| Sensory integration Activities that stimulate the senses, including proprioception, vestibular input, and visual-motor integration activities |
Sensory integration: This targets the somatosensory system, enhancing tactile discrimination and proprioceptive awareness. Different textures provide varied sensory input, crucial for sensory integration, which is often impaired in children with CP. |
Children will be positioned on surfaces with varying textures (e.g., carpet, foam, bumpy mats, soft blankets) making the child hold different textured objects (e.g., rough blocks, smooth balls, soft fabrics). |
| Weighted blankets provide deep pressure stimulation, enhancing proprioceptive input and body awareness. Deep pressure can have a calming effect, reducing hypertonicity and improving focus. |
Children will be encouraged to sit on stable and unstable surfaces (e.g., therapy balls, mats) while wrapped in weighted blankets. |
| Vestibular stimulation: Swinging provides vestibular input, which is essential for balance and spatial orientation. Dynamic trunk control: Maintaining balance on a moving surface challenges dynamic trunk control and postural adjustments. Motor planning: Reaching for objects while swinging improves motor planning and coordination. |
Children will be engaged in various activities while seated or prone lying in a suspended swing (e.g., gentle swinging, reaching for objects, maintaining balance). The speed and direction of the swing will be varied as a progression. |
| Dynamic stability: Therapy balls challenge dynamic stability and core muscle activation. Weight shifting: Activities promote weight shifting and trunk control, essential for sitting balance. Core strengthening: The unstable surface requires increased core muscle activation, improving strength and stability. |
Children will be encouraged to sit, lie in prone and supine, or perform exercises on therapy balls of varying sizes. Activities include weight shifting, rolling, and maintaining upright posture in sitting. |
| Visual feedback: Mirror play provides visual feedback, enhancing body awareness and motor learning. Motor control: Observing their movements helps children refine motor control and improve posture. Spatial awareness: Mirror play improves spatial awareness and understanding of body position in space. |
Children will be engaged in activities in a swing while observing themselves in a mirror. They will be encouraged to perform movements, reach for objects, and maintain posture while observing their reflection. |
| Visual tracking activities Bilateral motor co-ordination and motor planning mirror activities |
Visual-motor integration: This activity enhances visual tracking skills, which are crucial for coordinating eye movements with motor actions. |
Children will be encouraged to follow moving objects with their eyes, such as a brightly coloured ball, a laser pointer, or a toy moving across a table. |
| Oculomotor control: It improves oculomotor control, which is essential for maintaining stable gaze and focusing on moving objects. |
The speed and direction of the movement will be varied as progression and the child’s ability. |
| Attention and focus: Visual tracking requires sustained attention and focus, which can be beneficial for children with attention deficits. |
The activity will be performed in different planes (horizontal, vertical, diagonal). |
| Bilateral coordination: This activity improves the coordination of both sides of the body, which is often impaired in children with CP. Motor planning: It enhances motor planning skills, which are essential for sequencing movements and executing complex motor tasks. Visual feedback: The mirror provides visual feedback, which helps children refine their movements and improve motor control. |
Children will be encouraged to perform bilateral motor coordination tasks while observing their movements in a mirror. Examples include clapping hands, or performing symmetrical arm movements in sitting and lying based on their ability. Motor planning will be incorporated by asking children to perform sequences of movements or create patterns. |
| Component |
Mode of activation |
Sample exercise activities |
| Visual tracking activities Bilateral motor co-ordination and motor planning mirror activities |
Body awareness: This activity enhances body awareness and proprioceptive input, which are crucial for understanding body position and movement. Visual-proprioceptive integration: The mirror provides visual feedback, which helps children integrate visual and proprioceptive information. |
Children will be encouraged to look in a mirror and will be asked to touch different body parts as the therapists demonstrate on their body The therapist may also progress by encouraging them to perform specific movements with different body parts while looking in the mirror. |
| Visual attention: This activity enhances visual attention and focus in a low-stimulus environment. Visual tracking: It improves visual tracking skills and the ability to follow moving objects in a challenging setting. Sensory integration: The darkened room reduces visual distractions, allowing children to focus on the visual stimuli and enhance sensory processing. |
Children will be encouraged to follow the movements of illuminated toys or light sources in a darkened room. The speed, direction, and pattern of the light movements are varied based on their ability. |
| Tactile stimulation and facilitation Facilitating sensory information and improving postural control through therapist handling and touch |
This involves the therapist using specific handling techniques and touch to provide sensory input and facilitate postural control. This can include gentle touch, deep pressure, and movement facilitation. The therapist adjusts their handling based on the child´s needs and responses. |
Play activities will be used to incorporate tactile stimulation and therapist handling in a fun and engaging way. Examples include playing with textured toys, using play dough, or engaging in sensory play. The therapist adjusts the play activities to target specific sensory and motor goals. |
| Neuromuscular facilitation: Therapist handling can facilitate neuromuscular responses and improve motor control. |
E.g.: When a child could prop sit but struggled to free both hands for play due to poor sitting control, the therapist will provide steady, light touch at the shoulders or trunk. |
| Proprioceptive input: Touch and movement provide proprioceptive input, which is essential for postural control. Sensory integration: Therapist handling integrates tactile and proprioceptive input, which can improve sensory processing. Facilitated movement: The light touch provided sensory input and facilitated trunk control, enabling the child to explore new movement strategies. |
This is aimed to encourage the child to explore strategies for lifting the upper trunk over the pelvis or shifting pressure, allowing one hand to be free for reaching. Elevated targeted tasks will be used to promote spinal extension and dynamic stabilization in sagittal and transverse planes. Reaching in various directions while propping with one hand or arm will also be encouraged. |
