Occupational Therapy & Cerebral Palsy

One of the most frequent disabilities affecting children's motor abilities is cerebral palsy. According to the Centres for Disease Control and Prevention CDC, one in every 345 children has cerebral palsy (Fung, and Mittal, 2014).

Cerebral palsy occur in the developing fetal due to certain lesions or anomalies of brain and is known to be a non-progressive yet developmental disorder affecting the posture, movement limitations in performance of various day to day activities. These effects and outcomes of cerebral palsy depend upon the area affected and the severity and type of the condition. There is major impairment in motor control, performance of muscle and alignment of the muscle and skeletal attributes which restricts locomotion and consideration of the immediate surroundings. Different patterns of impairments and severity are observed in different children with cerebral palsy (Fung, and Mittal, 2014). These impairments further limit the functionality and strongly associated with self-care, motion and social activities. This social participation of children with cerebral palsy is an area of interest and concern amongst the occupational therapists. Social participation offers children an ability to perform a fluent transition of environment from home to the community which includes school, play sections, gatherings and so on. Additionally, it enables children to take part in numerous day to day occupations (Peters et al, 2019). Social participation is often understood as the intertwined occupational abilities that assist children to engage in family activities along with community which includes their friends and peers. There is well established promotion of a child’s development, health and well-being through social participation. This development through social participation of a child is assessed through the ability of the child to communicate and understand, through its physical ability to move and its context of emotional well-being with a social purpose. Recent studies emphasize the association of social participation and its impact on positive health and well-being promotion, social behaviour and its consequences on the further outlook of life (Anaby et al, 2017).

Apart from the environmental factors, the development of children with cerebral palsy is also attributed to age, gender and self-efficacy. The age consideration in this study is of teenagers, yet there are many variations in the gender and factors associated to self-efficacy (Anaby et al, 2017). Various recent studies have identified that the children with 12 years of age have difficulty in aspects related to assistance and related services, school, attitudes and work like studies, projects or fun activities, whereas children of age 13-16 had more recreational and physical disabilities (Marret et al, 2013), (Peters et al, 2019). These differences in findings attributed to the gross motor functionality of the body over the span of time and transition in stages of age towards adolescence (Levitt, and Addison, 2018).

In such an age, children develop personal independence, become productive and show interest in participation in various leisure or playful aspects. Any cause, including certain disability, disease or deficiency in skill, that restricts these engagement and participation can develop low self-esteem, marginalization or even social isolation. The support through occupational therapy and its interventions for such children efficiently promotes this engagement and participation of children in their daily life activities (Levitt, and Addison, 2018).

In terms of cognitive development and abilities in children with cerebral palsy, the cognitive impairment in such children cannot be solely attributed to the motor impairments. One third of the Children with unilateral cerebral palsy have been observed to suffer difficulties in learning, challenges in visual-spatial cognition, impairment in acquiring visual images and in executive functioning, but often demonstrate a normal comprehension in linguistic aspects (Fung, and Mittal, 2014). Whereas, children suffering from bilateral cerebral palsy demonstrate distorted verbal comprehension, non-verbal intelligence along with impairment of visual-spatial reasoning. The connectivity of the brain and is functioning is affected which eventually influence the impairment of vision and perception. The impairment in the cognitive functioning can attribute to various clinical factors including lesions of brains, motor functioning and so on (Levitt, and Addison, 2018). But it is significant to understand that such impairments also arise through reciprocating and continuous interactions between the child and its environment, which in eventually influenced by the opportunities for children to actively explore and participate in its social atmosphere. This also suggests that, social participation and cognitive development of a child are interlinked and are subjective to the motor development and abilities to some extent (Peters et al, 2019).

While there is no cure, children with cerebral palsy (CP) can stay healthy and active by using a variety of therapy choices. Occupational therapy is an important aspect of cerebral palsy treatment. Occupational therapy promotes the overall improvement in children with cerebral palsy (Peters et al, 2019). It is considered to be one of the best therapies in the form of treatment towards enhancing and promoting the ability of children with cerebral palsy in performing improvised day to day activities and rituals in a holistic approach of providing improvised quality of life and better possibilities of independent living (Anaby et al, 2017). Occupational therapy helps in providing personal care through trained and qualified therapists to adapt, compensate and achieve maximum levels of functioning (Graham et al, 2014). These functioning abilities include physical abilities, cognitive functioning levels, and the needs supporting emotional and social desires along with the mental willingness of the child. In such scenarios, the environment around the child socially and physically plays a significant role (Dalvand, Rassafiani and Hosseini, 2013).

Amidst the limitations of social, physical and mental understanding of the environment, this occupational therapy intervention aims in achieving elevated levels of functional performance in a suitable environment such as home, or social sections like school, public and work facilities (Peters et al, 2019). This therapy employs adaptive processes so that the child can learn to take part in various tasks in the basic activities initially in the daily routine. This involves focusing on the adaptive methods that are identified based on the individual needs of the child so that they can learn and discover ways to complete tasks individually. Further, various necessary tasks are fragmented and modified into achievable sizes. Overall these techniques help in establishing a sense of place and position in their social environment such as school or higher in the community (Rezaie and Kendi, 2020).

Occupational therapy has wide-ranging and far-reaching after-effects for children with cerebral palsy; the benefits include development and maintenance of a daily routine contributing towards an independent lifestyle with quality. Growing children, especially the teenagers, prefer to perform their tasks without assistance and rely on acceptance from peers along with active social participation. During this stage of life for children, there is observation of immense maturation, growth and identity development. This stage demonstrates transition in a child’s emotional, physical, cognitive and psychosocial functioning. (Graham et al, 2014).

This eventually prepares the child to react and respond to various demands of life and establishing the platform to develop social relationships, to meet his or her own needs physically and mentally, practice work and education, retain employment and recognize economic and physical correspondence with their contemporaries in the social stages of life (Anaby et al, 2017). The occupational therapy here puts the acquired knowledge of the child into practicing through its reinforcement in the daily customs. This includes the development of a routine to be worked upon, adaption of abilities instead of limitations, active interaction with others with effective community involvement, following your interests, hobbies, and activities, interaction with other people, being a member of a community, task completion on one's own, responding to daily life's demands, considering the significance of tasks, enhancing critical thinking abilities, managing difficulties and emotions, understanding how to adapt and adjust (Peters et al, 2019).

Various earlier studies and its theories have evolved the practice of occupational therapists. The interventions selected for such children are based their individualised identified needs. There is attainment of various analyses and study based on the performance of child in its daily routine and life roles, the effect of disability on their performances and the support and constrains from the environment that the child receives for its performance (Fung, and Mittal, 2014). Occupational therapy is believed to provide thinking flexibilities, adaptability, problem solving, exploring, learning and developmental skills to master the acquisition of surrounding environment, social intelligence, and physical and emotional skills. The child is motivated to freely participate and engage itself in the internal process of intervention through the outer actions (Marret et al, 2013). The imaginative power of the children is observed, utilised and enhanced to reflect the realities. This is observed to target and evoke the hindered cognitive abilities of the children and thus improve its cognitive abilities as well as socialisation. This affects healthy development of the areas of emotions, direct and indirect though process, language literacy, social participation and perception (Dalvand, Rassafiani and Hosseini, 2013).

1.2Background for the research

There has been various researches regarding the transition in age of children with cerebral palsy towards adolescence in consideration with their physical, emotional and cognitive abilities, but a very less amount is understood in the context of social participation (Dalvand, Rassafiani and Hosseini, 2013). The primary concern in teenagers with cerebral palsy is reported to be the mobility, to go to places and perform activities. This infers the mobility that is efficient yet safe, that offers participation in routine social activities. There are numerous clinician expertises for the kind of intervention to be approached for different individuals and these preferences are based not only on the person-centred practice but are also highly influenced by the financial and ethical aspects (Fung, and Mittal, 2014). Various studies evidentially support the incidences where the occupational therapists optimistically incorporate practice that supports person-centred care. Based on the evidential practices, there are certain areas that lag implementation of efficient and accurate practice(Levitt, and Addison, 2018), (Kruijsen?Terpstra et al, 2014).

The impairment in the cognitive functioning can attribute to various clinical factors including lesions of brains, motor functioning and so on. But it is significant to understand that such impairments also arise through reciprocating and continuous interactions between the child and its environment, which in eventually influenced by the opportunities for children to actively explore and participate in its social atmosphere. This also suggests that, social participation and cognitive development of a child are interlinked and are subjective to the motor development and abilities to some extent. It is significant to understand the risk factors of cerebral palsy as it can help in increasing awareness regarding the assessment needs, interventional aspects and in development of various policies and programmes to follow up the condition (Marret et al, 2013). Over the recent years, the factors associated with cerebral palsy has evolved, which includes the incidences of prevalence and also the effects on intellectual impairments. However, there are insufficient longitudinal studies and unclear information and knowledge about the cognitive developmental trails in children with cerebral palsy (Levitt, and Addison, 2018). It is well understood that when motor impairments are targeted early with interventions, it benefits in evading the disabilities and impairments in children with cerebral palsy. Various studies have focussed earlier on improving the educational aspects, where visual spatial impairment and difficulty in concentration have not much considered and thus the effect of cognitive training and its benefits from occupational therapy have been rarely touched as a major subject (Kruijsen?Terpstra et al, 2014).

The aim of this current study is to analyse the occupational therapy and it benefits in improving the social participation of children with cerebral palsy along with its impact on cognitive development helpful in educating children diagnosed with cerebral palsy. There are numerous existing interventions that help in addressing the specific goals designed to overcome the challenges faced by the children with CP (Levitt, and Addison, 2018). The benefits of the occupational therapy are best observed when there is involvement of the professional as well as the parents, where both these stakeholders play roles that adhere to the goals and choices, based on the diagnosis and improvement potential of the child, that yield the most promising and far-reaching outcomes. There is need of skills that are updated and often neglected sue to its time consuming factor, additionally appraisal of various evidences demands rationalization of time and resources.

