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Children benefit from movement and novelty. There have been some improvements in limb placement and balance and equilibrium seen in children who worked on the Bobath balls during neurodevelopment therapy. Hippo-therapy gives them, if you will, a hairy, olfactory-stimulating, warm, four-legged Bobath ball platform on which a trained therapist can capitalize on motor control, stretching, and equilibrium as the therapist works with the child.24–33 The North American Riding for the Handicapped Association (NARHA) has defined hippotherapy as “The use of the movement of a horse as a tool by physical therapists, occupational therapists, and speech-language pathologists to address impairments, functional limitations and disabilities in patients with neuromusculoskeletal dysfunction. This tool is used as part of an integrated treatment program to achieve functional outcomes.”33

The therapeutic use of water lies in the art of careful selection to use the many physical properties of water in the most appropriate way to produce a sensible result. Misuse or careless application can mean that well-intended therapy fades into merely tender loving care. Aquatic therapy provides countless opportunities to experience, learn, and enjoy new movement skills, which leads to increase functional skills, mobility and builds self-confidence.

Most children with CP will need assistive devices for standing and walking during their lifetime. There are many assistive device styles, accessories, and options in the durable medical equipment market. Choosing the walker that offers the appropriate support but allows the greatest degree of mobility is of utmost importance. Therefore, it is crucial to have several of these devices available for trial when evaluating a child for the use of assistive equipment.

No other area of technology for children with CP has shown any greater growth than that in mobility systems and seating components. There is no facility where you will not find consensus among the caregivers that an appropriate prescription for a seating device needs to include the family, the treating therapist, the physician, the equipment vendor, and, for the complex cases, a rehabilitation engineer. Guidelines for seating systems are outlined in Tables R9 through R17. Because wheelchairs are always large devices compared with the child’s size, when determining the functional use of the device one must very carefully consider the patient, the family environment and family goals, and the community environment where the device will be used (Figure R6). Many of the specific indications and contraindications are not well defined or widely agreed upon in the rehabilitation community. As with all interventions, there are pluses and minuses and these are included for consideration (see Tables R9-R17).

The M.O.V.E.™ Curriculum is an activity-based curriculum designed to teach individuals basic functional motor skills needed for adult life. These skills allow them to enjoy a more inclusive lifestyle because movement is an integral part of everyday life. People with physical disabilities often require assistance to participate in these everyday activities, such as moving to the bed or bathroom, to school, or to their place of work. The MOVE curriculum provides a framework for teaching the skills necessary for individuals with disabilities to gain greater physical independence. It combines functional body movements with an instructional process designed to help people acquire increasing amounts of independence in sitting, standing, and walking.

Individuals with CP may present with spasticity that causes dynamic or fixed contractures. Typical orthopaedic deformities include shoulder excessive external rotation, elbow flexion, pronation, ulnar deviation, wrist flexion, thumb adduction, tight finger flexion, and swan neck fingers. Surgery should improve these areas, but some children use their limits for function and may not do better. Examples are children who use augmentative communication aids and need a pronated arm or whose ability to point requires wrist flexion (tight tenodesis).

Neurosurgical interventions have been brought into wide use during the past 10 to 15 years. The first is that of dorsal root rhizotomies, which has met with mixed reviews. Recent meta-analysis of affected patients demonstrates that if there is any benefit it is only in a few points of improvement and not dramatic functional improvements. Use of intrathecal baclofen in the pediatric patient having CP has yielded as good a reduction in tone as dorsal rhizotomy and does not represent an ablative procedure. This is important because, unlike rhizotomies, it is entirely reversible.