Physiotherapy

Uses physical exercise techniques, massage, positioning, kneading and manipulating muscles to alleviate specific physical dysfunctions including stiffness and bad circulation. Aims to achieve normal movement or provide alternative means of independent mobility. Teaches positioning and handling techniques to carers. In cerebral palsy there is an emphasis on stretching, positioning and strengthening. For babies and children who have difficulty breathing, they may perform chest physiotherapy. Physiotherapy makes use of orthoses, TENS machines and other devices (qq.v.).

Usually provided by the NHS. Sometimes physiotherapy is suspended or reduced while a child is engaging in other physical programmes, such as conductive education.

An important belief of physiotherapists in cerebral palsy, is that ‘more is not necessarily better’. Sometimes, families assume that the more intensive physical work is done, the better for the child, particularly while they are very young. Some families feel guilty if they are not working all the time at home with a child, to the limit of their time and abilities. Periods of rest are needed in most therapies, in fact, and optimisation rather than maximisation should be possible with professional help. On the other hand, there is recognition that many children with cerebral palsy need more active routines (see ‘Activity, activity, activity’ below).

Physiotherapy is regulated by the Health Professions Council, which holds the full register. The professional association is the Chartered Society Of Physiotherapy, tel: 0207 306 6666, www.csp.org.uk. (The website links to Physio2u, the register of chartered physiotherapists offering private services.)

Because different methods are used in different countries, there is currently a limited evidence base for individual physiotherapy techniques. Many studies can be found on ‘Pedro’, an Australian physiotherapy evidence database, www.pedro.fhs.usyd.edu.au.

Damiano DL. Activity, activity, activity: rethinking our physical therapy approach to cerebral palsy. Physical Therapy 2006 Nov;86(11):1534-40.

Harris SR and Roxborough L. Efficacy and effectiveness of physical therapy in enhancing postural control in children with cerebral palsy. Neural Plasticity 2005;12(2-3):229-243

Marjukka M et al. Physiotherapeutic interventions in cerebral palsy: effectiveness and current practice. Cochrane Collaboration 2004 (study of practices in Finland).

Seniorou M et al. Recovery of muscle strength following multi-level orthopaedic surgery in diplegic cerebral palsy. Gait and Posture. 2007 Oct;26(4):475-81. Epub 2007 Sep 12.