Introduction to CP and how it affects people both physically and in terms of occupation

Cerebral palsy refers to a collection of conditions that impair a child's ability to move and maintain posture (Centres for Disease Control and Prevention [CDC], 2018). It impairs normal activities and causes issues with social, perceptual, and executive functioning. The life span in all children with CP till the age of 20 years is 90%. Most children with CP can grow up to be adults with early intervention, competent medical treatment, and continued support services (Graham et al, 2014). It is critical to note that several age-related changes and diseases manifest themselves early in people with cerebral palsy. The most prevalent cause of motor abnormalities in new-borns and children is cerebral palsy. Over the last several years, the incidence rate of CP has remained stable (Marret et al, 2013). While preterm and preterm delivery is significant risk factors, almost 50% of all infants who acquire CP are delivered at maturity, with standard birth weight and no known risk indicators. Only a few cases can demonstrate a definite underlying cause be determined. The assessment of CP is primarily supported by the findings from the history and clinical research (Marret et al, 2013). The majority of children with CP live to be healthy adults. The effects of CP are also measured based on the attitudinal attributes and acceptance of children with challenges like CP in the environment and neighbourhood. The participation and overall growth of children is determined by the facilitative and constraining capacity of the environment (Rezaie, and Kendi, 2020).

Due to the obvious numerous related conditions and the intricacy of the support required, CP is best managed by an interdisciplinary approach and one of the major approaches in occupational therapy (Kruijsen?Terpstra et al, 2014).

Introduction to occupational therapy

Occupational therapy stands as an important part of the interdisciplinary treatment of children with cerebral palsy, with numerous studies establishing its enduring effects on improving fine motor competence (Milton, Dunford, and Newby, 2019), (Dalvand, Rassafiani, and Hosseini, 2013). Occupational therapy focuses on improving fine motor skills in the upper extremities to help the child conduct daily activities more effectively (Levitt, and Addison, 2018). Occupational therapists also assist with the organising of children's play areas, the provision of adapted equipment for self-care and learning, and the modification of a child's learning environment to aid attention and information processing. Given the advantages, children with cerebral palsy should receive occupational therapy (Graham et al, 2014). Their brains are adaptable enough that it will be much easier for them to learn new long-term abilities, which will help them build and increase their self-confidence while also optimising their functioning, independence, and potential (Kruijsen?Terpstra et al, 2014). Finally, this would provide them with a sense of belonging within their group and society as a whole. Only because cerebral palsy is irreversible does not mean that children with the illness cannot or should not flourish in their surroundings. It is required to employ strength and perseverance. According to various studies, when combined with therapy, these can assist children with cerebral palsy in developing into successful and fit adults who can act as well as perform tasks independently and responsibly with a life of quality (Milton, Dunford, and Newby, 2019), (Dalvand, Rassafiani, and Hosseini, 2013).

Introduction of occupational therapy and CP

Parents are concerned about their child's quality of life, ability to function, health, emotional condition, ability to be accepted, and prospects from the moment he or she is diagnosed with Cerebral Palsy (Kruijsen?Terpstra et al, 2014). Occupational therapy can help alleviate some of those worries by teaching their child how to play, engage with others, go to school, traverse the community, and be productive in the workplace. Parents may feel less overwhelmed by their child's condition after the child masters skills within their own distinct skill sets. Occupational therapy is tailored to a child's specific needs and can be advised at any point after he or she has been diagnosed with Cerebral Palsy (Graham et al, 2014).

Children affected with cerebral palsy demonstrate unique needs and require individualised support (Milton, Dunford, and Newby, 2019). The goals of therapy will be determined by a full assessment of an individual's motor skills, cognitive functioning, developmental condition, overall environment, and physical and psychological requirements. Occupational therapy for children with cerebral palsy promotes neuroplasticity, which involves the formation of new neural connections and the rewiring of functions that have been impaired by brain injury. Repetitive practice is the key to optimising neuroplasticity. The purpose of occupational therapy is to have them practise an activity or a specific movement until it becomes second nature to them (Patel et al, 2020).

A wide ranging source of literature and study has reported the relation between children with cerebral palsy and motor impairments and functioning abilities (Anaby et al, 2017), (Levitt, and Addison, 2018). And, despite the fact that various studies have observed that parents of such children accept cognition as a significant and challenging concept in relation with cerebral palsy; that it has a greater effect on communication, yet the social functioning and participation has not much considered (Anaby et al, 2017). Therefore, the benefits of occupational therapy for social participation and cognitive development in children with cerebral palsy are not well-recognised and assessed. There is a need for various studies that emphasize the impact and influence of occupational therapy in these areas for better support in growing children with early intervention (Anaby et al, 2017), (Kruijsen?Terpstra et al, 2014).

1.3Research Aims and Objectives

This study aims to investigate the benefits of occupational therapy in improving the social participation of children with cerebral palsy along with its impact on cognitive development helpful in educating children diagnosed with cerebral palsy.

Following are the key research objectives:

1. To investigate the effectiveness of occupational therapy for children with cerebral palsy in relation to social participation.

2. To investigate the effectiveness of occupational therapy for children with cerebral palsy in relation to cognitive development.

3. To evaluate the effectiveness of occupational therapy interventions for children with cerebral palsy in relation to their physical and motor function.

CHAPTER 2- PROTOCOL FOR SYSTEMATIC REVIEW

Cerebral palsy is the disorder that impacts both physical and mental health and wellbeing of the person and this has an impact on their overall wellbeing and quality of life. Cerebral palsy is the condition were taking care of the child with cerebral palsy becomes a one-off use burden as well as a round the clock duty for the parents. Therefore, it is identified that understanding the experiences of parents with the children that are having cerebral palsy helps in mediating interventions that might help to meet the needs of parents and children subsequently and getting them engaged in the children's interventions appropriately. Therefore, occupational therapy as well as interventions are related to it are developed their parents early believe regarding the trials and prevention and treatment are also associated to developmental perspective and promote benefits for the treatment of children with cerebral palsy. It was identified that parents express to various contact and experiences with caring for the children with cerebral palsy and the needs that require specific interventions. developing better quality of life for the child. Occupational therapy and physical therapy are two main objectives of developing treatment of cerebral palsy children and classify the children's gross motor function to be determined and assessed in order to develop these interventions in cerebral palsy. It was reported that interventions that focused on modern to great extent on the primary impairments and secondary impairments activity as well as developed the structured play activities and moderate extent of environmental modifications and equipment used were helpful in developing moderate to small development of self-care routine and resulted in supporting to develop importance of coordination for physical therapist and occupational therapy services.

According to the qualitative study developed by Rezaie and Kendi (2020), cerebral palsy is one of the leading causes of permanent disability in children and occupational therapist serve as a primary role in developing rehabilitation services the and improvement of quality of life for children with cerebral palsy. Occupational therapy has several benefits for the children with cerebral palsy but one of the main issues that is considered of why these therapies are does not work for all children with cerebral palsy is coronavirus to treatment and the influential factors that impact the other answer to occupational therapy treatment among cerebral palsy children. In this study the aim was to explore the viewpoint of the occupational therapist on factors that impact the address of occupational therapy interventions are among parents of children with cerebral palsy and a qualitative approach using semi-structured interviews of work employed in the history in order to test this hypothesis. The results of the study through semi structured interviews identified that the first category of tractors that were related to child and family that described as the clinical status of the child and family and their composition. Visitors have both the potential of improving as well as reducing the adherence to occupational therapy treatment that are essential for cerebral palsy children. Another category of the therapist to related factors are described in this study there it is identified that these factors affect the appropriateness of the professional skills for the therapy to be provided to improve adherence to the practice and intervention as well as include clinical competency job satisfaction and communication skill of the professional. The third category identified is the environmental factors that addresses the both a potential and improving or reduces the adherence to the services and these factors are related to cultural views and the disability of child. Environmental barriers of towards adherence to treatment is very common among individual families were suffering from cerebral palsy children. Also, a fourth category of factors that are related to therapy related factors are described as barriers towards adherence to this treatment. it was concluded that adherence to the occupational therapy interventions among parents of children with cerebral palsy can be influenced by several factors that are related to the professional competence towards the services or barriers that promoted by environment and culture as well as other related factors. Yet, these factors that need to be well identified and addressed in order to develop potential for both positive effects of therapy and adherence to words of improving the quality of life of children with cerebral palsy.

Occupational therapy stands as an important part of the interdisciplinary treatment of children with cerebral palsy, with numerous studies establishing its enduring effects on improving fine motor competence (Milton, Dunford, and Newby, 2019). Given the advantages, children with cerebral palsy should receive occupational therapy (Graham et al, 2014). Their brains are adaptable enough that it will be much easier for them to learn new long-term abilities, which will help them build and increase their self-confidence while also optimising their functioning, independence, and potential (Kruijsen?Terpstra et al, 2014). Parents are concerned about their child's quality of life, ability to function, health, emotional condition, ability to be accepted, and prospects from the moment he or she is diagnosed with Cerebral Palsy (Graham et al, 2014). The goals of therapy will be determined by a full assessment of an individual's motor skills, cognitive functioning, developmental condition, overall environment, and physical and psychological requirements. Despite the fact that various studies have observed that parents of such children accept cognition as a significant and challenging concept in relation with cerebral palsy; that it has a greater effect on communication, yet the social functioning and participation has not much considered (Kruijsen?Terpstra et al, 2014).

CHAPTER 3- RESEARCH METHODOLOGY

3.1 Study Design

Research study employs one of three basic research approaches: qualitative, quantitative, or mixed research. In such research, the study design describes the basic tactics and procedures used by the researcher in its research effort. In the current study, the research design represents a framework that the researcher employed for designing, implementing, and analysing the investigation. As a result, it is the strategy for answering the research questions. The choice of research design, as well as whether to use a quantitative, qualitative, or mixed research design, is determined by the sorts of research questions and hypotheses to be created and tested. A systemic review involves both qualitative and quantitative methods of data collection to formulate a clear question involving reproducible and systemic methods to recognize, choose and critically evaluate all the relevant studies. This allows gathering and analysing reliable data from the selected studies to be included in the review (Mishra, and Alok, 2017).

