This case study focuses on the physical therapy management of Kayla, a young woman with spastic, diplegic cerebral palsy (CP). Kayla is now 20 years old and a sophomore in college. She was born prematurely and has received physical therapy services in a variety of settings since infancy. She has been followed for early intervention, early childhood, school-based, outpatient, and home health physical therapy services. At this time she does not regularly see a physical therapist, but does continue with occasional sessions to monitor adaptive equipment and to address episodes of foot pain or back pain. Kayla walks in her home/dormitory settings and on campus using bilateral forearm crutches. For longer distances, she uses a motorized cart.
Children and young adults with CP are reportedly less socially and physically active than their peers without a physical disability (Shikako-Thomas, Majnemer, Law, & Lach, 2008; Engel-Yeger, Jarus, Anaby, & Law, 2009; Maher, Williams, Olds, & Lane, 2007). Individuals with CP frequently present with impairments of range of motion (ROM), soft tissue mobility, strength, coordination, and balance, resulting in motor control difficulties. CP implies damage to the immature cortex, involving the sensorimotor system. Associated problems with vision, seizures, perception, and cognition may be seen if areas of the cortex associated with these functions are also damaged. Although the cortical lesion is nonprogressive, as the infant grows and strives to become more independent, functional limitations become more apparent, as do restrictions in activities and community participation. Secondary impairments in body structures and function, such as ROM limitations, disuse atrophy, and impaired aerobic capacity, may further limit functional motor skills and ability for activities and participation. Multiple episodes of physical therapy management are frequently warranted as the child attempts more complex functional skills and as the risk for secondary impairments increases. The goal of physical therapy intervention for children and young adults with CP is to maximize the individual's ability to participate in age-appropriate activities within the home, school, and community settings.
Children with CP present with a variety of functional abilities, reflecting the location and severity of their original neurological insult. Distribution of motor involvement varies and may include hemiplegia, diplegia, or quadriplegia. The degree to which the neurological insult impacts motor ability and function also varies. The Gross Motor Function Classification System (GMFCS) provides a mechanism to classify these children, based on their gross motor abilities and limitations (Palisano, Rosenbaum, Bartlett, & Livingston, 2008; Palisano et al., 1997). Based on Kayla's ability to ambulate with an assistive device and need to use power mobility for community mobility, she would be classified as functioning at the GMFCS level III through elementary and high school.
Based on the American Physical Therapy Association (APTA)'s Guide to Physical Therapist Practice (2001), Kayla's physical therapy needs may best be addressed by Preferred Practice Pattern 5C: Impaired Motor Function and Sensory Integrity Associated with ...