**2.1 Physical therapy**

Physical therapy relieves pain and muscle stiffness, improves mobility, and prevents future problems such as muscle tightness. It is always recommended as the first therapy intervention. It improves motor skills and can stop movement problems from worsening in the future. It includes varieties of treatment modalities such as strength, flexibility exercises, heat treatment, massages, and special equipment for CP children to give them more independence. How much the PT will help to improve the child's condition depends on the severity and CP type the child has. Mild cases only require some physical therapy. The best chance to improve the child's condition is with early intervention. Mobility can be improved by preventing contractures and joint dislocations by keeping the body strong and flexible. PT can improve the level of self-reliance of most CP children. The goal of PT is to make everyday movements easier. It can improve coordination, balance, strength, flexibility, endurance, pain management, posture, gait, and overall health.

**The benefits of PT depend on the CP type:**


The treatment plan will be based on the CP type. The child might have either hemiplegia, diplegia, or quadriplegia. Therapists design specific exercises and routines for each type, which helps the child regain movement in the affected area over time.

Other conditions such as scoliosis, thoracic kyphosis, lumbar lordosis, pelvic inclination, pelvic rotation, pelvic obliquity, knee deformity, shortened Achilles tendon, and hand and wrist deformities can be treated by PT. After the initial evaluation by the therapist, a treatment plan will be created, which might include a combination of exercises, muscle relaxing techniques, and special equipment to improve movement.

CP child either will have muscle hypotonia or hypertonia. Flexibility exercises and massages are usually used for the hypertonic child, which will develop mobility and prevent painful muscle tightening, which could require surgical intervention. On the other hand, the athetoid child will require strength training exercises to increase their muscle tone. Walking, posture, transitional movements, and sensory impairments such as touch and balance can be improved by certain exercises. Exercises that improve sitting, kneeling, and standing can improve posture. Infants use transitional movements to be able to walk, roll over, and sit up are examples of those movements.

*Management of Spasticity and Cerebral Palsy Update DOI: http://dx.doi.org/10.5772/intechopen.106351*

Different mobility aids are to be used to make therapy more effective. Different orthotics equipment can be used to help with walking, posture, and joint mobility; braces, casts, splints, and shoe inserts are some examples. There are other tools that have been used in PT include exercise balls, resistance bands, free weights, swimming pools, hot and cold packs, and electric muscle stimulation (it improves gait and upper limb function).

As the child gets older, the physical therapist will change the program to meet the child's needs. Toddlers and the early school years are the most important stages of a child's life.


Outcome of the therapy can be evaluated by observation and a set of standardized tests to measure motor function. Therapists will be looking for specific postures and movements that could be corrected to develop a strong treatment plan.

#### **2.2 Occupational therapy**

Health care providers usually recommend OT along with PT for CP children to provide easier independent lives because it has many benefits. On one hand, PT improves muscle tone and balance, and on the other hand, OT is helping children to accomplish daily living activities. According to the American Occupational Therapy Association (AOTA), OT helps people of all ages to learn how to improve their abilities to do their everyday activities [3]. Everyday school tasks, eating and drinking, dressing, hygiene, and other tasks necessary for daily use can be assisted by OT. Children with visual impairment, regardless of severity, can do their daily tasks by doing OT. Also, sensoryperceptual-motor (SPM) training, which helps to stimulate the senses of performing daily tasks more easily, can be assisted by OT. An occupational therapist usually uses visual input tools and cues, as well as verbal directions to help children in carrying out necessary everyday tasks. A cognitively impaired child can benefit from OT. Establishing daily schedules or routines to help those children some daily tasks such as remembering to dress, brush their teeth, and other tasks are needed to carry out their day.

The real challenge for CP children is their motor impairment, which makes their daily tasks difficult. For example, most children have difficulties with daily hygiene, moving around, posture, and completing school tasks due to their movement limitations. The occupational therapist will assess every child's needs individually to design a program to meet their personal goals. The main line of OT program includes stretching and guide motor output techniques and constraint-induced movement therapy (CIMT), which helps hemiplegic CP children [4], and neuromuscular facilitation techniques.

OT can help in other areas such as grasping objects; using computer and other electronics; opening doors; writing, holding, and reading books; playing; interacting with peers, caregivers, and parents; school and/or daycare activities; and sitting and standing up from tables and school desks. CP Children and their parents and caregivers can benefit from OT by watching children thrive both physically and emotionally. This progress reduces parents' stress and provides a sense of peace as the child becomes more independent and productive.

OT can take place in different settings such as outpatient offices, inpatient medical centers, at home, nursing centers, and OT providers. To obtain quality OT, the child must be under the care and supervision of a trained and licensed occupational therapist. By evaluating the child and assessing the child's strengths and weaknesses, they will be able to formulate an individualized plan to help the child best reach his or her goals. Per AOTA, licensed occupational therapists, besides they are licensed in their state to practice occupational therapy, have another degree in Social Services, Health, Biology, Chemistry, Psychology, Sociology, Human Development, and Anatomy & Physiology. To obtain their license, they must be graduated from an accredited school, do fieldwork hours, and pass the National Board for Certification in Occupational Therapy examination. The therapist will conduct a comprehensive assessment including testing the child's: motor skills, developmental condition, cognitive development and functioning, psychological needs, emotional needs, and home and school environment to be able to create an individualized treatment plan.
