Cerebral Palsy (CP) is a group of neurological disorders affecting movement, posture, and muscle coordination. Physiotherapy plays a crucial role in managing symptoms, improving mobility, and enhancing quality of life. Below is a structured rehabilitation protocol for individuals with CP.

1. Early Intervention (Infancy & Toddler Stage)

Goal: Promote normal movement patterns, prevent contractures, and improve sensory-motor integration.

Assessment:

• Muscle tone and reflexes (spasticity, hypotonia, athetosis)
• Range of motion (ROM) and joint flexibility
• Motor milestones (rolling, sitting, crawling)
• Postural alignment and symmetry

Intervention:

1. Positioning & Handling Techniques

•    Encourage proper posture during feeding, sleeping, and play.
•    Use supportive seating (e.g., corner chairs) to promote alignment.

2. Stretching & ROM Exercises

•    Daily passive stretching to prevent contractures (ankles, knees, hips).
•    Gentle active-assisted movements to maintain flexibility.

3. Facilitation of Motor Development

•    Promote head control, trunk stability, and balance.
•    Activities like rolling, crawling, and assisted sitting.

2. Sensory Integration Therapy

•    Exposure to different textures, sounds, and movements to improve proprioception.

2. Early Childhood (Preschool & School Age)

Goal: Enhance functional mobility, gait training, and independence in activities of daily living (ADLs).

Assessment:

• Gait analysis and walking ability
• Muscle strength and endurance
• Functional skills (dressing, feeding, mobility)
• Postural stability and balance

Intervention:

1. Gait Training & Mobility Assistance

•    Use of walkers, orthotics, or crutches as needed.
•    Treadmill training for improved walking endurance.

2. Strength & Endurance Training

•    Functional exercises (sit-to-stand, step-ups).
•    Core strengthening for posture control.

3. Balance & Coordination Activities

•    Exercises on balance boards, therapy balls.
•    Task-oriented training for motor planning.

4. Fine Motor Skill Development

•    Activities like grasping objects, finger painting.
•    Occupational therapy for hand function improvement.

3. Adolescence & Adulthood

Goal: Maintain mobility, prevent secondary complications, and enhance independence.

Assessment:

• Joint contractures and muscle stiffness
• Functional independence in ADLs
• Respiratory function (if severe spasticity affects breathing)
• Fatigue and pain levels
• Intervention:

1. Contracture Prevention & Management

•    Regular stretching and splinting.
•    Serial casting if needed.

2. Strength & Functional Mobility Training

•    Adaptive exercises based on capabilities.
•    Hydrotherapy for low-impact movement.

3. Assistive Devices & Adaptive Strategies

•    Use of wheelchairs, standers, or mobility aids.
•    Home modifications for accessibility.

4. Respiratory & Pain Management

•    Breathing exercises if respiratory muscles are affected.
•    Pain relief strategies (massage, heat therapy).

Conclusion

Physiotherapy in CP is individualized based on severity and type (spastic, ataxic, dyskinetic). A multidisciplinary approach with therapists, caregivers, and medical professionals ensures optimal outcomes in improving mobility, independence, and overall well-being.