Services 1300 888 378

Home programs for children and adults

Last update: 8 Dec 2016

Home programs are home-based activities that can improve the gross motor skills, arm and hand movements, self-care abilities, behaviour and communication of a person with cerebral palsy
The success of the home program depends on the intervention strategies used. Home programs need to include interventions known to be effective.
Home programs are a way of increasing the amount of therapy for a child or adult with cerebral palsy

Who are these for?

Home programs may be suitable for all children and adults with cerebral palsy as follows:
Type of cerebral palsy : Bilateral cerebral palsy, Diplegia, Hemiplegia, Quadriplegia, Unilateral cerebral palsy

More information about cerebral palsy is contained in the What is CP? section.

Mobility : GMFCS I, GMFCS II, GMFCS III, GMFCS IV, GMFCS V

Gross Motor Function Classification System (GMFCS) – classifies severity of mobility difficulties of children and adolescents with CP.

GMFCS Level I
Walks without limitations in the home and community, climbs stairs and can run and jump, difficulties with speed and coordination.

GMFCS Level II
Walks with limitations, difficulties with long distances and uneven surfaces, uses a railing for climbing stairs, limited running and jumping.

GMFCS Level III
Walks using a hand-held mobility device such as crutches or walking frame, may use wheeled mobility for long distances.

GMFCS Level IV
Usually relies on wheeled mobility with assistance, may use powered mobility, usually needs special seating and assistance with transfers.

GMFCS Level V
Usually transported in a manual wheelchair, requires specialised seating and full assistance for transfers.

See full glossary

Arm ability : MACS I, MACS II, MACS III, MACS IV, MACS V

Manual Ability Classification System (MACS) – classifies severity of upper limb impairment: how children with cerebral palsy use their hands to handle objects in daily activities in the home, school, and community settings.

MACS Level I
Handles objects easily and successfully.

MACS Level II
Handles most objects but with somewhat reduced quality and/or speed of achievement.

MACS Level III
Handles objects with difficulty; needs help to prepare and/or modify activities.

MACS Level IV
Handles a limited selection of easily managed objects in adapted situations.

MACS Level V
Does not handle objects and has severely limited ability to perform even simple actions.

See full glossary

Communication ability : CFCS I, CFCS II, CFCS III, CFCS IV, CFCS V

Communication Function Classification System (CFCS) – classifies severity of everyday communication of people with cerebral palsy.

CFCS Level I
Effective Sender and Receiver with unfamiliar and familiar partners.

CFCS Level II
Effective but slower paced Sender and/or Receiver with unfamiliar and/or familiar partners.

CFCS Level III
Effective Sender and Receiver with familiar partners.

CFCS Level IV
Inconsistent Sender and/or Receiver with familiar partners.

CFCS Level V
Seldom effective Sender and Receiver even with familiar partners.

See full glossary

Movement disorder : Ataxia, Athetosis, Dystonia, Hypotonia, Spasticity

More information about movement disorders can be found on our websites.

Intellectual ability : No intellectual disability, Mild intellectual disability, Moderate intellectual disability, Severe intellectual disability

A person’s thinking skills – ability to understand ideas, learn and solve problems. People with intellectual disability have difficulty with intellectual functioning which may influence learning, communication, social and daily living skills. Intellectual disability may be mild to very severe.

See full glossary

Home programs are widely recommended by a variety of health professionals including occupational therapists, physiotherapists, speech pathologists, physicians, dieticians, educators, social workers and psychologists.

Cerebral Palsy Alliance offers a service where our therapists can develop a home program and support a person and family as they complete it. They can also help decide whether a home program is a good choice.

Find a Cerebral Palsy Alliance service

Fees will apply for a health care practitioner assessment, to write the home program and to provide follow-up coaching sessions for the family. Fees will depend on the provider and the number of sessions needed. Check with the practitioner whether fees will also apply for report writing or therapist travel. There may be equipment costs which would depend on the goals and would be discussed at the time of assessment.

Ask health care providers if you are eligible for funding to assist with fees and equipment. People with a disability living in Australia may be eligible for a health care rebate through Medicare or funding from the National Disability Insurance Scheme.

The amount of time will depend on the recommended intensity or dose of the intervention.

More about home programs

Home-based programs are activities children and adults with cerebral palsy undertake at home to achieve certain goals1. They are considered important for several reasons. One is that home programs increase the amount of practice of an intervention a person with cerebral palsy is getting. This strong focus on ‘more is better’ is based on the large body of evidence about neuroplasticity, or the brain’s natural ability to change and adapt. Intensive practice of movements, activities and functional tasks helps the brain make permanent positive changes.
The home, or other real-life environments are considered the best and most logical location to practise tasks considered important to the child or adult with a disability2. Although home programs take time in a family’s life, they can be practiced when time permits - while waiting for therapy, between treatment sessions, during a break from an intervention or when it is difficult for a person and family to attend face-to-face therapy with a clinician2. In addition, time spent going to therapy appointments can be reduced, in exchange for more time practicing in the home or community environments.

