The evolution of physiotherapy in the clinical management of children with cerebral palsy: A functional approach
Cerebral palsy is the leading cause of childhood disability, with the most common prescription for physiotherapy treatment by medical spesialists, like child-neurologists, physiatrists and orthopedic surgeons.
The traditional physiotherapy methods, the so-called neurofacilitation approaches, such as Bobath/Neurodevelopmental Treatment, Ayres/Sensory Integration, Vojta etc, developed in the middle of 20th century for the clinical management of children with cerebral palsy, focus on remediation strategies of body impairments for performing function. Emerging new perspectives for the control of motor development, such as the dynamic systems theory, based on both neuroscience and biomechanical studies, as well as the family-centred model of children’s rehabilitation services, led to an evolution of paediatric neurological physiotherapy, by modifying some traditional approaches and developing new, alternative intervention strategies.
These new intervention strategies, called generally by the term ‘functional approach’, are directed at learning and optimizing self-initiated functional activities, via the changes in the environmental or task parameters, and not at the ‘normalization’ of movement patterns. The functional approach is based on the following five (5) principles: a) the establishment specific, measurable, attainable/action-oriented, realistic and time-limited (SMART) goals, b) the therapist as ‘teacher’ or ‘coach’ of the child, the family and the community assistance providers, c) the child as ‘active problem solver’ (hands-off process), d) the repetitive practice in functional situations and e) the active participation of family in all phases of the intervention (evaluation, decision making, goal setting, application in everyday life).
The current, reliable clinical studies support the equivalent efficacy of functional approach, versus the traditional intervention methods, in children with cerebral palsy. Key words: cerebral palsy, context therapy, dynamic systems theory, functional approach, physiotherapy