3.2 Research methods

A systematic review is being utilised and followed for this study. Systemic review is the evaluation of the evidence on a specific defined subject that employs systematic and explicit methods to discover, choose, and critically appraise reliable primary research, as well as to research the included studies. The approaches employed must be repeatable and comprehensible (Abutabenjeh, and Jaradat, 2018).

The systemic review describes and evaluates past work but does not specify the particular procedures used to identify, select, and assess the reviewed studies. The purpose of including a systemic review in the study is that it identifies, evaluates, and reconstructs all available research related to a specific assessment issue. Additionally, it can assemble all knowledge about a specific topic and identify the source of that knowledge. An extensive report can be created employing specific processes so that the justification, hypotheses, and methodology may be investigated by outside parties. It is possible to replicate and upgrade it for further evaluation in any given criteria (da Silva, 2017).

3.3 Search strategy

Database search

The search strategy utilised in this piece of work is based on reviewing various reliable literature sources through online database. Various database platforms are observed for the database search using reliable key words and Boolean logic to identify studies and literature most reliable and relatable to the aim of the study. For the study search related to occupational therapy and its benefits to children with cerebral palsy, the search was made through platforms such as Google Scholar and PubMed. These platforms offer public access to various authentic literature sources such as MEDLINE and other NLM databases. These sources are considered as the most renowned and updated sources with major receptacle of diverse literature and scientific publications. Additionally, these sources provide varied and comprehensive articles that are peer reviewed with efficient credibility to adequately understand and evaluate the occupational therapy and it benefits in improving the social participation of children with cerebral palsy along with its impact on cognitive development helpful in educating children diagnosed with cerebral palsy. A wide range is observed when specific targeted Boolean logic and key words are entered in these databases to get access to comprehensive articles.

Search terms

Keys words used were- “occupational therapy” “children with cerebral palsy” “benefits of occupational therapy” “social participation” “cognitive development” “occupational therapy impact” “occupational therapy AND cerebral palsy” “social participation AND cerebral palsy” “cognitive development AND cerebral palsy”

3.4 Restriction in the literature search

Several study restrictions are imposed within the researches in order to limit the process and narrow the search. As a result, one of the most relatable articles is chosen as the mother article on which the entire study is based, and other supporting articles are reviewed to support the evidences and hypotheses. The searches that have been added will then be filtered through appropriate filters, such as the use of the year of publication in this case. Okoli (2015) explains that research in the field of medicine and health is progressing at a rapid pace, and this must be taken into account (Okoli, 2015). As a result, studies prior to 2013 were excluded unless they had similar results or reached the desired conclusion. Aside from these limitations, certain other constraints were imposed on the evaluation and analysis of the researches thus reviewed. A search for specific keywords yielded a plethora of articles that would be nearly impossible to review. As a result, in this case, using some specific articles based on the content presented in the abstract would be beneficial. As a result, abstract reading would impose some study constraints on the researchers.

3.5 Inclusion criteria and exclusion criteria

The main strategy of research to use to was to search the online databases and narrow down the search using inclusion and exclusion criteria as well as a selecting appropriate article of a critical appraisal and development of the appraisal of research. The inclusion criteria that were followed in order to select appropriate and relevant literature for appraisal of this systematic review are as follows, firstly the articles that were published in last 10 years of from the year 2012 to 2022 were only included in the review. This was done in order to maintain the updated review of literature and include only up to date information in the review. The articles that were involved in the systematic review were in English language as well as in full text accessibility in order to provide easy appraisal and understanding of the information. The articles that were included in the systematic review were based on occupational therapy and its benefits and advantages in cerebral palsy only. The articles and resources that were involved in the systematic review but primary researches and mainly cross-sectional studies as well as randomised controlled study is a cohort study. The articles and resources that were involved in the systematic review we appear viewed as well as specific critical appraisal tool was used in order to appreciate each methodological and findings of these researches.

Articles that were published before 2012 excluded from the review as well as the articles and resources that was not published in English language and were not provided with full text access were also excluded from the review. The articles as well as a researcher's that were reviewed and critically appraised mainly based on cerebral palsy and all the articles that were not based on the topic were excluded from the review. The incomplete protocols as well as the duplicate articles were excluded from the review and the articles that were not peer reviewed or published in local journals were excluded from the review.

Author and title of the research	Design	Sample	Data collection method	Aims	Key findings
Saito, Y., Tomori, K., Sawada, T., Takahashi, S., Nakatsuka, S., Sugawara, H., Yaginuma, T., Sato, T., Kumagai, A., Nishimaki, S. and Hirano, Y., 2021. Determining whether occupational therapy goals match between pairs of occupational therapists and their clients: a cross-sectional study. Disability and Rehabilitation, 43(6), pp.828-833.	Cross sectional study	179	Semi structured interviews	The aim of the study was to identify the occupational therapy goals and its perception of achievement by therapist and client.	It was identified for the therapists that matched and planned goals of completion and occupational therapy with client matched and were highly completed in count.
McConnell, K., Johnston, L. and Kerr, C., 2012. Therapy management of the upper limb in children with cerebral palsy: A cross-sectional survey. Developmental Neurorehabilitation, 15(5), pp.343-350.	Cross sectional study	208	Questionnaire survey	To identify the perceived upper limb impairment and use of occupational therapy in its treatment for children with cerebral palsy.	The results identified that the upper limb impairments in children with cerebral palsy can be well managed and treated by use of standardized occupational therapy interventions.
Milton, Y.M., Dunford, C. and Newby, K.V., 2019. Occupational therapy home programmes for children with cerebral palsy: A national survey of United Kingdom paediatric occupational therapy practice. British Journal of Occupational Therapy, 82(7), pp.443-451.	Cross sectional national survey	123	National survey questionnaire	The aim of the survey was to identify the effectiveness of the cerebral palsy home program and their effectiveness for management of cerebral palsy children.	It was seen that participants identified and reported benefits of using home based occupational therapy programs for management and treatment of the impairments associated with cerebral palsy.
Klevberg, G.L., Østensjø, S., Krumlinde-Sundholm, L., Elkjær, S. and Jahnsen, R.B., 2017. Hand function in a population-based sample of young children with unilateral or bilateral cerebral palsy. Physical & occupational therapy in pediatrics, 37(5), pp.528-540.	Cross sectional design	202	Survey	Aim was to identify the use and benefit of occupational therapy intervention among cerebral palsy children for their hand function.	The results identified that the manual ability and hand function of children in the study was disturbed but using occupational therapy interventions helps in determining better outcomes.
Unger, M., Jelsma, J. and Stark, C., 2013. Effect of a trunk-targeted intervention using vibration on posture and gait in children with spastic type cerebral palsy: a randomized control trial. Developmental neurorehabilitation, 16(2), pp.79-88.	Randomized control trial, single blinded cross over trial	27	Walk test, ultrasound imaging and gait tests	The study aimed at exploring if strengthening truck muscles in cerebral palsy through occupational therapy interventions helps in promoting better function.	It was identified that continuous use of appropriate muscle strengthening interventions in cerebral palsy children helped in promoting better walking time, enhanced posture and improved function.
de Brito Brandao, M., Gordon, A.M. and Mancini, M.C., 2012. Functional impact of constraint therapy and bimanual training in children with cerebral palsy: a randomized controlled trial. The American Journal of Occupational Therapy, 66(6), pp.672-681.	Randomized control trial	16	Interventions for CIMT and HABIT therapies were implemented for both groups and their functional abilities were recorded.	The aim of the study was to identify the impact of occupational therapy interventions on the functional abilities of children with cerebral palsy.	The results identified that both therapies were helpful in determining functional management of inabilities associated with cerebral palsy children.
Marquez-Chin, C., Bagher, S., Zivanovic, V. and Popovic, M.R., 2017. Functional electrical stimulation therapy for severe hemiplegia: Randomized control trial revisited: La simulation électrique fonctionnelle pour le traitement d’une hémiplégie sévère: un essai clinique aléatoire revisité. Canadian Journal of Occupational Therapy, 84(2), pp.87-97.	Randomized control trial	21	Functional independence measure score scale	The aim of the study was to identify the effectiveness of functional electric stimulation for function in cerebral palsy patients.	The study indicated that use of the functional electrical stimulation method helped in determining better function in the given sample.
Cameron, D., Craig, T., Edwards, B., Missiuna, C., Schwellnus, H. and Polatajko, H.J., 2017. Cognitive orientation to daily occupational performance (CO-OP): a new approach for children with cerebral palsy. Physical & Occupational Therapy in Pediatrics, 37(2), pp.183-198.	Randomized control trial	18	Canadian occupational therapy effectiveness measures scale	The aim of the study was to identify the effectiveness of the occupational therapy interventions on the wellbeing of the client.	The results identify that use of occupational therapy helped them learn better and enhanced their cognitive functioning along with physical function.

CHAPTER 4 – CRITICAL APPRAISAL

Critical appraisal is the technique of thoroughly and methodically reviewing study to discover its credibility, as well as its usefulness and applicability in a certain setting. By eliminating unnecessary or poor research, critical evaluation helps us to decrease sensory overload. Select the most published papers, differentiate facts from opinions, preconceptions, false reporting, as well as belief, evaluate the trustworthiness, utility, and therapeutic application, and uncover any potential bias. Comprehensive assessment of research literature is a vital skill that academic healthcare experts, as well as those participating in medical practise, must learn. Before making improvements in their clients' care, evidence-based physicians must do a comprehensive analysis of the recent or previous research. A systematic approach for order to determine the strength and flaws of a journal article in order to determine the relevance and validity of published research is known as critical evaluation. CASP provides assessment checklist for Systematic Reviews, Cohort Studies, Randomized Controlled Trials, Case Control Studies, Diagnostic Studies, Economic Evaluations, Qualitative Studies, and Clinical Prediction Rules. The CASP instrument was shown to be a pretty excellent indicator of research practise openness and reporting requirements, but a rather poor estimate of investigation design and administration.

PAPER 1

Saito, Y., Tomori, K., Sawada, T., Takahashi, S., Nakatsuka, S., Sugawara, H., Yaginuma, T., Sato, T., Kumagai, A., Nishimaki, S. and Hirano, Y., 2021. Determining whether occupational therapy goals match between pairs of occupational therapists and their clients: a cross-sectional study. Disability and Rehabilitation, 43(6), pp.828-833.

