Established care
Physiotherapy and strength training
Functional physiotherapy, progressive resistance training, fitness
Well supported when it is built around function and genuinely loaded — much weaker when it is passive stretching and generic exercise.
Either a medicines regulator has licensed it for this use, or clinical practice guidelines recommend it on the strength of controlled trials. This is the standard everything else on the scale is measured against — and for most children, the treatments at this level are the ones that will actually change their day.
Where it stands, condition by condition
The same therapy can be well supported for one problem and completely untested for another. This is the single most common place families are misled.
| Condition | Evidence | What that means here |
|---|---|---|
| Cerebral palsy — gross motor function | Established care | Function-focused physiotherapy is standard, guideline-supported care. |
| Strength and fitness | Established care | Progressive resistance training improves strength. Translation into walking function is less consistent. |
| Passive stretching to prevent contracture | Early research only | Long-held belief, weak evidence. Stretching alone has not been shown to prevent contracture. |
What it is
Physiotherapy here means work on posture, balance, walking, transfers, strength and fitness, aimed at things the child wants to do.
The modern version is active, loaded and specific. The older version — the therapist passively moving the child, long sessions of stretching — has not survived testing well.
Equipment is part of it: orthoses, walkers, standing frames and seating, each prescribed for a defined purpose rather than as a default.
How it is meant to work
Muscles in children with cerebral palsy are not only spastic; they are often smaller, shorter and weaker. Weakness is a bigger limit on function than tone in many children, and it responds to loading.
Fitness matters separately: many children with motor disability are profoundly deconditioned, which limits participation more than the primary impairment.
What has actually been tested
- Progressive resistance training reliably increases strength in children with cerebral palsy.
- Whether that strength converts into better walking depends on how closely the training resembles the task — which brings it back to goal-directed practice.
- Stretching deserves a direct word. Passive stretching is one of the most widely delivered interventions in this field, and the evidence that it prevents contracture is poor. It is not useless, but it should not be the main content of a session.
- Fitness and sport participation improve endurance and wellbeing, and are undervalued relative to clinic-based therapy.
What we still do not know
- Optimal dose and frequency across ages.
- How to maintain strength gains after a training block ends.
- Which children are at real risk of contracture and therefore need surveillance rather than routine stretching.
Risks and costs
- Overuse injury and pain if loading is progressed carelessly.
- Burnout, in the child and the family, from programmes that fill every evening.
- Opportunity cost: hours spent on passive techniques are hours not spent on active practice.
Questions to ask before you agree
A centre that is doing good work will welcome these questions and answer them in writing.
- What proportion of each session is active practice versus passive handling?
- Is strength training progressive — is the load actually increasing?
- What is each piece of equipment for, and when is it reviewed?
More in this section
Early detection and early intervention
The single highest-value thing in this whole field, and the one least often discussed in clinics selling treatment. Cerebral palsy can be identified in the first months of life, and that is when therapy does the most.
Established careGoal-directed, task-specific training
Not a brand of therapy but the principle underneath the ones that work: the child practises the actual task they are trying to learn, with enough repetition to matter.
Established careConstraint-induced therapy and bimanual training
For a child who uses one hand much more than the other, these are among the best-evidenced interventions in paediatric neurology — and both work, for different things.
Established careOccupational therapy
The discipline that works on what the child actually does all day — dressing, eating, writing, playing, getting through a school morning.
Established careSpeech, language and communication
For a child who cannot speak clearly, giving them a way to communicate is among the most consequential interventions available — and the fear that it will stop them talking is unfounded.
Established careSpasticity and tone management
Medical and surgical treatment of tone, which works best when it is tied to a functional goal rather than to a number on a tone scale.
In clinical trialsTechnology-assisted rehabilitation
Useful mainly as a way of delivering more practice, not as a treatment in its own right — and that distinction decides whether it is worth the money.
In clinical trialsNamed physiotherapy approaches
Families are usually asked to choose between brands. The evidence says the brand matters far less than whether the session is active, goal-directed and repeated often enough.
In clinical trialsSensory therapies
Two things are sold under one word. Manualised Ayres Sensory Integration has been tested in trials; the sensory add-ons sold around it mostly have not.
Established careVision and cerebral visual impairment
The most commonly missed problem in children with brain injury. A child who cannot interpret what they see is often described as inattentive, uncooperative or more delayed than they are.