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Arch Hellen Med, 33(4), July-August 2016, 532-541


The evolution of physiotherapy in the clinical management of children with cerebral palsy:
A functional approach

V.C. Skoutelis,1,2 Z. Dimitriadis2
1Physiotherapy Centers "ENA" and "Vioanadrasi", Athens,
2Department of Physiotherapy, School of Health and Caring Professions, Technological Educational Institute of Athens, Athens, Greece

Cerebral palsy is the leading cause of childhood disability, with the most common referral for physiotherapy treatment by such medical specialists as child neurologists, physiatrists and orthopedic surgeons. The traditional physiotherapy methods, the so-called neurofacilitation approaches, including the Bobath neurodevelopmental treatment, the Ayres sensory integration, the Vojta approach, etc., which were developed in the middle of 20th century for the clinical management of children with cerebral palsy, focus on remediation strategies of body impairments for achieving function. Emerging new perspectives on the control of motor development, such as the dynamic systems theory, based on both neuroscientific and biomechanical studies, and the family-centered model of children's rehabilitation services, have led to an evolution in pediatric neurological physiotherapy, with modification of some traditional approaches and development of new, alternative intervention strategies. These new intervention strategies, covered generally by the term "functional approach", are directed at learning and optimizing self-initiated functional activities, via changes in the environmental or task parameters, instead of the "normalization" of movement patterns. The functional approach is based on the following five principles: (a) Establishment of specific, measurable, attainable/ action-oriented, realistic and time-limited (SMART) goals, (b) use of the therapist as the "teacher" or "coach" of the child, the family and the community assistance providers, (c) designation of the child as the "active problem solver" (i.e., hands-off process), (d) repetitive practice in functional situations, and (e) active participation of the family in all the phases of intervention (i.e., evaluation, decision making, goal setting, application in everyday life). Current, reliable clinical studies support the equivalent efficacy of the functional approach, compared with the traditional intervention methods, for children with cerebral palsy.

Key words: Cerebral palsy, Context therapy, Dynamic systems theory, Functional approach, Physiotherapy.

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