Did the study address a clearly focused research question?

The purpose of this study was to see how well occupational therapists' (OTs') reported goals complemented those of their patients.

Sample of the study and design?

A sample of 100 patients and 79 occupational therapists were enrolled from 7 Japanese subacute rehabilitation wards.

Measures used in the study and length of follow up?

Semi-structured interviews were used to question matched pairs of occupational therapists and their clients regarding their perceptions of the clients' occupational therapy objectives. Semi structured interviews are an excellent data collecting strategy whenever the researcher attempts to: (1) measurement test, open-ended data; (2) investigate respondent ideas, feelings, and opinions about a certain topic; as well as (3) dig extensively into intimate and even sometimes sensitive problems. A lot of detail is created, it's really adaptable and responsive, and it's fairly trustworthy and straightforward to analyse.

Data analysis

The OTs recorded 239 goals in all, whereas the clients recorded 161 goals. Thematic analysis is a widely used analytic technique. Its appeal stems in part from its autonomy from any certain methodological perspective or philosophical persuasion. As a result, it will be valuable to sociologists who place their work either within realist or structuralist perspectives.

Thematic analysis is useful for the purpose of investigating volunteer community engagement because it allows us all to investigate, from a constructivism measurement process, the manner in which individuals attach to their participatory democracy, the relevance it has in their lifestyles, and, extra widely, their preconceived notions of it. At the very same time, it allows us to investigate how all these creations may represent the ‘reality' of individuals' real-life experiences, as well as the material or social circumstances in which they exist.

Results

Whereas both OTs and patients reported high levels of patient participation in the goal-setting process, 79 percent of goal declarations were discordant among pairs of OTs as well as respective clients. Goal alignment was marginally better for objectives related to daily everyday activities or involvement than for objectives related to body composition.

Discussion

Even though most OTs as well as their patients believed they were main objective collaboratively, only 21% of documented objectives matched across OTs and patients. And it would be worthwhile to look at if there is a link in between substance of objectives, patient involvement in strategic planning, the amount of goal alignment, and the health achievements made by patients when they leave treatment programs.

Strengths

The study managed to understand the research aim which is the benefits of occupational therapy in improving the social participation of children with cerebral palsy along with its impact on cognitive development helpful in educating children diagnosed with cerebral palsy.

Limitations

Despite the perception that most occupational therapy practitioners (OTs) and their patients participated in main objective jointly, 79 percent of the objectives separately recorded by OTs and their patients did not reflect in 7 post-acute treatment departments across Japan. Objectives were actually more likely to complement if the subject of the objectives was linked to instrumental or involvement activities of daily life (30.3 percent) or basic daily functioning (24.7 percent) than if the topic of the goals was really about body structure and function (11.2 %); moreover, the overall number of goal similarity was low. Japanese occupational therapists must create more effective strategies for tracking or conveying objectives in methods that customers can comprehend; this may be true in other nations as well.

Semi-structured interviewing has the following drawbacks: Spending time with responders and conducting an open-ended conversation takes time. It necessitates a substantial investment. It might be difficult to locate an interviewer who has received the required qualifications to perform a professional question.

PAPER 2

McConnell, K., Johnston, L. and Kerr, C., 2012. Therapy management of the upper limb in children with cerebral palsy: A cross-sectional survey. Developmental Neurorehabilitation, 15(5), pp.343-350.

Did the study address a clearly focused research question?

The purpose of this study was to examine the perceived degree of upper limb (UL) deficits and associated therapeutic treatment in cerebral palsy (CP) children.

Sample of the study and design?

A cross-sectional questionnaire has been distributed to all 208 juvenile occupational therapists (OTs) and physiotherapists (PTs) working in a UK region. Cross-sectional studies are far less expensive and time-consuming than that of other forms of research since they simply collect data at one moment in time. Cross-sectional studies help in gathering information from a wider group of people and examine differences among them.

Measures used in the study and length of follow up?

A 74% participation rate was obtained, with 94 questionnaires suitable for analysis.

Data analysis

Descriptive analysis, frequency table, and chi-square testing were used to analyse the data. It provides users with a conclusion about the distributions of the data, assists with detecting typos as well as outliers, and allows users to spot commonalities among factors, preparing one for additional statistical analysis.

Results

Goniometry as well as manual muscle assessment were often used to assess UL impairments and had been indicated by substantially more PTs than OTs. Therapists seldom reported having access to or using UL activity measurements. Participants commonly reported employing posture, neurodevelopmental treatment, and task practise to improve their performance.

Discussion

The use of standardised measuring techniques and evidence-based treatments might improve UL administration in children with CP.

Strengths

Limitations

Many limitations were judged as having a considerable or significant impact on the UL.

The key limitations of the descriptive analysis are the participants' lack of anonymity and sincerity. Sometimes responders are not genuine and do not offer the correct response for a variety of reasons. Cross-sectional research has the problem of just informing researchers regarding differences rather than genuine changes.

PAPER 3

Milton, Y.M., Dunford, C. and Newby, K.V., 2019. Occupational therapy home programmes for children with cerebral palsy: A national survey of United Kingdom paediatric occupational therapy practice. British Journal of Occupational Therapy, 82(7), pp.443-451.

Did the study address a clearly focused research question?

Although there is a substantial body of research supporting occupational therapists home courses for children with developmental disabilities, their composition and use in UK practise is unclear. This study clearly addresses the occupational therapy programs for children with cerebral palsy.

Sample of the study and design?

Sample of the study was 123 participants and the design of the study was cross-sectional.

Measures used in the study and length of follow up?

A nationwide survey questionnaire of occupational therapists was done to investigate their present occupational therapy residential project practises and views regarding using residential courses with kids with cerebral palsy. Survey research has several advantages, including its low cost, generalizability, dependability, and variety.

Data analysis

Participants of 2 phases of the Royal College of Interprofessional were recruited, as was a University's Fieldwork-Database Supervisor's as well as self-selection after marketing on occupational therapists’ networks, social networking sites, and publications.

Results

The bulk of the survey participants (n = 123) utilized occupational therapists’ residential sessions (60%). The adoption and utilisation of evidence-based residential training package varied, suggesting corroboration gaps. Interviewees indicated their expert thinking well and highlighted the advantages of adopting home courses.

Discussion

Occupational therapists cite problems in managing evidence-based therapies as well as the regular, methodical use of a variety of standardized measuring methods before and after occupational therapists’ residential courses. These technologies would improve the quality of life for toddlers with cerebral palsy and associated caregivers. Occupational therapists, on either hand, suggested the need for further management support, additional training, and skills training within those areas.

Strengths

Limitations

They did, although, indicate difficulties in managing them inside a family-centered paradigm, including time restrictions, a lack of understanding, skills, as well as training, along with lack of support. Inflexibility as well as validity concerns are two of survey research's limitations.

PAPER 4

Klevberg, G.L., Østensjø, S., Krumlinde-Sundholm, L., Elkjær, S. and Jahnsen, R.B., 2017. Hand function in a population-based sample of young children with unilateral or bilateral cerebral palsy. Physical & occupational therapy in pediatrics, 37(5), pp.528-540.

Did the study address a clearly focused research question?

To characterise characteristics of existing strategies to enhance functional ability in young kids with Cerebral Palsy (CP), as well as to investigate variables linked with an elevated risk of hand and ADL learning, and to investigate child relationship between training and development.

Sample of the study and design?

A number of 102 children were enrolled (53 percent of the group of recruitment of new kids in the CPOP, average age: 30.3 months, SD: 12.1).

Measures used in the study and length of follow up?

A cross-sectional approach was employed, including statistics from of the Norwegian CP Follow-up Research as well as parent-reported data (CPOP).

Data analysis

Descriptive statistical analysis, cross-tabulations, as well as direct multivariable regression were used to examine the data. The Mini-Manual Ability Classification System was used to classify functional ability (Mini-MACS).

Descriptive analysis is thought to be more comprehensive than some other quantitative studies, providing a more comprehensive picture of such an event or phenomena. To do descriptive survey, any set of variables, or essentially a single complexity of the model, can be used. This style of analysis is seen to be a better approach for obtaining information since it defines interconnections as spontaneous and depicts the environment as it is. Because all trends are based on study through into response variable of the data, this assessment is very realistic as well as close to mankind.

Results

The bulk of the youngsters trained extensively in mechanical aptitude as well as ADL. Parents said that they received a lot of instruction, and that it was frequently incorporated into their daily routines. Both mom and dad (OR = 5.6, p.011) and occupational therapists (OR = 6.2, p.002) indicated that students at Mini-MACS levels II-III received more hands practice than kids at Mini-MACS level I. Whenever instruction was conducted as a mixture of fitness training and practise within continuing operations, parents showed increased welfare benefits (OR = 7.090, p =.011).

Discussion

Mother and fathers remarked that their children's daily activities were used as chances for education, allowing them to describe the severity of therapy simply by counting moments.

Strengths

Limitations

The limitations of a cross-sectional design is that it Cannot be used to study behaviour over time. It does not assist in determining correlation and causation. The snapshot's time is not assured to be accurate and whether there's a contradiction with the funding mechanism, the conclusions may be erroneous or distorted.

PAPER 5

Unger, M., Jelsma, J. and Stark, C., 2013. Effect of a trunk-targeted intervention using vibration on posture and gait in children with spastic type cerebral palsy: a randomized control trial. Developmental neurorehabilitation, 16(2), pp.79-88.

Did the study address a clearly focused research question?

The purpose of this study was to see if employing vibration to stimulate trunk movements may enhance stance and walking in adolescents with spastic cerebral palsy (STCP).

Sample of the study and design?

A combination of 27 youngsters (6–13 years old) took part in a single-blind pre–post crossover experimental investigation.

Measures used in the study and length of follow up?

The 1-Minute Walk Test, 2D-posturography, ultrasound imaging, including one sit-up were utilised to evaluate the impact on gait, postural, resting core muscle mass, and operational strength.

