Developing fine motor skills for children with cerebral palsy

About cerebral palsy

Cerebral palsy is a group of lifelong conditions that affect movement and co-ordination. It's caused by a problem with the brain that develops before, during or soon after birth.

The symptoms of cerebral palsy are not always obvious just after a baby is born. They normally become noticeable from an early age. Read more about cerebral palsy symptoms.

The severity of symptoms can vary significantly. Some children only have minor problems, while others may be severely disabled.

With some children it may only affect their legs or one side of their body, or it can affect both legs and arms and trunk.

Cerebral palsy - NHS YouTube channel

Modified or baby constraint induced movement therapy (CIMT)

Constraint induced movement therapy (CIMT) is a treatment approach for children with unilateral cerebral palsy or hemiplegia, who have weakness on one side of their body. Children with hemiplegia tend to use their stronger, less affected hand or arm when doing activities and therefore find it difficult to carry out two handed activities. This treatment approach involves restraining their stronger arm or hand and encouraging them to use their affected arm or hand in play.

Please do not expect your child to use their affected hand or arm as the dominant hand when carrying out activities. For example, do not expect them to use their affected hand to hold pens or pencils when drawing or writing, hold scissors when cutting or hold the toothbrush when brushing their teeth.

This is an intensive home-based program. You will need complete this programme for 30 minutes, 6 to 7 days a week.

Children can struggle to pay attention for whole a 30 minute session. You can split the session into two 15 minute sessions.

How to do baby or modified CIMT

Baby CIMT or modified CIMT requires you to restrain the stronger arm or hand as your child plays.

There are different ways you can restrain their stronger arm or hand:

For babies, use a teething mitt or place a sock over their stronger hand. You can also pull your baby's babygrow over their stronger hand and use a food clip to secure it.

For children, you can hold their stronger hand as they play.

For older children, you can place an oven mitt on their stronger hand, put a piece of thick cardboard inside the glove, against the palm of their hand to help reduce their ability to move it.  Alternatively, you can put their stronger arm in a sling.

If your child is unable to sit independently, you can place them in a chair or seat. This could be a:

• baby bouncer
• car seat
• highchair

If your baby struggles to sit upright, you can also use rolled-up towels to give them support as they sit.

Baby or modified CIMT activities

Bimanual (two-handed) therapy

Bimanual (two-handed) therapy is a treatment approach for children with cerebral palsy. It is for children with one-sided weakness, also known as hemiplegia. This treatment approach involves your child using their weaker hand or arm as a helping hand when carrying out two-handed activities. It aims to encourage them to use their affected arm or hand in play and when carrying out functional tasks, in whatever way they are able to.

Please do not expect your child to use their affected hand or arm as the dominant hand when carrying out activities.  For example, do not expect them to use their affected hand to hold pens or pencils when drawing or writing, hold scissors when cutting or doing up zips.

This is an intensive home-based program. You will need complete this programme for 30 minutes, 6 to 7 days a week.

Children can struggle to pay attention for whole a 30 minute session. You can split the session into two 15 minute sessions.

How to do bimanual therapy

Bimanual therapy encourages your child to use both hands together. This is through different activities and games. The therapy should be intensive but fun. 

It is important for your child to use their weaker hand or arm to the best of their ability in the activities. The way your child uses their weaker hand will depend on the severity of their one-sided weakness (hemiplegia). Your child may be able to hold an object still by using their whole arm to hold it still on the table. They may be able to hold an object still if it is placed in their affected hand.

Bimanual (two-handed) activities for children