Evidence-Based Occupational Therapy Practice for Cerebral Palsy

Summary of Evidence for CP

  • OT Interventions most supported by EBP
    • Constraint-Induced Movement Therapy (CIMT)
    • Orthotics and Casting (Lower limb casting)
    • Goal-directed training
    • Bimanual training
    • Context-focused therapy
    • Home programs
  • Avoid: NDT, SI


Constraint-induced movement therapy constrains the dominant hand in a mitt or a cast to enable intensive training in the hemiplegic hand. For children with CP, CIMT was found to improve hand function of the hemiplegic hand. This approach is supported by randomized-control trials including reviews that confirm its effectiveness. If children meet the protocol for CIMT, often referred to as the 10 x 10 x 10 eligibility criteria in selecting a patient for CIMT:

  1. 10 degrees active wrist extension on the affected hand
  2. 10 degrees active thumb abduction on the affected hand
  3. 10 degrees active extension of any other two digits on the affected hand

Orthotics and Casting

  • Orthotics and casting is often effective for OT interventions in many conditions.
  • However, for CP, it was not found to be as effective for the upper extremities compared to the lower extremities, e.g., AFO.
  • There was insufficient evidence to conclude that orthotics were effective in improving upper limb function.

Goal-Directed Training

  • Goal-directed training AKA functional training
  • Involves specific practices of child-set goals using a motor learning approach.
  • Was found to be effective in improving gross motor function and hand (fine motor) function.
  • Example of outcome measure: Goal-Attainment Scaling (GAS)

Bimanual Training

  • Bimanual training involves repetitive task training that involves the use of both hands.
  • Examples include crossing midline.
  • Was found to improve hand function in children with hemiplegia.
  • Was found to have equal effectiveness as CIMT.

Context-based Therapy

  • Involves changing or modifying the task or environment, but NOT the child or client.
  • Promotes successful task performance.
  • Overall improvement was seen in function (very OT).
  • Research was found to be effective via a rigorous RCT.

Home Programs

  • Involves the therapeutic practice of goal-based tasks by the child.
  • Led by the parent.
  • Supported by the therapist
  • Context is the home environment.
  • Participants saw an improved performance in functional activities as well as participation in the home environment (carry-over).
  • EBP is supported by a rigorous RCT.


  1. Novak, I., Mcintyre, S., Morgan, C., Campbell, L., Dark, L., Morton, N., … & Goldsmith, S. (2013). A systematic review of interventions for children with cerebral palsy: state of the evidence. Developmental medicine & child neurology, 55(10), 885-910.