily living, interests, values, needs, and relevant contexts.” --AOTA (2020)

The occupational profile includes the following components and methods of assessment:

• 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 a child’s perceived occupational performance in self-care, productivity, and leisure.
• Values
  • Semi-structured interview with the parent and/or child about the child’s values and interests.
• Contexts
  • Observation and semi-structured interviews with the parent and/or child to define the different environmental and personal factors specific to each child.

Occupational Performance Analysis

• Occupational performance is an interaction and interdependence of a person, environment, and occupation components
• Includes 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

• It 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 clients, their family members, or other professionals and includes the following three steps:

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

Intervention plan

Gross Motor Function Classification System (GMFCS):

• Allows to tailor treatment strategies and interventions to match an individual's specific functional abilities

Intervention Implementation

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

• Interactions with the 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 hospitals, clinics, and specialised services)

• A 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 them 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 the client's participation in daily activities

Outcome Evaluation

The assessment tools are instruments to monitor a child's progress. They can assist with the following:

• tracking changes in functional abilities,
• assessing the impact of interventions
• making necessary adjustments to treatment plans
• ensuring that interventions remain aligned with evolving needs

Goal Attainment Scaling (GAS)

GAS evaluates services or an individualised program based on attaining individualised goals.

Resources

• Rehabilitation Guideline for the Management of Children with Cerebral Palsy