Cerebral palsy (CP) is the most common physical disability of childhood. Children with CP have multiple sensorimotor deficits that impact development and daily function. These deficits can be identified and measured as well as modified with new neural rehabilitation techniques and therapies. This article reviews the primary and secondary deficits of this motor disorder utilizing definitions from the National Institutes of Health Taskforce on Childhood Motor Disorders. In addition, a combination of co-morbidities may alter or affect the ultimate outcome for the child with CP including cognition, epilepsy, behavioral, and sensory deficits. Strengthening, decreasing spasticity, and improving range of motion can be accomplished with robotic training and are core therapeutic goals in the management of children with CP. The use of technology provides a motivating, stimulating play environment that captures the child’s interest and enhances motor learning through repetitive practice.
Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8-14.
,
A report: the definition and classification of cerebral palsy April 2006
, Dev Med Child Neurol Suppl.
, vol. 109
(pg. 8
-14
) Palisano RJ, Hanna SE, Rosenbaum PL, et al. Validation of a model of gross motor function for children with cerebral palsy. Phys Ther. 2000;80(10):974-985.
,
Validation of a model of gross motor function for children with cerebral palsy
, Phys Ther.
, vol. 80
(pg. 974
-985
) Hanna SE, Bartlett DJ, Rivard LM, Russell DJ. Reference curves for the Gross Motor Function Measure: percentiles for clinical description and tracking over time among children with cerebral palsy. Phys Ther. 2008;88(5):596-607.
,
Reference curves for the Gross Motor Function Measure: percentiles for clinical description and tracking over time among children with cerebral palsy
, Phys Ther.
, vol. 88
(pg. 596
-607
) Eliasson AC, Krumlinde-Sundholm L, Rosblad B, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol. 2006;48(7):549-554.
,
The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability
, Dev Med Child Neurol.
, vol. 48
(pg. 549
-554
) Morris C, Bartlett D. Gross Motor Function Classification System: impact and utility. Dev Med Child Neurol. 2004;46(1):60-65.
,
Gross Motor Function Classification System: impact and utility
, Dev Med Child Neurol.
, vol. 46
(pg. 60
-65
) Sanger TD, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW. Classification and definition of disorders causing hypertonia in childhood. Pediatrics. 2003;111(1):e89-97.
,
Classification and definition of disorders causing hypertonia in childhood
, Pediatrics.
, vol. 111
(pg. e89
-97
) Sanger TD, Chen D, Fehlings DL, et al. Definition and classification of hyperkinetic movements in childhood. Mov Disord. 2010;25(11):1538-1549.
,
Definition and classification of hyperkinetic movements in childhood
, Mov Disord.
, vol. 25
(pg. 1538
-1549
) Kim DS, Choi JU, Yang KH, Park CI. Selective posterior rhizotomy in children with cerebral palsy: a 10-year experience. Childs Nerv Syst. 2001;17(9):556-562.
,
Selective posterior rhizotomy in children with cerebral palsy: a 10-year experience. Childs
, Nerv Syst.
, vol. 17
(pg. 556
-562
) Mooney JF, 3rd. Selective posterior rhizotomy and intrathecal baclofen for the treatment of spasticity. Pediatr Neurosurg. 2002;36(4):223.
,
3rd. Selective posterior rhizotomy and intrathecal baclofen for the treatment of spasticity
, Pediatr Neurosurg.
, vol. 36
pg. 223
Tichy M, Kraus J, Horinek D, Vaculik M. Selective posterior rhizotomy in the treatment of cerebral palsy, first experience in Czech Republic. Bratisl Lek Listy. 2003;104(2):54-58.
,
Selective posterior rhizotomy in the treatment of cerebral palsy, first experience in Czech Republic
, Bratisl Lek Listy.
, vol. 104
(pg. 54
-58
) von Koch CS, Park TS, Steinbok P, Smyth M, Peacock WJ. Selective posterior rhizotomy and intrathecal baclofen for the treatment of spasticity. Pediatr Neurosurg. 2001;35(2):<57-65.
,
Selective posterior rhizotomy and intrathecal baclofen for the treatment of spasticity
, Pediatr Neurosurg.
, vol. 35
(pg. 57
-65
) Wong AM, Chen CL, Hong WH, Tang FT, Lui TN, Chou SW. Motor control assessment for rhizotomy in cerebral palsy. Am J Phys Med Rehabil. 2000;79(5):441-450.
,
Motor control assessment for rhizotomy in cerebral palsy
, Am J Phys Med Rehabil.