Data analysis

Post-urography is a technique for measuring equilibrium. Sway is measured when standing on a steady level, as well as with inclination or longitudinal movement of the platform, also with eyes wide open as well as closed, and with change of the surrounding image. Data is analysed through Postural sway is detected via computerised static post-urography, which measures movements in the centre of mass (COM) when a man passes within normal limits of stability.

Results

There seemed to be a marked increase in walking distance (p = 0.001), extra upright stance, an increment in sit-ups implemented (p = 0.001), as well as a raise in resting layers of all four core muscles – transversus abdominis (p = 0.047), obliquus externus (p = 0.023), obliquus internus (p = 0.003), and rectus abdominis (p = 0.001). At 4-weeks post-intervention, endurance and stance were stable.

Discussion

A trunk-targeted approach utilising vibratory can advantageous in situations and gait in adolescents with STCP while causing any recognized bad impacts. Vibrating and particular trunk conditioning should be used in education or treatment services. Further evidence on the impact of resonance on force production and stiffness is required.

Strengths

Limitations

The limitations of post urography are Computerized dynamic post-urography doesn't provide any localising or lateralizing data, nor provide cause information; however, it will provide useful details about how well a person can also use their alignment, as well as an inkling of the relevance of a participant's balance disruption on their everyday activities. Furthermore, computerised dynamic post-urography gives a functioning measurement that may be used to anticipate the improvement that sufferers might expect from clinical treatment with therapy.

PAPER 6

de Brito Brandao, M., Gordon, A.M. and Mancini, M.C., 2012. Functional impact of constraint therapy and bimanual training in children with cerebral palsy: a randomized controlled trial. The American Journal of Occupational Therapy, 66(6), pp.672-681.

Did the study address a clearly focused research question?

The aim of the study was to compare Child's self-competence and caretakers' perceptions of children's achievement on performance objectives developed for children with hemiplegic cerebral palsy (CP) following unimanual constraint-induced movement therapy (CIMT) or hand–arm bimanual intense training was examined (HABIT).

Sample of the study and design?

16 children with cerebral palsy were randomly assigned to either the CIMT or HABIT groups.

Measures used in the study and length of follow up?

The interventions continued 15 days at a rate of 6 hours each day for a total of 90 hours. To measure the children's everyday functioning, we utilised the Paediatric Evaluation of Disability Inventory and the Canadian Occupational Performance Measure (COPM). The COPM is an assessment instrument created for occupational therapists to use in assessing client results in the areas of personal, output, and leisure. The COPM is a five-step approach that uses a semi-structured questionnaire to assess specific, client-identified weak points in daily function.

Data analysis

we conducted mixed analyses of variability to evaluate group averages on functioning test scores in between intervention. The COPM is a client-centered assessment instrument that allows individuals to recognize and prioritise daily difficulties that limit their involvement in daily life. This metric is concerned with occupational performance in all aspects of life, such as self-care, recreation, and production. Summing set of symptoms scores and dividing by the total number of issues yields the average PERFORMANCE and SATISFACTION score. After just an assessment interval, change scores for both PERFORMANCE and SATISFACTION can be determined.

Results

On operational metrics, both groups improved significantly. The association between assessment task and COPM performances suggested that the HABIT group improved more after treatment (p =.04).

Discussion

The findings imply that trained specificity occurs mostly for the achievement of particular goals set by parents, because both CIMT as well as HABIT may be utilised to improve children's everyday performance.

Strengths

Limitations

Limitation of the study was method of conducting the study.

PAPER 7

Marquez-Chin, C., Bagher, S., Zivanovic, V. and Popovic, M.R., 2017. Functional electrical stimulation therapy for severe hemiplegia: Randomized control trial revisited: La simulation électrique fonctionnelle pour le traitement d’une hémiplégie sévère: un essai clinique aléatoire revisité. Canadian Journal of Occupational Therapy, 84(2), pp.87-97.

Did the study address a clearly focused research question?

The purpose of this study is to determine the effectiveness of adaptive electrical stimulation treatment in restoring voluntary extending and gripping following extreme hemiplegia.

Sample of the study and design?

The sample of the study was 21 individuals.

Measures used in the study and length of follow up?

A post-hoc analysis of a successfully cleared randomised control study (clinicaltrials.gov, No. NCT00221078) including 21 individuals with significant upper-limb hemiplegia due to stroke was performed.

Data analysis

Data analysis method was not mentioned in the study.

Results

Measurement of Functional Independence Throughout 40 hours of equal-intensity therapy, self-care sub scores rose by 22.8 (6.7) points in the experimental group and 9 points inside the comparison group. The control and intervention categories had FMA-UE score changes of 27.2 and 5.3, correspondingly.

Discussion

The findings might indicate the most significant gains in upper-limb functioning in whatsoever stroke sample to present, particularly in individuals with severe upper-limb deficits.

Strengths

Limitations

There were not many limitations in the study only the data analysis method was not determined.

PAPER 8

Cameron, D., Craig, T., Edwards, B., Missiuna, C., Schwellnus, H. and Polatajko, H.J., 2017. Cognitive orientation to daily occupational performance (CO-OP): a new approach for children with cerebral palsy. Physical & Occupational Therapy in Pediatrics, 37(2), pp.183-198.

Did the study address a clearly focused research question?

The findings of a short single-case research episode showed that Cognitive Orientation to Everyday Occupational Performance (CO-OP) may have been an effective method for children with cerebral palsy (CP).

Sample of the study and design?

18 kids between the ages of 7 as well as 12 (nine in the CO-OP group and nine in the Present Usual Practicing Approaches (CUPA) group) had ten 60-minute sessions of treatment at homes once per day on aggregate.

Measures used in the study and length of follow up?

As a result, a prototype randomized clinical trial was achieved through the accompanying questionnaire: is CO-OP a practical technique to employ with kids with CP, but what were the benefits of CO-OP when opposed to ordinary therapy, and seems to be bigger research merited.

Data analysis

The Canadian Occupational Performance Measure as well as the Enhanced Performance Scoring System have been used as primary outcome measures (PQRS). The PQRS evaluators were not aware of the organization.

The Canadian Occupational Performance Measure as well as the Performance Quality Rating Scale were the primary outcome measures (PQRS). PQRS assessors were unaware of group assignment or test timing.

Results

All of the students in the CO-OP group were ready to comprehend the tactics and attain their desired goals, showing the approach's viability. At the follow-up, both techniques simultaneously increased academic achievement and skill persistence.

Discussion

Further study is needed based on these preliminary findings.

Strengths

Limitations

The effect sizes imply that CO-OP may have a little benefit in terms of transmission and durability.

CHAPTER 5- RESULTS

To investigate the effectiveness of occupational therapy for children with cerebral palsy in relation to social participation.

de Brito Brandao et al (2012), aimed to compare Child's self-competence and caretakers' perceptions of children's achievement on performance objectives developed for children with hemiplegic cerebral palsy (CP) following unimanual constraint-induced movement therapy (CIMT) or hand–arm bimanual intense training was examined (HABIT). The interventions continued 15 days at a rate of 6 hours each day for a total of 90 hours. To measure the children's everyday functioning, we utilised the Paediatric Evaluation of Disability Inventory and the Canadian Occupational Performance Measure (COPM). The COPM is an assessment instrument created for occupational therapists to use in assessing client results in the areas of personal, output, and leisure. The COPM is a five-step approach that uses a semi-structured questionnaire to assess specific, client-identified weak points in daily function. The COPM is a client-centered assessment instrument that allows individuals to recognize and prioritise daily difficulties that limit their involvement in daily life. This metric is concerned with occupational performance in all aspects of life, such as self-care, recreation, and production. On operational metrics, both groups improved significantly. The association between assessment task and COPM performances suggested that the HABIT group improved more after treatment (p =.04). The findings imply that trained specificity occurs mostly for the achievement of particular goals set by parents, because both CIMT as well as HABIT may be utilised to improve children's everyday performance.

Social participation is referred to the ability of the individual to interact as well as take part in the activities the socially and in society. Children suffering from cerebral palsy have both physical and mental disabilities that makes them limited to social participation. Social participation provides the young individuals as well as children with cerebral palsy opportunities to develop their self-care esteem friendship as well as meaning in life. Social participation is closely related and associated with the cognitive well-being of a person. Children with cerebral palsy have been reported to participate more in-home base leisure activities and furious social experiences with friends or other individuals that enhances that disabilities.

The study by Tan et al (2016), Long-term outcomes of a different interventions especially the social participation and intervention that leads to better cognition supports individual with cerebral palsy and their families in setting a realistic expectation as well as supporting the practitioner's in order to optimise the interventions for early as well as moderate stages of cerebral palsy. According to the longitudinal paediatric rehabilitation research that was the conducted in Netherlands a program recently identified and determine the developmental trajectories of different outcome measures that includes the help of social participation for cerebral palsy the intellectual impairment as well as a level of gross motor function were observed to be the primary factors that were identified in longitudinal development of social participation for cerebral palsy children aged 1 to 16 years. It is seen that the level of social participation increases with age and stabilizes at 18 years of age or for individual and an average of the better interventions a focus that social participation typically helps in development of independence and self-esteem. The level of social participation developed through intervention of without intervention for individual with terrible policy may vary from one individual to another.

The primary factors such as age and intellectual impairment as well as the gross motor function are some of the factors that influence of social participation of the individual with cerebral palsy. The study identified that cerebral palsy and speech impairment of what each independently associated with the longitudinal development of social participation as well as the effects were rather very small or did not change with age. It was also seen that the train was found the where children attending special education develop less favourable social participation as compared to other children with cerebral palsy. moreover, it was seen that use of social participation interventions including parents and caregivers of with starting point of therapies helps in tailoring support for the individual with cerebral palsy and also helps them in developing better education platforms and reduce the risk of suboptimal social isolation. Hence, it was concluded that use of social participation is helpful in determining better cognitive function for children with cerebral palsy.

