Occupational Therapy & Cerebral Palsy

1.1Introduction

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 emphasizes 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.

Protocol for Systemic 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 where 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 cause 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).

RESEARCH METHODOLOGY

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).

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).

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”

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.

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.

Outcome of the search

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.

References

(Centers for Disease Control and Prevention [CDC], 2018)

Abutabenjeh, S. and Jaradat, R., 2018. Clarification of research design, research methods, and research methodology: A guide for public administration researchers and practitioners. Teaching Public Administration, 36(3), pp.237-258.

Al Kilani, M., 2016. An overview of research methodology in information systems (IS). Open Access Library Journal, 3(11), p.1.

Anaby, D., Korner-Bitensky, N., Steven, E., Tremblay, S., Snider, L., Avery, L. and Law, M., 2017. Current rehabilitation practices for children with cerebral palsy: focus and gaps. Physical & occupational therapy in pediatrics, 37(1), pp.1-15.\

da Silva, C.S.R., 2017. Research design-the new perspective of research methodology. Journal of Education, Society and Behavioural Science, pp.1-12.

Dalvand, H., Rassafiani, M. and Hosseini, S.A., 2013. Handling in the children with cerebral palsy: A review of ideas and practices (A literature review).

Fung, C. and Mittal, R., 2014. G157 (P) Changing Referral Patterns to a District Child Development Centre (CDC). Archives of Disease in Childhood, 99(Suppl 1), pp.A69-A69.

Graham, N., Truman, J. and Holgate, H., 2014. An exploratory study: expanding the concept of play for children with severe cerebral palsy. British Journal of Occupational Therapy, 77(7), pp.358-365.

Kruijsen?Terpstra, A.J., Ketelaar, M., Boeije, H., Jongmans, M.J., Gorter, J.W., Verheijden, J., Lindeman, E. and Verschuren, O., 2014. Parents’ experiences with physical and occupational therapy for their young child with cerebral palsy: a mixed studies review. Child: care, health and development, 40(6), pp.787-796.

Levitt, S. and Addison, A., 2018. Treatment of cerebral palsy and motor delay. John Wiley & Sons.

Marret, S., Vanhulle, C.A.T.H.E.R.I.N.E. and Laquerriere, A.N.N.I.E., 2013. Pathophysiology of cerebral palsy. Handbook of clinical neurology, 111, pp.169-176.

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.

Miranda, P.A. and Vendivel, F.G., 2021. Center-Home-Based Instruction of Children with Cerebral Palsy from a Symbolic Interactionist Perspective: A First Look. Asia Pacific Higher Education Research Journal (APHERJ), 8(1).

Mishra, S.B. and Alok, S., 2017. Handbook of research methodology. Educreation,.

Okoli, C., 2015. A guide to conducting a standalone systematic literature review. Communications of the Association for Information Systems, 37(1), p.43.

Patel, D.R., Neelakantan, M., Pandher, K. and Merrick, J., 2020. Cerebral palsy in children: a clinical overview. Translational pediatrics, 9(Suppl 1), p.S125.

Peters, C., Chang, A., Morales, A., Barnes, K. and Allegretti, A., 2019. An integrative review of assessments used in occupational therapy interventions for children with cerebral palsy. Cadernos Brasileiros de Terapia Ocupacional, 27, pp.168-185

Randolph, J., 2009. A guide to writing the dissertation literature review. Practical Assessment, Research, and Evaluation, 14(1), p.13.

Rezaie, L. and Kendi, S., 2020. Exploration of the influential factors on adherence to occupational therapy in parents of children with cerebral palsy: A qualitative study. Patient preference and adherence, 14, p.63.

Ridley, D., 2012. The literature review: A step-by-step guide for students.

Kruijsen?Terpstra, A.J., Ketelaar, M., Boeije, H., Jongmans, M.J., Gorter, J.W., Verheijden, J., Lindeman, E. and Verschuren, O., 2014. Parents’ experiences with physical and occupational therapy for their young child with cerebral palsy: a mixed studies review. Child: care, health and development, 40(6), pp.787-796.

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.

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.

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.

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.

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.

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.

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.

Occupational Therapy's Impact on Social Participation and Cognitive Development in Children with Cerebral Palsy