, vol. 79
(pg. 441
-450
) Whelan MA, Delgado MR. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the quality standards subcommittee of the american academy of neurology and the practice committee of the child neurology society. Neurology. 2010;75(7):669.
,
Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the quality standards subcommittee of the american academy of neurology and the practice committee of the child neurology society
, Neurology.
, vol. 75
pg. 669
Hayek S, Gershon A, Wientroub S, Yizhar Z. The effect of injections of botulinum toxin type A combined with casting on the equinus gait of children with cerebral palsy. J Bone Joint Surg Br. 2010;92(8):1152-1159.
,
The effect of injections of botulinum toxin type A combined with casting on the equinus gait of children with cerebral palsy
, J Bone Joint Surg Br.
, vol. 92
(pg. 1152
-1159
) Engsberg JR, Ross SA, Collins DR, Park TS. Predicting functional change from preintervention measures in selective dorsal rhizotomy. J Neurosurg. 2007;106(4 Suppl):282-287.
,
Predicting functional change from preintervention measures in selective dorsal rhizotomy
, J Neurosurg.
, vol. 106
(pg. 282
-287
) Kim WH, Park EY. Causal relation between spasticity, strength, gross motor function, and functional outcome in children with cerebral palsy: a path analysis. Dev Med Child Neurol. 2011;53(1):68-73.
,
Causal relation between spasticity, strength, gross motor function, and functional outcome in children with cerebral palsy: a path analysis
, Dev Med Child Neurol.
, vol. 53
(pg. 68
-73
) Blasco PA. Primitive reflexes. Their contribution to the early detection of cerebral palsy. Clin Pediatr (Phila). 1994;33(7):388-397.
,
Primitive reflexes. Their contribution to the early detection of cerebral palsy
, Clin Pediatr (Phila).
, vol. 33
(pg. 388
-397
) Burns YR, O’Callaghan M, Tudehope DI. Early identification of cerebral palsy in high risk infants. Aust Paediatr J. 1989;25(4):215-219.
,
Early identification of cerebral palsy in high risk infants
, Aust Paediatr J.
, vol. 25
(pg. 215
-219
) Futagi Y, Tagawa T, Otani K. Primitive reflex profiles in infants: differences based on categories of neurological abnormality. Brain Dev. 1992;14(5):294-298.
,
Primitive reflex profiles in infants: differences based on categories of neurological abnormality
, Brain Dev.
, vol. 14
(pg. 294
-298
) Zafeiriou DI. Primitive reflexes and postural reactions in the neurodevelopmental examination. Pediatr Neurol. 2004;31(1):1-8.
,
Primitive reflexes and postural reactions in the neurodevelopmental examination
, Pediatr Neurol.
, vol. 31
(pg. 1
-8
) Zafeiriou DI, Tsikoulas IG, Kremenopoulos GM. Prospective follow-up of primitive reflex profiles in high-risk infants: clues to an early diagnosis of cerebral palsy. Pediatr Neurol. 1995;13(2):148-152.
,
Prospective follow-up of primitive reflex profiles in high-risk infants: clues to an early diagnosis of cerebral palsy
, Pediatr Neurol.
, vol. 13
(pg. 148
-152
) Sanger TD, Chen D, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW. Definition and classification of negative motor signs in childhood. Pediatrics. 2006;118(5):2159-2167.
,
Definition and classification of negative motor signs in childhood
, Pediatrics.
, vol. 118
(pg. 2159
-2167
) Gorter JW, Verschuren O, van Riel L, Ketelaar M. The relationship between spasticity in young children (18 months of age) with cerebral palsy and their gross motor function development. BMC Musculoskelet Disord. 2009;10:108.
,
The relationship between spasticity in young children (18 months of age) with cerebral palsy and their gross motor function development
, BMC Musculoskelet Disord.
, vol. 10
pg. 108
Dobson F. Assessing selective motor control in children with cerebral palsy. Dev Med Child Neurol. 2010;52(5):409-410.
,
Assessing selective motor control in children with cerebral palsy
, Dev Med Child Neurol.
, vol. 52
(pg. 409
-410
) Fowler EG, Goldberg EJ. The effect of lower extremity selective voluntary motor control on interjoint coordination during gait in children with spastic diplegic cerebral palsy. Gait Posture. 2009;29(1):102-107.
,
The effect of lower extremity selective voluntary motor control on interjoint coordination during gait in children with spastic diplegic cerebral palsy
, Gait Posture.
, vol. 29
(pg. 102
-107
) Deng J, Yao J, Dewald JP. Classification of the intention to generate a shoulder versus elbow torque by means of a time-frequency synthesized spatial patterns BCI algorithm. J Neural Eng. 2005;2(4):131-138.