Milton et al (2019), study clearly addresses the occupational therapy programs for children with cerebral palsy. A nationwide survey questionnaire of occupational therapists was done to investigate their present occupational therapy residential project practises and views regarding using residential courses with kids with cerebral palsy. Survey research has several advantages, including its low cost, generalizability, dependability, and variety. The bulk of the survey participants (n = 123) utilized occupational therapists’ residential sessions (60%). The adoption and utilisation of evidence-based residential training package varied, suggesting corroboration gaps. Interviewees indicated their expert thinking well and highlighted the advantages of adopting home courses. Occupational therapists cite problems in managing evidence-based therapies as well as the regular, methodical use of a variety of standardized measuring methods before and after occupational therapists’ residential courses. These technologies would improve the quality of life for toddlers with cerebral palsy and associated caregivers. Occupational therapists, on either hand, suggested the need for further management support, additional training, and skills training within those areas.

To investigate the effectiveness of occupational therapy for children with cerebral palsy in relation to cognitive development.

Cameron et al (2017). Identified through their study that short single-case research episode showed that Cognitive Orientation to Everyday Occupational Performance (CO-OP) may have been an effective method for children with cerebral palsy (CP). 18 kids between the ages of 7 as well as 12 (nine in the CO-OP group and nine in the Present Usual Practicing Approaches (CUPA) group) had ten 60-minute sessions of treatment at homes once per day on aggregate. The Canadian Occupational Performance Measure as well as the Enhanced Performance Scoring System have been used as primary outcome measures (PQRS). The PQRS evaluators were not aware of the organization. The Canadian Occupational Performance Measure as well as the Performance Quality Rating Scale were the primary outcome measures (PQRS). PQRS assessors were unaware of group assignment or test timing. All of the students in the CO-OP group were ready to comprehend the tactics and attain their desired goals, showing the approach's viability. At the follow-up, both techniques simultaneously increased academic achievement and skill persistence.

The study evidence by Aran et al (2020), cognitive impairment is identifying the in children with cerebral palsy along with their motor dysfunction that impacts the overall quality of life. It is a well-recognised neurodevelopmental condition that begins at early childhood and impacts of the cognition sensation as well as physical and mental limitation of the individual and is non-progressive disturbance that occurs in infant brain. Several rehabilitation approaches of for cerebral palsy rehabilitation and used but virtual reality including occupational therapy approaches are used to enhance their cognitive abilities. Virtual reality is described as the user computer interface including real life interactions as well as environment and object that helps in developing multiple censorial channels and enhances the overall participation of the individual in developing better cognitive function. Occupational therapist always encourages and develop the increase in usage of virtual reality interventions for rehabilitation of cerebral palsy children in order to enhance their cognitive and mental abilities and psychological association. Several investigators identified that motor effects of a virtual reality interventions for cerebral palsy children are well identified and a large number of studies identifies that cognitive function in children with cerebral palsy are remarkably improved with better occupational therapy and cognitive interventions.

Similar reports are provided by the study findings of Jackman et al (2018), where it is identified that effectiveness of cognitive orientation to the daily occupational performance and helps in development of a combination of physical and mental approaches to help children with cerebral palsy develop independent living. Didn't mention here introduced by the author is the functional plants that are worn when performing any activity and these plans are also help in developing cognitive function as well as physical function of the individual with cerebral palsy. These plans are developed in order to focus on the neuro rehabilitation of the individual where the loss of nervous and motor function for a person is well identified as well as the solution for developing better performance and function is established. It is said that are specific training is developed for group, and group of interventions are involved in order to develop better by manual training programs to help the children with cerebral palsy develop better cognitive orientation. the results of the study identified that use of cognitive approaches as well as a sprinting mechanism and hands the goal achievement over the functional abilities of the children with cerebral palsy as well as a developed a better functional goals and achievements.

Unger et al (2013), aimed at employing vibration to stimulate trunk movements may enhance stance and walking in adolescents with spastic cerebral palsy (STCP). The 1-Minute Walk Test, 2D-posturography, ultrasound imaging, including one sit-up were utilised to evaluate the impact on gait, postural, resting core muscle mass, and operational strength. Post-urography is a technique for measuring equilibrium. Sway is measured when standing on a steady level, as well as with inclination or longitudinal movement of the platform, also with eyes wide open as well as closed, and with change of the surrounding image. Data is analysed through Postural sway is detected via computerised static post-urography, which measures movements in the centre of mass (COM) when a man passes within normal limits of stability. There seemed to be a marked increase in walking distance (p = 0.001), extra upright stance, an increment in sit-ups implemented (p = 0.001), as well as a raise in resting layers of all four core muscles – transversus abdominis (p = 0.047), obliquus externus (p = 0.023), obliquus internus (p = 0.003), and rectus abdominis (p = 0.001). At 4-weeks post-intervention, endurance and stance were stable. A trunk-targeted approach utilising vibratory can advantageous in situations and gait in adolescents with STCP while causing any recognized bad impacts. Vibrating and particular trunk conditioning should be used in education or treatment services. Further evidence on the impact of resonance on force production and stiffness is required.

To evaluate the effectiveness of occupational therapy interventions for children with cerebral palsy in relation to their physical and motor function.

The study findings by Saito et al (2021), after developing the cross-sectional study and including hundred patients and 79 occupational therapists from Japan rehabilitation was and collecting data through semi-structured interviews following findings were identified. The OTs recorded 239 goals in all, whereas the clients recorded 161 goals. Thematic analysis is a widely used analytic technique. Its appeal stems in part from its autonomy from any certain methodological perspective or philosophical persuasion. As a result, it will be valuable to sociologists who place their work either within realist or structuralist perspectives. Whereas both OTs and patients reported high levels of patient participation in the goal-setting process, 79 percent of goal declarations were discordant among pairs of OTs as well as respective clients. Goal alignment was marginally better for objectives related to daily everyday activities or involvement than for objectives related to body composition. Even though most OTs as well as their patients believed they were main objective collaboratively, only 21% of documented objectives matched across OTs and patients. And it would be worthwhile to look at if there is a link in between substance of objectives, patient involvement in strategic planning, the amount of goal alignment, and the health achievements made by patients when they leave treatment programs.

According to Türker et al (2015), cerebral palsy is a developmental disorder that impacts of the movement and posture of an individual and creates a disorder that occurs as a result of lesion in the cerebral motor centres of the brain. The study identified that the cerebral palsy causes that their physical and progressive disorders for motor function of the individual and musculoskeletal system changes with the growing of the child these emerging problems affect child the daily living skills as well as the ability to have an independent and quality life. The participation in social activities as well as other physical limitations are exceeded to the level that impacts of the overall quality of life. Therefore, the authors are identified that goal directed therapy including occupational and physical therapy gradually increases the independence of the individual with cerebral palsy and help them in daily living activities as well as improve functional performance. The goal-oriented approach using occupational in physical therapy based on neuronal group selection theory and dynamic system theory that helps in overall development of quality of life and functional activities as well as improvements. The results of the study were similar to the previous study and indicated that positive development after therapy were identified for both of gross and fine motor functions of for the children with cerebral palsy as well as it helps in the case of self-care transfer and locomotion subscales as well as enhance the overall independence of the individual. Moreover, the study findings are identified that there were improvements in gross motor function as well as a social status and living activities of the individual with cerebral palsy undergoing occupational therapy and physical therapy interventions that were gold refined and this helps in improving the health-related quality of life of children with cerebral palsy.

Another concrete finding are identified by the study McConnell et al (@012), that examined the perceived degree of upper limb (UL) deficits and associated therapeutic treatment in cerebral palsy (CP) children. The cross-sectional questionnaire has been distributed to all 208 juvenile occupational therapists (OTs) and physiotherapists (PTs) working in a UK region. Cross-sectional studies are far less expensive and time-consuming than that of other forms of research since they simply collect data at one moment in time. Goniometry as well as manual muscle assessment were often used to assess UL impairments and had been indicated by substantially more PTs than OTs. Therapists seldom reported having access to or using UL activity measurements. Participants commonly reported employing posture, neurodevelopmental treatment, and task practise to improve their performance.

The findings of the study by Labaf et al (2015), indicates that Neurodevelopmental treatments including occupational in physical therapy treatments are advance therapeutic approaches that are practiced by the experience of occupational therapists to for the rehabilitation of children with cerebral palsy. The authors indicated quasi experimental design including 28 children with cerebral palsy that were randomly divided into two groups or achieving neurodevelopmental therapy and control group. It is identified that the central nervous system lesions in cerebral palsy causes motor sensory impairment that progressively deteriorate over time for the individual. The main challenges of cerebral palsy are gross motor dysfunction where there are limitations with physical activity and independence of the child. Occupational therapy in children with cerebral palsy is often performed in order to avoid abnormal muscle tone and posture as well as a in order to treat muscle and joint deformity is caused by the legions of brain. The occupational therapy is also performed in order to reduce the motor and sensory disorders as well as a developer better functional ability for the individual.

The primary purpose of a neurodevelopmental occupational therapy is to correct abnormal posturing tone as well as facilitate more normal moments and physical function for the individual that will enhance their performance and skills. The study identified that as a result statistical a significant difference in the values of the baseline as well as a post treatment therapies of the two groups were identified. The groups that were receiving neurodevelopmental occupational therapy were significantly having better and significant improvements in laying rolling crawling and mailing as well as a standing ability as well as the control group did not show any significant difference. Moreover, the results also identified that there was no significant difference in running jumping abilities of the two groups but there were some functional improvements identify the due to neurodevelopmental occupational therapy of the children with cerebral palsy. It was concluded that the near developmental treatment not only improve the gross motor function of the child with cerebral palsy but it also enhances function towards the four dimensions that is rolling link sitting crawling and mailing as well as standing. Some of the limitation of this study was that the method used for interpretation of data provided a great deal of data and it is a complex and time-consuming for staff together and analysing get the interpretation of the total score is also very complex.

Hence, the overall evaluation of the findings from the review and the supporting evidences from other sources identified that occupational therapy use helps in development of the physical function and improves the gross motor functioning of the children with cerebral palsy because it helps in determining and improving the overall independence and functional abilities of the children with cerebral palsy.

