Rehabilitation aims to prevent disability by minimizing the effects of impairments, preventing secondary disabilities and maximizing motor function throughout the child’s life. The focus of treatment shifts over the years but the principles remain the same. Functional goals change as the baby becomes a child and the child matures into an adult. Younger children focus mainly on mobility whereas adults shift their focus to communication and activities of daily living. The first four years are spent in physiotherapy and bracing, orthopaedic surgical procedures are performed between 5 to 7 years of age, education and psychosocial integration become main issues in the school age (7-18 years). Reach mobilization goals by the time the child is ready to go  to school. The child needs aggressive physiotherapy in the growth  spurt period and after orthopaedic surgery. Communicate with the school physiotherapist or the physical education teacher to help with the child’s exercise program to enable an active life for the child at school.

Early intervention
Early intervention is the general name given to many therapy modalities including exercise and caregiver education. Early intervention programs involving infant stimulation and caregiver education may retard or reverse the central nervous system lesion  causing the clinical picture of CP and thus prevent or minimize neuromotor delay. There is no established routine and no proven  value of these programs, however until we know which babies  are going to be normal on their own, it is better to let them have the benefit of early treatment so that any improvement potential is not lost. Despite the controversies early treatment benefits the parents. They receive a great deal of practical advice and support this way. The child’s functional status may improve with parental support. Early treatment creates more opportunity for the potential to develop any normal abilities and for decreasing the defects.

Infancy
Rehabilitation goals are to educate the family about the child’s problem, to improve parental bonding, to help the mother care for the baby and to promote optimal sensorimotor development through positioning, stimulation and exercises  if possible. Increase mobility and help the baby explore his surroundings. Use positioning, carrying, feeding and dressing techniques which promote bodily symmetry in the infant. These limit abnormal posture and movements and make functional activity possible. Provide sensory stimulation using various movements and postures. Some positions lengthen the spastic muscles and make voluntary movement easier. Add weight shifting, weight bearing, trunk rotation and isolated movements into the exercise regimen.  Customized seating or seating supports are necessary. Visual attention, upper extremity use and social interaction improve in the child who is supported in sitting. When the child is sitting comfortably without fear of falling he sees his hands, practices midline play, reaches for his or her feet and sucks on his fingers. All of these movements provide sensory stimulation and promote a voluntary motor response to that stimulation. Active movements encourage the infant to develop flexor control and symmetry. Use toys that require two hands, facilitate the use of neck and trunk muscles and anteroposterior control of the head. Educate the parents to help them accept their child’s problems and raise their child in the best possible way.

Childhood
The needs of the children are different starting at age one depending on the type and severity of involvement. Redefine goals of treatment at this stage. Limitations in motor function create disabilities in learning and socialization. The child cannot become independent. The major goal of rehabilitation in the
preschool period is achieving independent mobility. At this age child’s maximum level of motor function can be predicted with greater accuracy. Choose a method of mobilisation and teach the child how to use it so that he will be free to explore his environment. Bring every child to an erect position regardless of prognosis for walking. Encourage the use of standers. Focus on independent mobility in every child. The total body involved child needs sitting supports and wheeled mobility. The diplegic and the hemiplegic must be supplied with appropriate bracing to begin to work on ambulation. As the child matures physically by the age of four he must be involved in self care activities and activities of daily living at home. Always aim for functional tasks in the limits of the child’s capacity. Address educational issues with help from  special educators if necessary. Plan and complete all surgical procedures directed towards better ambulation by school age if
possible.

School age and adolescence
Children in mainstream schools regress because of a lack of exercise. Physiotherapy done in clinics in contrast, takes too much time, causes separation of the child from his peers and prevents socialization. Physiotherapy should be performed at school if possible with the help of a community physiotherapist or the physical education teacher. Coordinate school with play and exercise. Handle social and vocational issues during school years for a better state of independence. Efforts to improve the
psychological well being of the child are necessary especially in adolescence. Children with CP have a significantly lower level of physical activity and cardiovascular fitness compared to their healthy peers even if they are only mildly impaired. Keep in mind the fact that cardiovascular issues continue to be a problem for the CP patient in adulthood, increase the activity levels of these children at school by sports and play.

The family
Physical impairments that create lifelong disability for the child cause psychological disturbance in the family. The parents are  in need of constant support, have problems understanding and accepting the situation and tend to blame themselves or the physicians. Explain the nature of the problem to the family and include them in the treatment plan. Remember that families may need to hear the same information many times before they can fully comprehend the problems they will encounter. The concept of management rather than cure forms the basis of intervention. Long term aggressive therapy programs cause social isolation and delay normal psychological development. Integrate therapy programs into summer camps,  home activities and school. Let the child live like a child, as close to normal as possible. Do not raise false hopes. Successful rehabilitation includes the prevention of additional problems, reduction of disability and community integration. Rehabilitation is successful if the child is a happy child and if the parents are well adjusted, happy people.