,
Classification of the intention to generate a shoulder versus elbow torque by means of a time-frequency synthesized spatial patterns BCI algorithm
, J Neural Eng.
, vol. 2
(pg. 131
-138
) Keller T, Ellis MD, Dewald JP. Overcoming abnormal joint torque patterns in paretic upper extremities using triceps stimulation. Artif Organs. 2005;29(3):229-232.
,
Overcoming abnormal joint torque patterns in paretic upper extremities using triceps stimulation
, Artif Organs.
, vol. 29
(pg. 229
-232
) Schwerin S, Dewald JP, Haztl M, Jovanovich S, Nickeas M, MacKinnon C. Ipsilateral versus contralateral cortical motor projections to a shoulder adductor in chronic hemiparetic stroke: implications for the expression of arm synergies. Exp Brain Res. 2008;185(3):509-519.
,
Ipsilateral versus contralateral cortical motor projections to a shoulder adductor in chronic hemiparetic stroke: implications for the expression of arm synergies
, Exp Brain Res.
, vol. 185
(pg. 509
-519
) Yao J, Chen A, Carmona C, Dewald JP. Cortical overlap of joint representations contributes to the loss of independent joint control following stroke. Neuroimage. 2009;45(2):490-499.
,
Cortical overlap of joint representations contributes to the loss of independent joint control following stroke
, Neuroimage.
, vol. 45
(pg. 490
-499
) Yao J, Dewald JP. Cortico-muscular communication during the generation of static shoulder abduction torque in upper limb following stroke. Conf Proc IEEE Eng Med Biol Soc. 2006;1:181-184.
,
Cortico-muscular communication during the generation of static shoulder abduction torque in upper limb following stroke
, Conf Proc IEEE Eng Med Biol Soc.
, vol. 1
(pg. 181
-184
) Damiano DL, Arnold AS, Steele KM, Delp SL. Can strength training predictably improve gait kinematics? A pilot study on the effects of hip and knee extensor strengthening on lower-extremity alignment in cerebral palsy. Phys Ther. 2010;90(2):269-279.
,
Can strength training predictably improve gait kinematics? A pilot study on the effects of hip and knee extensor strengthening on lower-extremity alignment in cerebral palsy
, Phys Ther.
, vol. 90
(pg. 269
-279
) Fowler EG, Kolobe TH, Damiano DL, et al. Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: section on pediatrics research summit proceedings. Phys Ther. 2007;87(11):1495-1510.
,
Promotion of physical fitness and prevention of secondary conditions for children with cerebral palsy: section on pediatrics research summit proceedings
, Phys Ther.
, vol. 87
(pg. 1495
-1510
) Hagberg B, Sanner G, Steen M. The dysequilibrium syndrome in cerebral palsy. Clinical aspects and treatment. Acta Paediatr Scand Suppl. 1972;226:1-63.
,
The dysequilibrium syndrome in cerebral palsy. Clinical aspects and treatment
, Acta Paediatr Scand Suppl.
, vol. 226
(pg. 1
-63
) Woollacott MH, Burtner P. Neural and musculoskeletal contributions to the development of stance balance control in typical children and in children with cerebral palsy [review]. Acta Paediatr Suppl. 1996;416:58-62.
,
Neural and musculoskeletal contributions to the development of stance balance control in typical children and in children with cerebral palsy [review]
, Acta Paediatr Suppl.
, vol. 416
(pg. 58
-62
) Woollacott MH, Shumway-Cook A. Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems and what new therapies might improve balance? Neural Plast. 2005;12(2-3):211-219; discussion 263-272.
,
Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems and what new therapies might improve balance?
, Neural Plast.
, vol. 12
(pg. 211
-219
) Tedroff K, Knutson LM, Soderberg GL. Synergistic muscle activation during maximum voluntary contractions in children with and without spastic cerebral palsy. Dev Med Child Neurol. 2006;48(10):789-796.
,
Synergistic muscle activation during maximum voluntary contractions in children with and without spastic cerebral palsy
, Dev Med Child Neurol.
, vol. 48
(pg. 789
-796
) Bleck EE. Musculoskeletal examination of the child with cerebral palsy. Pediatr Ann. 1979;8(10):606-13.
,
Musculoskeletal examination of the child with cerebral palsy
, Pediatr Ann.
, vol. 8
(pg. 606
-13
) Bleck EE. The sense of balance. Dev Med Child Neurol. 1994;36(5):377-378.
,
The sense of balance
, Dev Med Child Neurol.
