Perspectives on tactile intervention for children with cerebral palsy: a framework to guide clinical reasoning and future research

Abstract

Purpose: Many children with cerebral palsy (CP) are known to experience tactile impairments. Research evaluating specific interventions to manage this is, however, minimal. This paper seeks to consolidate current literature and provide a framework to help clinicians and researchers think strategically about tactile treatment selection and future research planning.

Method: The framework is described via a novel analogy – “The Apartment Block Theory”. The theory describes the relative effectiveness of three intervention strategies aimed at overcoming a poorly responsive tactile system: (1) Pressing the buzzer – providing repeated passive tactile stimulation at the periphery; (2) Sneaking in the door – providing active tactile-enhanced motor training that capitalises on the opportunity to provide high-dose tactile input during motor interventions; and (3) Connecting another way – providing visually enhanced touch strategies with the aim of enhancing tactile function, which can be compared to phoning the apartment as an alternative to using the buzzer.

Results: Using this theory, the paper describes which sub-groups of children with CP may benefit from each intervention strategy when considering their capabilities in visual, motor, and attention domains.

Conclusions: This theory can assist clinicians to provide effective interventions and researchers to make informed future research decisions to optimise tactile function for children with CP.

Implications for Rehabilitation

• Although tactile impairments are reported to be common in children with cerebral palsy, very few successful interventions are reported in the literature.

• Visually enhanced touch is a successful strategy for treating tactile impairments in children with cerebral palsy who have sufficient vision and attention.

• Combining intentional tactile input with upper limb movement training may improve tactile function in children with cerebral palsy who have sufficient movement and attention.

• In children who have complex co-morbidities, including both visual and movement impairments, it may be necessary to consider providing passive tactile stimulation in tactile intervention.

Keywords:

• Tactile
• sensation
• touch
• therapy
• child
• cerebral palsy

Disclosure statement

The authors report no declarations of interest.

Additional information

Funding

MA is supported by a Translation of Research into Practice (TRIP) Fellowship from the National Health and Medical Research Council (NHMRC), Australia (#1073226).