Professional Roles in Mental Health and Cerebral Palsy

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

Top Contributors - Ewa Jaraczewska, Jess Bell and Kim Jackson  

Introduction

Association of motor impairment, sleep disorders, pain and fatigue with mental health disorders in children, adolescents and adults with cerebral palsy is well documented. The number and the complexity of factors affecting mental health requires the team of professionals to address all of them to achieve the best possible outcome. Both high- and low-income countries have only few mental health services that provide adequate support for mental health care within rehabilitation systems to address the unique mental health needs of individuals with cerebral palsy. This article highlights the roles of different healthcare professionals to help understand their role within the rehabilitation team. 

Physiotherapists

Goals:

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

Physical Aspects of Care

• A daily dose of at least sixty minutes of moderate-to-vigorous intensity, mostly aerobic, physical activity, across the week physical activity is recommended for children aged 5 to 17, 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."

You can learn more about physiotherapy management from this Physiotherapy Treatment Approaches for Individuals with Cerebral Palsy article.

Mental Health and Emotional Well-Being

• Pain can lead to depression and anxiety. Physiotherapy intervention can positively affect mental health by helping individuals with CP manage pain.
• Regular physical activity can help to reduce symptoms of depression and anxiety. Physiotherapy intervention promotes physical activity through development of an exercise program tailored to the abilities and goals of a child and a caregiver.
• Physiotherapy should address an individuals' physical abilities and regain their sense of control over their bodies. This can help improve self-esteem and body image.

Coping in Daily Life

• The Coping with and Caring for Infants with Special Needs (COPCA) Program is designed to offer family autonomy to choose activity and participation for living quality for a child with CP.
• Family decides about child care and the interaction of health professionals. This family‐specific parenthood focuses on child training which gives the child responsibility and become independent.
• The goal is to provide the family with tools to solve daily care problems that are observed during parenthood using family own resources.
• The role of the physiotherapist is to coach the family, listen to them, make observations and suggestions, inform and support them.
• Learn more about COPCA program here.

Occupational Therapists

Goals:

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

Daily Life Skills

Ability to perform activities of daily living effectively and independently demand skills in multiple areas. These areas include:

• Gross Motor Skills . Example include lifting the arm to put on shirt.
• Fine Motor Skills. Example 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 option
• Create a bond between a child and a caregiver

Read more about the ADL in cerebral palsy here.

Occupational Performance

Occupational performance include self-care, productivity and leisure activities. The occupational therapy's goal is to "use of 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."

• The Canadian Occupational Performance Measure (COPM) allows the clinician to determine an individual's occupational performance. The scale facilitate the assessment of the person's roles and role expectations in the area of personal care, productivity, and leisure. It is standardised for all developmental stages and all disabilities groups.
• 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:
  • Occupation-focus interventions where "occupation is the immediate focus of the evaluation or intervention. " These are "goal-directed activities delivered therapeutically to lead to an occupation."
  • Component-focused interventions where the intervention focuses on “components underlying occupation.” It may include strength training, range of motion exercises, coordination, visual perception, problem solving, balance, and attention.

Social Participation

• Communication skills have a significant impact on child's participation in social activities. It enables frequent interaction with peers and enjoyment of participation.
• The most important determinant of participation in children with CP aged two to four is self-care. For children age five through thirteen it is self-care and mobility.

Speech Language Pathologists

Goals:

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

Speech and Communication Abilities

Speech:

• Therapy to increase respiratory effort focusing on maintaining sufficient breath support for words or phrases and breathing at appropriate points in phrases.
• Therapy to improve coordination of exhalation and phonation
• Therapy to improve articulation and production of individual speech sounds

Communication:

Good communication depends on the sending and receiving of messages between at least two individuals. Communication uses speech, vocalisation, facial expression, gesture and whole body movements which can be affected by motor abilities of the child with CP.

• Teaching the caregiver to become more responsive to the child’s communication.
• Investigate the use of augmentative and alternative systems of communication (AAC) to supplement the child's natural modes of communication.

Nursing

Goals:

1. To develop and implement a family-centered care plan
2. To offer stress and coping strategies to the parents of the children with cerebral palsy
3. To help strengthening family support to create a more nurturing and conducive environment

Family-Centered Care Plan

Family-centered approach is based on the following principles:

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

Resources

• Occupational performance and social participation of children with cerebral palsy
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