How we treat cerebral palsy in children

Three or four goals, chosen by the child and family, written so they can be scored at the end. Not "improve gross motor function" but "carry a tray from the counter to the table" — a goal a seven-year-old recognises and can tell you whether they achieved.

This is not a softer way of working. Goal-directed training is one of the strongest interventions in the evidence review, and the reason is that a goal the child owns produces effort that an exercise sheet does not.

The child works. Approaches where the therapist moves the child while the child is passive sit at the ineffective end of the evidence, and we do not build plans from them.

In practice a session looks busier and noisier than families expect, and often less like traditional therapy. That is the point.

The paediatric robotic gait trainer delivers a high volume of correctly shaped steps in a session — a dose that therapists cannot sustain by hand. The hippotherapy simulator delivers the trunk and balance work of hippotherapy indoors, repeatably. Hydrotherapy allows movement against reduced gravity for children who cannot yet produce it on land.

All three are ways of delivering green-light interventions at dose. None of them is the plan on its own, and a child whose goals are hand-based may use none of them.

A home programme is one of the interventions the evidence supports — but only if it is actually done, which depends on whether the parent was taught properly or handed a sheet.

So the parent is scheduled in: doing the exercises under supervision, learning how to grade them as the child improves, and leaving with something realistic for a working family rather than an ideal that collapses in week two.