The study by Marquez-Chin et al (2017), was purposed on determining the effectiveness of adaptive electrical stimulation treatment in restoring voluntary extending and gripping following extreme hemiplegia. Another intervention that is electrical brain stimulation therapy is one of the common forms of occupational in physical therapy combination that is used to manufacture children with cerebral palsy. It is the first of its kind therapy that researchers have found to stimulate the target areas of brain and help in developing mild electrical current that can enhance the motor skills and gross motor function of the human body that are a due to cerebral palsy. The study focused on establishing an understanding of how this therapy is helpful and useful as well as the benefits of the cerebral palsy in children in enhancing their functional ability of gripping. The ability to use their hands limbs or even walking is impaired in cerebral palsy and the electric brain stimulation therapy is found out to be very beneficial in stimulating the specific areas of brain that will help in determining better control over these functions are and enhances the functionality of the child. Measurement of Functional Independence Throughout 40 hours of equal-intensity therapy, self-care sub scores rose by 22.8 (6.7) points in the experimental group and 9 points inside the comparison group. The control and intervention categories had FMA-UE score changes of 27.2 and 5.3, correspondingly.

CHAPTER 6- DISCUSSION

This systemic review has narratively synthesized 8 publications based on the occupational therapy as an intervention for children with cerebral palsy. Various factors considering the objectives of social participation and cognitive development varied among the selected articles. There were significant associations found and after the data extraction of these publications, the following themes were developed to evaluate the findings and upgrade the availability of information and resources that are currently present and that might be required to focus upon.

Theme 1- The effectiveness of occupational therapy for children with cerebral palsy in relation to social participation.

McConnell et al (2012) studied the impairments of the upper limb and the severity observed in children with cerebral palsy along with the effect of occupational therapy as a therapeutic intervention in such children. A cross-sectional study of 208 was carried out to assess the gap between the researched and evidential based practice followed by occupational therapist to support the children. The questionnaire survey assisted in reaching out 94 valid candidates for analysis. It was observed that children with impairments in upper limb had a great impact on their social lifestyle along with challenges in various activities performed in day to day routines. Stretching, neurodevelopmental therapy, task practice and positioning were the most reported interventions that were performed on children with cerebral palsy, by the paediatric occupational therapists. The majority of attention by the therapists was offered on increasing muscle tone. Therapists seldom reported having access to or using UL activity measurements. Participants commonly reported employing posture, neurodevelopmental treatment, and task practise to improve their performance. This research also highlights the gap in availability of measurement tools and their infrequent use despite the free availability. This study explains that the increase in training of neurodevelopmental therapy and sensory integration is due to limited fine working in the paediatric sector, which illustrates the reason of neurodevelopmental therapy being used most frequently to address the issues associated with the functions and performance abilities of the upper limb. Certain barriers such as funding, low feasible implementation approaches and low training levels have also been identified. As per Russell et al (2010), to address this concern, development and documentation of guidelines might not be worthwhile. Implementation of strategies that focus on knowledge translations through educational seminars and knowledge brokers helps in self education and development to assess various available measures and tools to manage the upper limb challenges in children with CP. The use of standardised measuring techniques and evidence-based treatments might improve UL administration in children with CP.

Unger et al (2013) studied the employment of vibration to stimulate trunk movements may enhance stance and walking in adolescents with spastic cerebral palsy (STCP). A combination of 27 youngsters (6–13 years old) took part in a single-blind pre–post crossover experimental investigation. A trunk-targeted approach utilising vibratory can be advantageous in achieving accurate postures and gait in adolescents with STCP while causing any recognized bad impacts. Vibrating and particular trunk conditioning should be used in education or treatment services. Various evidences support that despite of numerous tools and relatable approaches, the primary support and benefit through therapeutic interventions is often offered to the limbs than to the trunk muscle structure or the core. The study of Butler (2018) supported that the seating intervention has helped sitting acquisition in children with spastic cerebral palsy (STCP). According to Bertoti et al (1988) and Sterba et al (2002), short term posture correction and balancing abilities have always been favoured and concerned and the use of horse-back riding as a therapeutic intervention has proven effective since long time. Unger et al (2006) reported that involvement of trunk in the therapeutic exercise programme may not have been very helpful in providing a good posture and gait overall, when compared to studies and outcomes that support programmes that focussed on lower limb strengthening. This study successfully claims that brisk walking and posture can be corrected in short-term by targeting the abdominal muscles through WBV in children with spastic cerebral palsy (STCP). This paves way and creates opportunity to facilitate the movement of muscles and to strengthen them by targeting the spasticity. This finding is confirmed positively through the recorded selected thickness of the abdominal muscles during the ability to perform sit-ups. Further evidence on the impact of resonance on force production and stiffness is required along with additional evidences and practices to support the potential effect of exercise performed on the vibrating platform.

Marquez-Chin et al (2017) in its study determined the effectiveness of adaptive electrical stimulation treatment in restoring voluntary extending and gripping following extreme hemiplegia. This study was based on randomised controlled trial samples including 21 individuals from the Toronto Rehabilitation Institute-University Health Network who suffered with severe hemiplegia of the upper limb. The participants involved were offered with occupational therapy assistance to improve the functioning of hand, shoulder, wrist and elbow. Hemiplegia hinders and also disables daily functioning in individuals. This study evidentially and strongly support that advanced functional electrical stimulation (FES) treatment proves to be a substantial intervention technique for the rehabilitation of upper limb. This study is also suggestive of the element that functional electrical stimulation (FES) treatment when coupled with other interventions from occupational therapy sector can produce major far-reaching outcomes. It successfully demonstrates that functional electrical stimulation is harmless, without any invasive properties as well without nay side-effects. This therapy shifts the patients’ marginal interdependency into complete non-dependent functioning individual. This provides better community participation and a sense of self-worth and confidence in the social world. The research by Craven, Hadi and Popvic (2015) is highly supportive of the functional electrical stimulation as an intervention in the occupational therapy system to promote the functionality advancement of the upper limp in individuals with strokes and hemiplegic conditions. Similarly, the research and study by Soderback (2015) based on individuals who suffered with stroke before the hemiplegic condition, identifies this therapy as an innovative approach to address therapeutically the hemiplegia and post-stroke physical condition in the setting of occupational therapy.

Theme 2- the effectiveness of occupational therapy for children with cerebral palsy in relation to cognitive development.

Saito et al (2021) compared the occupational therapy goals of the occupational therapists and their clients. To determine the aim, a sample of 100 patients and 79 occupational therapists were enrolled from 7 Japanese minor rehabilitation wards. The goals were based on the improvements of the participants in engaging themselves in various daily life activities and tasks and body functions. The occupational therapy provides a person-centred approach to effectively engage the patient and bring out the best outcomes. These approaches are often hindered due to minimal efforts from the patients or due to dominant behaviours of health professionals. This study highlights that the participation goal is more frequently achieved than the goals for similar body function or other activity. Even though most OTs as well as their patients believed they were main objective collaboratively, only 21% of documented objectives matched across OTs and patients. Anaby et al (2017) showed in its study that, the goals that matched were more based on the communication skills such as more towards the cognitive functioning- reading ability, semantic system function or focusing abilities and functions. This study indicates that it is difficult to maintain and perform activities on similar goals as per the requirements of the patients and therefore it would be worthwhile to look at if there is a link in between substance of objectives, patient involvement in strategic planning, the amount of goal alignment, and the health achievements made by patients when they leave treatment programs.

Cameron et al (2017) studied and showed that Cognitive Orientation to Everyday Occupational Performance (CO-OP) may have been an effective method for children with cerebral palsy (CP) in the findings of a short single-case research episode. This study focussed on 18 kids between the ages of 7 as well as 12 (nine in the CO-OP group and nine in the Present Usual Practicing Approaches (CUPA) group) had ten 60-minute sessions of treatment at homes once per day on aggregate. Following this, a prototype randomized clinical trial was achieved through the accompanying questionnaire: is CO-OP a practical technique to employ with kids with CP, but what were the benefits of CO-OP when opposed to ordinary therapy, and seems to be bigger research merited. This paper demonstrated that both the techniques simultaneously increased academic achievement and skill persistence. According to the study by Polatajko and Mandich (2004), supports the Cognitive Orientation to Everyday Occupational Performance as a well-explicated approach that helps children to acquisition the problem solving abilities, ability to plan and manage tasks and to identify self-domain activities for increasing generalizability and acquisition of other such skills through a person centred approach. Samonte et al (2004) also encourage that this therapeutic intervention helps in achieving motor skills and goals. Furthermore, the study by Cameron et al (2017) distinctly promotes the feasible use of Cognitive Orientation to Everyday Occupational Performance in children with cerebral and are 7-12 years of age. This therapy effectively produces results that may be not only helpful in acquisition of skills but also in transferability and generalizability of those skills. The results of this study simultaneously promote the investigation of Samonte et al in 2004. There is also evidential statements in this study that shows that unimanual constraint-induced movement therapy (CIMT) or hand–arm bimanual intense training (HABIT) are equally effective and supportive therapy for children with cerebral palsy, but unlike Cognitive Orientation to Everyday Occupational Performance, these therapies follow formats that are time-sensitive. Further study is needed based on these preliminary findings.

Theme 3- the effectiveness of occupational therapy interventions for children with cerebral palsy in relation to their physical and motor function.

Milton et al (2019) conducted a cross section survey of 123 candidates through national survey questionnaire. The purpose of this study was to recognize the effectiveness of home program occupational therapy in children with cerebral palsy and its benefits in managing the condition. It is evident with various older studies that, their practice in the UK is unclear and therefore this study clearly addresses the concern. A nationwide survey questionnaire of occupational therapists was done to investigate their present occupational therapy residential project practises and views regarding using residential courses with kids with cerebral palsy. The adoption and utilisation of evidence-based residential training package varied, suggesting corroboration gaps. Interviewees indicated their expert thinking well and highlighted the advantages of adopting home courses. This study is one of its kinds to recognize the utilization of professional and reasoning process that supports the occupational therapy home programme in children with cerebral palsy. The aim of the occupational therapists in home programme is to improvise the motor activity of children coupled with induced neuroplasticity, enhancement in functioning that supports self-care by regular practice sessions through professional occupation-based activities. In some cases it was observed that occupational therapy home programme was carried out by parents themselves which demonstrates that parents are part of life and not an additional liability. It is evident with this study along with the study of Novak And Berry (2014) that home based programme creates a significant impact on the cognitive rehabilitation of child along with its active social participation when the environment is supportive through parents as the therapists. This magnifies the holistic effect sustainability of sessions delivered by the professional occupational therapists. Occupational therapists, on other hand, suggest the need for further management support, additional training, and skills training to improve the quality of life for toddlers with cerebral palsy and associated caregivers.