, vol. 36
(pg. 377
-378
) Ziv I, Blackburn N, Rang M, Koreska J. Muscle growth in normal and spastic mice. Dev Med Child Neurol. 1984;26(1):94-99.
,
Muscle growth in normal and spastic mice
, Dev Med Child Neurol.
, vol. 26
(pg. 94
-99
) Wright M, Bartlett DJ. Distribution of contractures and spinal malalignments in adolescents with cerebral palsy: observations and influences of function, gender and age. Dev Neurorehabil. 2010;13(1):46-52.
,
Distribution of contractures and spinal malalignments in adolescents with cerebral palsy: observations and influences of function, gender and age
, Dev Neurorehabil.
, vol. 13
(pg. 46
-52
) O’Sullivan R, Walsh M, Hewart P, Jenkinson A, Ross LA, O’Brien T. Factors associated with internal hip rotation gait in patients with cerebral palsy. J Pediatr Orthop. 2006;26(4):537-541.
,
Factors associated with internal hip rotation gait in patients with cerebral palsy
, J Pediatr Orthop.
, vol. 26
(pg. 537
-541
) Nordmark E, Hagglund G, Lauge-Pedersen H, Wagner P, Westbom L. Development of lower limb range of motion from early childhood to adolescence in cerebral palsy: a population-based study. BMC Med. 2009;7:65.
,
Development of lower limb range of motion from early childhood to adolescence in cerebral palsy: a population-based study
, BMC Med.
, vol. 7
pg. 65
Gage j. UPdate of treatment for gait in cerebral palsy. J Peds Orthop. 2001(10):265-274.
,
UPdate of treatment for gait in cerebral palsy
, J Peds Orthop.
(pg. 265
-274
) Prange GB, Jannink MJ, Groothuis-Oudshoorn CG, Hermens HJ, Ijzerman MJ. Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke. J Rehabil Res Dev. 2006;43(2):171-184.
,
Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke
, J Rehabil Res Dev.
, vol. 43
(pg. 171
-184
) Saavedra S, Woollacott M, van Donkelaar P. Head stability during quiet sitting in children with cerebral palsy: effect of vision and trunk support. Exp Brain Res. 2010;201(1):13-23.
,
Head stability during quiet sitting in children with cerebral palsy: effect of vision and trunk support
, Exp Brain Res.
, vol. 201
(pg. 13
-23
) Borggrafe I, Meyer-Heim A, Heinen F. [Robotic assisted treadmill therapy in children with cerebral palsy]. MMW Fortschr Med. 2009;151(suppl3):123-126.
,
[Robotic assisted treadmill therapy in children with cerebral palsy]
, MMW Fortschr Med.
, vol. 151
(pg. 123
-126
) Wu YN, Ren Y, Hwang M, Gaebler-Spira DJ, Zhang LQ. Efficacy of robotic rehabilitation of ankle impairments in children with cerebral palsy. Conf Proc IEEE Eng Med Biol Soc. 2010;1:4481-4484.
,
Efficacy of robotic rehabilitation of ankle impairments in children with cerebral palsy
, Conf Proc IEEE Eng Med Biol Soc.
, vol. 1
(pg. 4481
-4484
) Snider L, Majnemer A. Virtual reality: we are virtually there. Phys Occup Ther Pediatr. 2010;30(1):1-3.
,
Virtual reality: we are virtually there
, Phys Occup Ther Pediatr.
, vol. 30
(pg. 1
-3
) Wann JP, Turnbull JD. Motor skill learning in cerebral palsy: movement, action and computer-enhanced therapy. Baillieres Clin Neurol. 1993;2(1):15-28.
,
Motor skill learning in cerebral palsy: movement, action and computer-enhanced therapy
, Baillieres Clin Neurol.
, vol. 2
(pg. 15
-28
) Bartlett DJ, Hanna SE, Avery L, Stevenson RD, Galuppi B. Correlates of decline in gross motor capacity in adolescents with cerebral palsy in Gross Motor Function Classification System levels III to V: an exploratory study. Dev Med Child Neurol. 2010;52(7):e155-160.
,
Correlates of decline in gross motor capacity in adolescents with cerebral palsy in Gross Motor Function Classification System levels III to V: an exploratory study
, Dev Med Child Neurol.
, vol. 52
(pg. e155
-160
) Parsons TD, Rizzo AA, Rogers S, York P. Virtual reality in paediatric rehabilitation: a review. Dev Neurorehabil. 2009;12(4):224-238.
,
Virtual reality in paediatric rehabilitation: a review
, Dev Neurorehabil.
, vol. 12
(pg. 224
-238
)
This content is only available as a PDF.