Some of the benefits of home programs include:

  • Physical gains, such as improved muscle strength
  • Activity gains, like learning to get dressed independently
  • Participation gains, such as meaningful inclusion in a local community sporting team
  • Environmental adaptations, such as positive change in parenting style to manage a child’s behaviour
  • Personal gains, such as practising a goal that will enhance pleasure in life.
Home programs are usually completed over six to 12 weeks. The amount of time will depend on the recommended intensity of the intervention. It can range from as little as one hour per week to 15 hours per week. Some experts3 recommend home programs are carried out, on average, four times per week for 15 minutes per session, making a total dose of one hour per week. However, families planning to implement intense, contemporary intervention approaches designed to encourage movement and neuroplasticity gains (for example, constraint-induced movement therapy) will need to consider committing more time. The recommended time for this type of intervention will be more like seven to 14 hours of weekly practice over a six to eight-week period.
Assistance from preschool staff, teachers’ aides, volunteers, family members, paid assistants and carers may be sought to increase the opportunities for practice, either at home or in other familiar settings.

Parents have identified they are best able to undertake home programs when they receive these supports:

  • Information and guidance from a health professional to set realistic expectations
  • A treatment team that co-ordinates one home program, rather than the family having multiple home programs from different professionals
  • A program created around the person’s goals, so they are motivated to carry out the program
  • Emotional and physical support from other family members
  • Using a logbook as a reminder to practise
  • Being provided with the necessary equipment to carry out the home program4.
  • Having a program with a small number of goals and activities, so the person feels confident and capable2,4,5.

Families may feel concerned that they are not trained as therapists, however, specific guidelines can be used to create an effective home program.

The effectiveness of the home program will also depend on how it operates6. Research completed with children and their families suggests home programs established according to parent preferences are more likely to be used by parents, and at a higher dose3,5. A model for setting up effective home programs2 with children includes five steps:

  1. Collaborate – establish a collaborative partnership, where the caregiver is the expert on their child and their home environment, and the health professional acts as a resource and coach
  2. Set goals – the child and family set goals about what they would like to learn and practice in the home and in community settings
  3. Create a program – develop a program which includes interventions known to be effective for helping children and families achieve their goals
  4. Seek support – obtain regular support and coaching as a family to identify improvements and fine tune the complexity of the program as the child starts to improve
  5. Evaluate – together with health professionals, the family evaluates the outcomes. The evaluation component is integral not optional, because research suggests that when parents can identify improvements in their child arising from the home program they are likely to practise more often2.

Assessments

There are two types of assessment a person should complete when undertaking home programs:
It is really important for a health professional to carry out a thorough assessment to carefully target and monitor the intervention. Time is also required to establish goals and determine the type of support a person and family needs. A health professional will then provide a home program, usually in written format. This may be developed during an appointment or it may be developed outside of an appointment, depending on the level of detail required.

The second type of assessment measures the outcome of the intervention to determine whether a home program benefits a person and helps them to meet their goals. The health professional, together with the person with cerebral palsy and their family, will decide on the most suitable measure to use. Some examples of outcome measures include:

Best available research evidence

We searched the medical and allied health literature to find the best available evidence of whether home programs are effective for people with cerebral palsy.
The search aimed to find the best available evidence that home programs help children and adults with cerebral palsy achieve their desired health outcomes.

No high quality research evaluating home programs for adults with cerebral palsy was located. The best available evidence for children was two randomised controlled trials (RCTs)3,7 which evaluated home programs with children with cerebral palsy or brain injury.

Overall, high quality evidence shows that home programs are effective for improving self-care and motor abilities in children with cerebral palsy.

Although no research has been completed with adults, there is high-quality evidence in many other conditions that home programs are as effective as clinic-based treatments8. It is reasonable to think adults with cerebral palsy would benefit in the same way, even though the effectiveness of home programs for adults with cerebral palsy has not yet been specifically researched. Families, caregivers and specialist therapists are encouraged to carefully consider the unique goals and needs of each person with cerebral palsy to determine whether home programs should be implemented.