Klevberg et al (2013) studied about the characteristics of existing strategies to enhance functional ability in young kids with Cerebral Palsy (CP), as well as investigated the variables linked with an elevated risk of hand and ADL learning, and to investigate child relationship between training and development. A cross-sectional method was employed, involving statistics from the Norwegian CP Follow-up Research as well as parent-reported data (CPOP). A number of 102 children were enrolled. Mother and fathers remarked that their children's daily activities were used as chances for education, allowing them to describe the severity of therapy simply by counting moments. Parents reported that they received a good amount of information and instructions regarding the fitness training and practices within ongoing operations, and that the benefits were escalating in overall terms. The occupational therapists were more involved with training of hand skills in multiple ways than ADL. 80% of the children were reported to gain benefits and efficiency from this training, which was also performed and followed in homes of these children, based on the guidance provided to the parents and care takers of these children. According to the study of Palisano and Murr (2009), there is often difference observed in reports of professional occupational therapists and parents on perspectives of the training. This is understood to be due to the fact that a child, in its developing stage spends most of its time in eating, dressing and playing at home and gradually develops independency in practising various day to day activities. Further, various other studies also complement these findings that the occupational therapists also agree on participation of participation as a viable factor and it integrates and accelerates the overall activities through hand training in natural settings. The collaboration of therapists with parents, children and community as consultants and coach to guide a family-centred approach promotes the building capacity and development of the child, family and community; and overall enhances the social participation and physical and motor functioning.

de Brito Brandao (2012) studied the comparison of Child's self-competence and caretakers' perceptions of children's achievement on performance objectives developed for children with hemiplegic cerebral palsy (CP) following unimanual constraint-induced movement therapy (CIMT) or hand–arm bimanual intense training (HABIT). In this study, 16 children with cerebral palsy were selected and randomly assigned to either the CIMT or HABIT groups. The findings imply that trained specificity occurs mostly for the achievement of particular goals set by parents, because both CIMT as well as HABIT may be utilised to improve children's everyday performance. There is also evidential statements in the study by Cameron et al (2017) that shows that unimanual constraint-induced movement therapy (CIMT) or hand–arm bimanual intense training (HABIT) are equally effective and supportive therapy for children with cerebral palsy, but unlike Cognitive Orientation to Everyday Occupational Performance, these therapies follow formats that are time-sensitive. Further study is needed based on these preliminary findings. According to Andrew et al (2011), constraint-induced movement therapy coupled with bimanual raining or individually has proven to produce efficient improvement and outcomes in the functioning of hand and provide better independency in social participation and performance of daily routine tasks and activities in children with hemiplegic cerebral palsy. It is also suggested that bimanual training may induce potential benefits in improving self-determined goals. There has been contradictory reports by Jeanne and Andrew (2006) suggesting that, though constraint induced movement therapy physically intervenes and improves impairment in unimanual hand function n children with hemiplegic cerebral palsy, however, hemiplegic children are seen with impaired coordination bimanually which is not much considered beyond their unilateral impairments. Therefore, this study by de Brito Brandao (2012) supports that constraint induced movement therapy along with hand–arm bimanual intense training helps in addressing the limitations of constraint induced movement therapy. The hand–arm bimanual intense training individually involves practice that is routinely structured and child-friendly.

Conclusion and recommendations

It can be implied that this review of literature demonstrates several aspects of certain studies that were never explored and can prove to be great interventional procedures in improving the lifestyle, social participation and cognitive development of children to achieve better community and educational prospective in children with cerebral palsy. There are numerous approaches that can be specific and person-centred to target the individualised needs of the children depending on the severity and ability of the condition of the child (Novak and Berry, 2014). Thematic analysis is useful for the purpose of investigating volunteer community engagement because it allows us all to investigate, from a constructivism measurement process, the manner in which individuals attach to their participatory democracy, the relevance it has in their lifestyles, and, extra widely, their preconceived notions of it. At the very same time, it allows us to investigate how all these creations may represent the ‘reality' of individuals' real-life experiences, as well as the material or social circumstances in which they exist. Overall, collectively, all these findings may provide a window of opportunity for the health professionals and policy makers to significantly gain the goals of attaining abilities and skills in children with cerebral palsy. Certain studies pose certain limitations and are based on criteria. This study looks further to provide support for developing a person-centred and task-specific approach. The effects of CP are measured based on the attitudinal attributes and acceptance of children with challenges like CP in the environment and neighbourhood. The participation and overall growth of children is determined by the facilitative and constraining capacity of the environment (Rezaie, and Kendi, 2020). Due to the obvious numerous related conditions and the intricacy of the support required, CP is best managed by an interdisciplinary approach and one of the major approaches is the occupational therapy (Kruijsen?Terpstra et al, 2014). It is recommended that, inclusion of various clinical based practices pertaining to improvement in children with various levels of cerebral palsy must be made on the basis of evidential factors and approaches to promote sustainability and to avoid gaps in any sort of intervention to save and increase the life-span of children with cerebral palsy and other associated challenges. A wide ranging source of literature and study has reported the relation between children with cerebral palsy and motor impairments and functioning abilities (Anaby et al, 2017), (Levitt, and Addison, 2018). There is a need for various studies that emphasize the impact and influence of occupational therapy in these areas for better support in growing children with early intervention (Anaby et al, 2017), (Kruijsen?Terpstra et al, 2014).

CHAPTER 7- REFLECTION

This section is the reflection on the process of undertaking a systematic review for dissertation in the context of personal and professional development that has been followed during this project. The Gibbs reflective cycle that is introduced by Graham Gibbs in 1988 with six different stages of reflection is utilised there in order to develop the reflection for this project.

Description

The module here introduced the assessment for a systematic review project that involved literature review on the topic of research that is a how occupational therapy enhances and improve the overall social participation and functional abilities of children with cerebral palsy. Firstly, while this project was introduced, I was not aware of how to develop a systematic review as I never did it before as well as they had no knowledge of it. Systematic review is identified to be a strategic search of literature on any specific scientific topic of interest that helps in interpreting the data using appropriate tools and developing new ideations as well as understanding towards a better practice phenomenon. The topic that was chosen for the systematic review included one of my areas of specialisation that is a working with children with cerebral palsy as well as occupational therapy. It is identified that several interventions are used for children with cerebral palsy in order to develop better functional abilities both physical and cognitive as well as a social participation. Therefore, it is essential that importance of occupational therapy in regard to developing functional abilities for cerebral palsy children is well determine the and this systematic review is aimed towards it. Therefore, in order to develop the systematic review, the brief was well followed as well as the university guidelines and guidance from the tutor and colleagues of was achieved. The background and proposal of the research was developed and after initiating a feedback on it appropriate development of the search strategy and review of literature using the critical appraisal skills program tool for 8 relevant papers were developed. The appraisal of each paper was developed as well as the results were indicated after thorough interpretation of the findings through the appraisal. Later the discussion using the supporting evidence as well as the results indicating findings for each objective of the research was developed and the overall interpretation was concluded. The overall process of development of systematic review was a learning experience for me and therefore this reflection is helpful in identifying what aspects I learned.

Feelings

Initially while the project was introduced to us in this module, I was very nervous because I had no knowledge of research or even systematic review. I did some parts of the literature review in my previous assignments are but a developing a whole systematic review on a specific topic was a new thing for me. It made me nervous but simultaneously I was very much excited to learn about it and develop my researching and critical appraisal skills.

Eventually when I developed the plan for doing the systematic review, I gained some knowledge regarding researching as well as developing the search strategy and critical appraisal of the papers from my colleagues and tutor. I felt really good that I got the opportunity to develop Mira searching a skill that I can use din future prospects also to enhance my evidence-based practice. Moreover, when I started searching for relevant to literature, I felt a little overwhelmed up because of the wide and huge data set on the particular topic that made me really confused regarding which articles to choose and which to not. Yet after overall development of the review as well as search strategy I was able to select 8 appropriate articles. All song my nervousness and relative fear of not doing this project will also reduce as I started doing it and also received help from my colleagues and tutor.

Evaluation and Analysis

Systematic reviews are a credible source of literature that develops over all interpretation of the findings of from different pre-existing literature on any topic and help the reader to identify the up-to-date and current knowledge on any specific topic of research. Systematic review is the one aspect of research that helps the researcher to develop appropriate search strategy and researching skills that are utilised for developing other mixed method researches in future. According to Aveyard 2014, developing a thorough and appropriate systematic review provides the researcher and opportunity to develop effective skills of critical appraisal that not only helps in increasing the methodologies and findings of the pre-existing result but also provides an in-depth understanding of the methods as well as designs that can be utilised for developing future primary researches on similar or other topics. The overall systematic review on this topic helped me to understand several aspects of how occupational therapy can be used in developing better functional ability is a both physically and mentally for the children with cerebral palsy as well as it also enhances the mine researching skills and critical appraisal skills that will be required in determining better evidence-based practice in future.

Conclusion

The overall evaluation and reflection on how the systematic review was developed the concludes that this overall project helped me understand the skills of researching as well as enhanced my overall ability to work the developing better evidence-based practice and future and also develop critical appraisal skills for identifying and embracing the methods and findings of different researches.

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Occupational Therapy for Children with Cerebral Palsy

Contents

CHAPTER 1

1.1Introduction

1.2Background for the research

1.3Research Aims and Objectives

CHAPTER 2- PROTOCOL FOR SYSTEMATIC REVIEW

CHAPTER 3- RESEARCH METHODOLOGY

3.1 Study Design

3.2 Research methods

3.3 Search strategy

Database search

Search terms

3.4 Restriction in the literature search

3.5 Inclusion criteria and exclusion criteria

CHAPTER 4 – CRITICAL APPRAISAL

CHAPTER 5- RESULTS

CHAPTER 6- DISCUSSION

CHAPTER 7- REFLECTION

References