Cerebral Palsy (Children)

Cerebral palsy is described by how a child moves, not by the size of the injury on a scan. The Gross Motor Function Classification System runs from level I — walks without limitation — to level V, transported in a wheelchair with limited head and trunk control. It is stable over time and it is the single most useful thing to tell us about your child.

It matters because it sets what a programme is for. At level I or II the work is precision, endurance and participation. At level IV or V it is comfort, positioning, hip protection, communication and the equipment that makes daily care possible — and framing that as a lesser goal is a mistake families are often pushed into.

When you write to us, the GMFCS level, the current equipment and a short video of your child moving tell a rehabilitation physician more than any report.

The programme runs as an intensive block of three to four weeks rather than as two sessions a week for a year. This follows the evidence on dose: intensity is one of the clearest predictors of whether motor training changes function.

Between blocks the work continues at home, which is why the parent is trained rather than briefed. A second block is usually planned six to twelve months later, and it starts from a reassessment rather than from the previous plan.

The international review of cerebral palsy interventions sorts treatments into a traffic-light system by the strength of the evidence behind them. The treatments that come out green share a shape: the child is active, the goal is explicit, the task is real, and the dose is high enough to matter.

That includes goal-directed training, bimanual training and constraint-induced movement therapy for the hands, task-specific practice, strength and fitness training, treadmill and body-weight-supported treadmill training, casting, home programmes, and hippotherapy. Botulinum toxin combined with occupational therapy or casting is also supported, as are selective dorsal rhizotomy and intrathecal baclofen in selected children.

Our programme is built from that list. The paediatric robotic gait trainer and the hippotherapy simulator are on this page because they deliver green-light interventions at a dose a therapist cannot sustain by hand — not because they photograph well.

The same review has a red list: treatments where good-quality trials show no benefit, and in some cases harm. It includes craniosacral therapy, hyperbaric oxygen, and passive neurodevelopmental therapy in its original form — the approach where the therapist moves the child rather than the child moving.

Hyperbaric oxygen deserves a specific mention because it is heavily marketed to families who are already travelling abroad for their child. Trials found no difference in motor outcomes against the control group, and serious side effects occurred. If a centre offers it for cerebral palsy, that tells you something about the centre.

Sensory integration therapy is also on the red list for cerebral palsy. We offer sensory integration therapy at Romatem and it has evidence in other paediatric conditions — but not for motor function in cerebral palsy, and we would rather say so on our own page than sell you something that is not indicated for your child.

The general finding behind all of this is worth carrying home: generic and passive treatments, where things are done to the child, perform worse than active ones where the child works towards a goal they understand.

Goal-directed training means the goal is a real thing the child and family want: managing a school bag, drinking from an open cup, getting up a kerb, being understood by a grandparent. Motor gains that do not attach to a goal like that tend not to survive the flight home.

So the first days are spent agreeing three or four goals that matter to you, written so that they can be scored at the end of the block. That is also how you find out whether the block worked, rather than being told that it did.

Children who do not walk are at real risk of the hip moving out of the socket, and the process is silent until it is advanced and painful. Structured hip surveillance — an x-ray at defined intervals according to GMFCS level — is one of the clearest green-light interventions there is.

We ask when the last hip x-ray was taken. If a child at level IV or V has not had surveillance, that is worth more than anything a therapy block will achieve in three weeks, and we will say so.

Cerebral palsy does not go away, and no block of therapy changes the GMFCS level in most children. What a good programme changes is what the child can do inside their level: more endurance, better hand use, a skill that was out of reach, less pain, easier daily care.

We write the goals so that this distinction is explicit before you travel. A family that arrives expecting their child to walk, when the evidence never supported that, has been failed by whoever set the expectation — and it is easier to set it honestly at the start than to explain it at the end.

Three to four weeks, three to five hours of active therapy a day adjusted to the child's age and tolerance. Physiotherapy for gross motor goals, occupational therapy for hand use and daily tasks, speech and language therapy where communication or feeding is affected, robotic gait work and hippotherapy where they fit the goals, and hydrotherapy.

A parent is present throughout and trained in the home programme. Equipment and orthotics are reviewed during the stay, because a well-set-up chair or a correct brace often does more for daily life than an extra therapy hour.