Physiotherapy management of cerebral palsy: current evidence and pilot analysis

Cerebral palsy is the main neurological referral within paediatric physiotherapy. The management of such children echoes the key elements of multidisciplinary, client centered, evaluative practice reinforced by the legislation and research of the past decade. This current paper reviews the issues involved in the management of children with cerebral palsy through a literature review and pilot study of paediatric physiotherapists working within a Scottish rural environment. A comparison between physiotherapists working within a child development unit and rural community paediatric teams was undertaken, to establish whether practice differed across sectors of care. Its aim was to analyse whether existing principles were reflective of guidelines laid down by legislation and literature. A high response rate of 85% was recorded. Results highlighted inter-disciplinary practice prominent with physiotherapists in both environments and the other paramedical professions but lacking in relation to educational and social care professions, a factor supported within the literature review. Client centred practice although advocated by the majority of physiotherapists across both sectors of care, leaned towards the application of an expert led model of practice where passive parental involvement was advocated, despite literature to support the contradiction of such application. Outcome evaluation was applied in practice by a marginal majority of physiotherapists, although only those within the child development unit and a further three rural team physiotherapists used such methods on a regular basis. The literature review echoed the general difficulties encountered by physiotherapists in the application of outcome measures within clinical practice, where time is limited and ease of application a necessity often underemphasized in the literature. Treatment has now become management. This literature review and pilot study highlight analysis of the themes above in the management of children with cerebral palsy and serve to reinforce the growing extrinsic demands placed on the paediatric physiotherapist today.