New recommendations aim to improve the physical function of children and young people with cerebral

New international clinical practice guidelines for treating children with cerebral palsy have been developed by a panel of experts, including researchers from The University of Queensland and the Cerebral Palsy Alliance.

With a wide array of therapy options available, parents and children often find it hard to determine which ones work best. What’s effective for one might not work for another. As a mother to twin boys with cerebral palsy (CP), CPSN’s telehealth nurse Amy Seeary has quickly learned that when her boys enjoy therapy and have fun, they achieve their goals much faster.

Thirteen new recommendations were released last week to improve the physical function of children and young people with cerebral palsy. This work was led by researchers at the Cerebral Palsy and Rehabilitation Research Centre at the University of Queensland, alongside other healthcare professionals across Australia.

The expert panel evaluated evidence and engaged with international stakeholders—including parents, consumers, clinicians, and researchers—to produce 13 practice guidelines for the care of children with cerebral palsy.

According to the University of Queensland, fact sheets will be used to promote these recommendations among allied health and specialist professionals involved in CP care.

Amy says she looks forward to these resources and hopes the fact sheets will also be distributed to families and children.

“We need to empower children and families to make treatment decisions based on the best available evidence. This is key to improving outcomes, independence, and choice—while reinforcing what we parents already know: the best therapy is the one our child wants to do. Therapy should relate to their goals, be motivating, and above all—fun!”

Amy encourages all parents of children with cerebral palsy to explore the following recommendations:

Recommendation 1: Client-chosen goals should be set
This should always have been the standard—goals should come from the child, or if they’re unable, from their family or carers. Prioritising the child’s goals boosts motivation and achievement.
Intervention should begin by understanding the child’s functional goals. When the child cannot express goals, families should guide goal-setting based on preferences and interests.
Goals must be functional, clearly defined, achievable, and measurable.
They should match the child’s ability and progress.
A written copy should be given to the family.
Performance should be assessed at the start and end of intervention.

Recommendation 2: Clinicians should determine factors limiting goal achievement
Barriers must be identified to make a plan for achieving the child’s goals.
Clinicians should observe the child working toward the goal to understand which skills or barriers limit progress.

Recommendation 3: Intervention should directly target the child’s chosen goals
Building from Recommendation 1, families should lead in setting goals, and clinicians should design interventions focused directly on them.
Intervention should involve active goal practice. Clinicians should take a hands-off approach, giving the child space for independent practice.
They can guide children by encouraging problem-solving, identifying challenges, and giving feedback.
If tasks are broken into smaller parts, these should lead back to full-task practice as soon as the child is ready.

Recommendation 4: Intervention should be enjoyable and motivating
“Intervention should be enjoyable and motivating for the child. I really connect with this—parents know it’s key to reaching goals.”
If the child becomes distressed, the clinician should stop, provide comfort, and adjust the activity to suit the child’s needs and preferences.

Recommendation 5: Practice of goals should occur at home or in community settings
The fifth recommendation stresses the importance of practicing in familiar places. Research shows these environments are more effective than traditional clinics.
Real-life practice encourages carry-over into daily life.
If home practice isn’t possible, the environment should replicate real-life scenarios.
Home practice plans should be provided in written or visual form.

Recommendation 6: Parent-delivered intervention is key
“One of my early lessons was that therapies often revolve around parent education so we can continue the work at home. It’s not always easy to fit into daily life. We found that weaving therapy into routines—like standing practice during TV time or fine motor skills during meals—worked best. Support workers are also a great help.”

Clinicians should:

• Educate and coach caregivers to engage in therapy.
• Help caregivers encourage autonomy and goal-specific practice.
• Offer structured home programs based on the child’s goals.
• Provide ongoing support and reviews.

Recommendation 7: Children and families should remain the decision-makers
“I’m glad to see this acknowledged. Parents and children know what works best and what needs to be changed or tried.”
Clinicians must provide current evidence so families can make informed decisions.
Parental involvement greatly impacts success.
Recommendations must match the child’s function and potential.
Timing and content should reflect the child’s age, ability, resources, and family preferences.
Only feasible, acceptable, and effective interventions should be pursued.

Recommendation 8: A high enough dose of practice is needed to reach goals
This builds on Recommendation 6—reaching goals requires frequent practice.
“It can feel overwhelming. Integrating it into daily routines and getting help from family or support workers really helps. Even a grandparent helping with standing practice counts. Be kind to yourself—we can’t do everything.”

Clinicians should plan how to achieve the right therapy dose through in-person and home sessions.
The ideal amount will vary by child, goal complexity, intervention type, and available resources.

Recommendation 9: A team approach should guide goal-setting and interventions
A child’s care team is often large, and good communication among members is crucial.
Including families in goal-setting and planning ensures smoother services and prevents overload.

Recommendations 10–13: Evidence-based clinical guidelines
These final recommendations summarise proven methods for improving gross motor function, hand use, self-care, and leisure activities.

“I’ve tried many therapies with my boys—conductive education, thera suit, home therapy, video modelling. Evidence is limited for some, but if it’s fun and works, trust your intuition. Still, some therapies can be harmful, so it’s best to balance gut feeling with professional guidance.”

Recommendation 10: Mobility
To improve mobility in children with CP (GMFCS I–IV), mobility training should be goal-directed and based in real-life settings.
10.1 Walking speed and endurance: Overground or treadmill training, and HABIT-ILE are effective.
10.2 Gross motor function: Goal-directed training and HABIT-ILE can improve function.
Environmental or child-focused therapy may also help, tailored to age and preferences.

Recommendation 11: Hand use
To improve hand use (MACS I–IV), use a task-specific or goal-directed approach.
For unilateral CP: CIMT, bimanual therapy/HABIT, CO-OP, and HABIT-ILE are recommended.
For bilateral CP: HABIT/HABIT-ILE and CO-OP are effective.
For MACS IV: Combine goal-directed therapy with environmental adjustments and assistive technology.
Clinicians should account for age, ability, context, and preferences when selecting interventions.

Recommendation 12: Self-care
Use goal-directed, task-specific therapy plus adaptive equipment to promote independence.
Effective methods include CO-OP, HABIT, and HABIT-ILE for GMFCS I–IV.
Adaptive equipment is especially useful for those in GMFCS IV and V to improve safety and reduce caregiver strain.

Recommendation 13: Leisure
For participation in leisure activities, combine goal-directed approaches (like CO-OP and HABIT-ILE) with strategies to overcome environmental and personal barriers.
This is more effective than no treatment or function-only interventions.

To read the full research article, click here.

Amy Seeary is CPSN’s Telehealth Nurse. For questions or to book a Telehealth appointment, call 9478 1001 or email cpsn@cpsn.org.au.

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