Activity, Activity, Activity: Rethinking our Physiotherapy Approach to Cerebral Palsy

This presentation will provide a scientific overview of current and perhaps future therapeutic (re)habilitation strategies for individuals with cerebral palsy (CP). The entire field of neurorehabilitation is experiencing tremendous change and excitement that is spilling over into pediatric rehabilitation. Evidence has been accumulating in recent years that strongly supports the role of therapists in helping patients improve their motor functioning and consequently enhance their levels of activity and participation. Many of these interventions have demonstrated efficacy in patients who had reached a plateau after more traditional approaches. Proactively emphasizing early and frequent motor activity for those with physical disabilities will be highlighted. A case will be made for a dramatic change in our profession to abandon philosophically-based approaches in favor of evidence-driven practice. Strength training will be featured as an effective strategy that had been, mistakenly, not utilized for many years in neuromotor disorders. Both positive and negative aspects of muscle plasticity will also be discussed. Insights into neuroplasticity of damaged nervous systems and potentially promising interventions will be provided as a basis for further thought and discussion. Take home messages are: (1) based on current knowledge, many effective intervention strategies now exist for improving motor status and lives of patients with physical disabilities such as CP; and (2) the capacity of the neuromuscular system and the central nervous system for change is far greater than previously suspected and it is apparent that therapists will play an integral role in facilitating and directing these changes.