| Weight shifting and balance: Encouraging weight shifting and pressure redistribution improved balance and trunk stability. Functional reaching: Promoting reaching while propping with one hand enhanced functional reaching skills and upper limb control. Trunk extension and stabilization: The elevated targeted tasks promoted trunk extension and dynamic stabilization, which are crucial for sitting control. |
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| Perceptual skills Program includes exercises that target these skills, enhancing the child´s ability to interpret sensory information, focusing on developing spatial awareness, body schema, and motor planning |
Motor planning and sequencing: Serial activities require planning and sequencing of movements, improving motor planning skills. |
Children will be engaged in serial activities like peg board tasks, constructional tasks, puzzles, and block designs. |
| Visual-motor integration: These activities integrate visual perception with motor actions, enhancing visual-motor coordination. Cognitive skills: Problem-solving and spatial reasoning are involved, improving cognitive skills alongside motor skills. Postural control integration: Performing these tasks on unstable surfaces challenges postural control and integrates it with fine motor skills. |
These activities will be performed while seated on different surfaces (e.g., stable chairs, therapy balls, foam mats) to challenge postural control. The complexity of the tasks will be gradually increased based on the child´s progress. |
| Component |
Mode of activation |
Sample exercise activities |
| Perceptual skills Program includes exercises that target these skills, enhancing the child´s ability to interpret sensory information, focusing on developing spatial awareness, body schema, and motor planning |
Motor planning and problem solving: Navigating obstacles requires motor planning, problem-solving, and adaptation of movement strategies. Spatial awareness and body schema: Creeping through obstacles enhances spatial awareness and body schema. Gross motor coordination: This activity improves gross motor coordination and dynamic stability. |
Children will be encouraged to navigate obstacles in a creeping position. The child will be allowed and motivated to initiate and problem-solve their movements, with minimal therapist intervention. The obstacles will be varied in height, width, and texture, providing diverse sensory and motor challenges based on the child’s ability. |
| Child-initiated learning: Encouraging child-initiated movements promotes active learning and problem-solving. Anticipatory postural control: This activity targets anticipatory postural adjustments, which are crucial for maintaining balance and preventing falls. Problem-solving and adaptation: Children learn to solve motor problems and adapt their movements to different task demands. Base of support modification: They learn to modify their base of support to maintain stability and control their center of mass. Independent learning: Minimal therapist intervention promotes independent learning and development. |
The child will be encouraged and cued or lightly facilitated and guided to solve problem by giving different tasks in sitting and allowing the child to learn how to modify his or her base of support under their center of mass for anticipatory postural adjustments. E.g., children are presented with various tasks while sitting, requiring them to modify their base of support and make anticipatory postural adjustments. The therapist provides minimal cues or light facilitation, encouraging the child to problem-solve and develop independent strategies. Tasks can include reaching for objects at different distances, shifting weight, or maintaining balance on unstable surfaces. |
| Core stability This component focuses on strengthening and stabilizing the core muscles, which are essential for trunk control and sitting balance. Task-oriented trunk activities are incorporated in both sagittal and transverse planes, in sitting and lying positions. The goal is to improve core muscle activation, endurance, and coordination, leading to enhanced postural control. Trunk Control Foundation: Strong core muscles provide a stable base for trunk movements and postural adjustments. |
Functional activities: Task-oriented activities mimic real-life movements, promoting functional carryover. Plane-specific training: Training in both sagittal and transverse planes ensures comprehensive core muscle activation. Postural stability: Enhanced core stability improves postural stability and reduces the risk of falls. Trunk rotation: Rolling promotes trunk rotation, which is essential for functional movements. Weight shifting: Weight shifting improves balance and coordination. Foundation movement: Supine and prone are foundational positions for motor development. |
Children will be positioned in supine (lying on their back) and prone (lying on their stomach) positions. They will be encouraged to perform small weight shifts by moving their limbs or torso. They will also be guided / facilitated to roll over to each side, promoting trunk rotation and core muscle activation. |
| Increased challenge: The inclined wedge provides a greater challenge to core muscles and postural control. Gravity resistance: Working against gravity enhances core muscle activation. Dynamic stability: These activities improve dynamic stability and trunk control. |
Children will be positioned on an inclined wedge in supine and prone positions. They will be encouraged to perform weight shifts to the sides and roll towards the side of the incline. The incline increases the challenge to core stability and postural control. |
| Core and upper limb integration: This activity integrates core muscle activation with upper limb movements. Lateral stability: Lateral weight shifts improve lateral stability and trunk control. Dynamic reaching: Reaching in prone position enhances dynamic reaching skills. |
Children will be positioned in prone with their arms reaching forward. They will be encouraged to perform lateral weight shifts, moving their weight from one side to the other. This activity challenges core stability and upper limb coordination. |
| Core strengthening: Pelvic bridging and twists strengthen core muscles, particularly the gluteal and abdominal muscles. Dynamic stability: Progressing to arm elevation and ball throws enhances dynamic stability and core control. Functional progression: This progression mimics functional movements, promoting carryover to daily activities. Increased challenge: The progressive nature of the activity allows for gradual increases in difficulty. |
Children will be encouraged to perform pelvic bridging exercises, lifting their pelvis off the mat. They will be progressed to pelvic twists, rotating their pelvis while maintaining a bridge depending on their ability. The exercises will be progressed futher by elevating the arms and then incorporating ball throws, increasing the challenge to core stability. |
Impact of sensory perceptual motor core stability training on sitting control in children with cerebral palsy
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