Home programs are effective compared to no intervention

Two RCTs provided high quality evidence that home programs are effective when compared to no intervention. The self-care and motor abilities (hand and arm skills, mobility) of children using the home programs improved. The home programs in both studies included goal directed training known to be an effective intervention. In one of the studies3, the home program included parent education and coaching as well as goal directed training. This study3 also found that children using the home program achieved their goals for intervention in a shorter amount of time than those without.

Home programs are an effective way to increase the amount of therapy

Several recent RCTs have studied the effects of different ways of delivering therapy (e.g., groups versus individual versus school-based). In each of these trials the authors used home programs to increase the “dose” of therapy9-13, that is, the therapist delivered some of the therapy and the parent delivered some of the therapy. Examples of interventions delivered in this way include constraint-induced movement therapy, electrical stimulation, traditional physiotherapy and strength training. This increasing body of evidence validates home programs as a means of effectively increasing the “dose” of therapy. One of the RCTs9 evaluated face-to-face therapy plus home programs for infants at risk of cerebral palsy. Prior to this study, home programs had predominantly been used to supplement therapy for children over 4-years of age, where there is typically less funding for face-to-face therapy and thus home programs are more commonly used. It appears that home programs are valid to use to supplement the dose of evidence based interventions in infants, children and adults.

Date of literature searches: July 2016

  1. Novak, I., Cusick, A., & Lowe, K. (2007). A pilot study on the impact of occupational therapy home programming for young children with cerebral palsy. American Journal of Occupational Therapy, 61(4): 463-468. See abstract
  2. Novak, I. & Cusick, A. (2006). Home programmes in paediatric occupational therapy for children with cerebral palsy: Where to start? Australian Occupational Therapy Journal, 53(4): 251-26. See abstract
  3. Novak, I., Cusick, A. & Lannin, N. (2009). Occupational therapy home programs for cerebral palsy: Double-blind, randomized, controlled trial. Pediatrics, 124(4), e606-14. See abstract
  4. Taylor, N.F., Dodd, K.J., McBurney, H., & Graham, HK. (2004). Factors influencing adherence to a home-based strength-training programme for young people with cerebral palsy. Physiotherapy, 90(2), 57-63. See abstract
  5. Novak, I. (2011). Parent experience of implementing home programs. Physical and Occupational Therapy in Pediatrics, 31(2): 198–213.
  6. Novak, I. & Berry, J. (2014). Evidence to practice commentary: Home program intervention effectiveness evidence. Physical and Occupational Therapy in Pediatrics, (early online on October 15, 2014). Link to journal website
  7. Katz-Leurer, M., Rotem, H., Keren, O., & Meyer, S. (2009). The effects of a home-based task-oriented exercise programme on motor and balance performance in children with spastic cerebral palsy and severe traumatic brain injury. Clinical Rehabilitation, 23(8), 714-724. See abstract
  8. Novak, I. (2011). Effective home program intervention for adults: A systematic review. Clinical Rehabilitation, 25(12): 1066 – 1085. See abstract
  9. Morgan, C. J., et al. (2014). Optimizing the motor outcomes of infants at high risk of cerebral palsy: A pilot randomized controlled trial. Developmental Medicine and Child Neurology, 56, 96-97 DOI: 10.1111/dmcn.12540
  10. K. Xu, L. H., et al. (2015). Muscle recruitment and coordination following constraint-induced movement therapy with electrical stimulation on children with hemiplegic cerebral palsy: A randomized controlled trial. PLoS One 10(10).
  11. Sakzewski, L., et al. (2014). Randomised comparison trial of upper limb intensive group compared to individualised training for children with congenital hemiplegia. Developmental Medicine and Child Neurology 56, 55-56 DOI: 10.1111/dmcn.12368
  12. Thomas, R. E., et al. (2016). Evaluation of group versus individual physiotherapy following lower limb intra-muscular Botulinum Toxin-Type A injections for ambulant children with cerebral palsy: A single-blind randomized comparison trial. Research in Developmental Disabilities 53-54, 267-278. See abstract
  13. Wely, L., et al. (2014). Physical activity stimulation program for children with cerebral palsy did not improve physical activity: A randomised trial. Journal of Physiotherapy 60, 40-49 DOI: 10.1016/j.jphys.2013.12.007
Find out about CP Check-Up™

Cerebral Palsy Alliance offers a service called CP Check-Up™ which provides ongoing surveillance of the health and well-being of our clients aged 0-18 years.
The information on this page was developed using the best research evidence combined with the expertise of clinicians and people with cerebral palsy and their families. It is provided to help people with cerebral palsy, their families and caregivers, clinicians and service providers make decisions about suitable interventions. This information is intended to support, but not replace, information exchanged, and decisions made, between people with cerebral palsy, their families and health professionals.