Play and cerebral palsy: bathing, hygiene, dental care, dressing, exercise, feeding, hearing, nutrition, seizures, sleep, suctioning techniques, suppositories & enemas, toilet training & bowel issues, and vision care.

“Play is an essential activity for all children. This is where real learning begins. It may not be easy to some children who have CP to engage in spontaneous play so you will need to be ready to give whatever assistance you can to help them enjoy playing. This is an area where you can fully involve friends and family in helping your child to develop.

…You will need to ensure that your child’s toys are readily available, easy to get at and that she has some way of letting you know what she wants to play with at any given time. As she gets older, and depending on the degree of her disability, she will be able to indicate this in a clear and certain way. However you need to ensure that she doesn’t miss out on the early opportunity to make choices in the area of play. As early as possible you need to establish a way for her to indicate preferences. This may be through speech or signs and, later on, through sign boards or electronic communications. If you child is slow to develop speech, a speech and language therapist can help you and your child to find the quickest and easiest method of communication.

The following list of play ideas are graded from the very young upwards. I’m sure there are lots more ideas that you can think of yourself. A mirror can be a great aid in playing so that your child can get visual feedback on what she is doing. It can even be actively introduced into play by enabling the child to, for example, smear shaving cream on to it or blow bubbles toward one.

0 –2 Years
• Play mat and frame with dangling toys
• Rattles, windmills
• Rocking and bouncing games
• Making lots of babbling and cooing noises
• Tickling games
• Building bricks – begin with building them up for her to knock down, later on help her to build her own towers to knock down
• Picture books – you can also get picture books which have the complement of sounds and raised textures to stimulate hearing and touch
• Hide and seek toys and people behind curtains/under towels etc.
• Hitting things – wooden spoons on saucepans, for example
• Imitation and turn-taking
• Playing with mirrors
• Unwrapping toys (don’t put tape on wrapping paper)
• Water and sand
• Lentils, rice and pasta in tubs to sit in, put your hands in or just throw about

NB: You need to be careful to watch that she doesn’t put small objects in her mouth that she might choke on.

1-3 Years
• Posting box games
• Finger puppets
• Tunnel games
• Surprise bags full of toys and interesting objects for your child to find
• Pulling and pushing
• Lucky dip
• Picking correct object from a selection (for example you can ask your child to find the cow from a selection of farmyard animals)
• Pretend games with dollies and teddies
• Painting, using fingers or brushes
• Cars and trains

2-4 Years
• Story books
• Helping round the house
• Making cakes and other food
• Ball games
• Obstacle courses
• Messy play with a purpose (i.e. sculptures in sand, boats on water)
• Playdough modeling
• Sticking textures on paper with non-toxic glue
• Printing (potato prints etc.)
• Spot the difference
• Shape and color matching
• Make believe
• ‘Simon says’-type copying games
• Toy shops
• Turning boxes into toys (such as castles, cars or space ships)
• Lego-Duplo
• Action rhymes
• Listening games
• Making music with home-made instruments (The Cerebral Palsy Handbook: p 107 – 108)

“If your child has the cognitive and social-emotional skills, he should have help bypassing or making adaptations for lagging motor skills. For example, if your child’s problems with head or hand control prevent him from actually building a block tower, he may still enjoy watching you construct the tower – perhaps by choosing the color of each successive block verbally or by eye gaze. If possible, you should let him experiment with making the blocks fall through some type of body movement. Let your child be the architect of the play situation, while you take the role of laborer.

When your child plays by himself, simple adaptations to toys can often help him overcome motor problems. For example, if he has some control, he may enjoy constructing a tower using magnet blocks or large plastic snap blocks, or you can adapt some wooden blocks for him by gluing Velcro to them. In this age of advanced technology, even children with serious motor problems can activate a switch to turn on a tape recorder or cause the toy piano to play or a mechanical dog to walk and talk.

There are many adaptations that can allow children with limited movement to play with the help of a computer. For example, a “touch window” or “touch screen” placed directly on the monitor screen can give your child control of the computer, bypassing the need to use the keyboard or mouse. Alternative switches, modified trackballs, and mouse devices are also available for children with limited hand function. With the help of these devices and appropriate software, a child can use he computer to draw or paint a picture, even if he is unable to hold a pencil or paintbrush. Many familiar childhood manipulation games, including jigsaw puzzles, card games, and board games such as Candy Land, checkers, chess, and Monopoly have been adapted to computer use. Computers and CD-Roms have truly expanded the possibilities for play and learning opportunities for children with cerebral palsy.

Toys are the tools of play and they can be elaborate and expensive as you desire, but often the best toys are simple household objects or throwaways. Pots and pans, measuring spoons and cups, cardboard paper rolls, cardboard boxes are perennial favorites. When choosing these or any other toys for your child, first keep safety and ease of care in mind. Then think of the appeal of the toy, and how many different ways your child can use it. For example, a video game can only be used as a video game, but a truck or a doll can be used in many ways. Finally, it is important to remember your child’s developmental age and choose toys for that age level.” (Children with Cerebral Palsy: p. 139 –141)

“The right kind of toys in a therapy department has a good impact on children and their families when they first attend. Seeing other children actively playing during therapy motivates both the child and his family to be actively involved themselves. A broken doll and a therapist desperately snapping his fingers to attract a child’s attention are very poor substitutes.

It is very important to keep the toys in a cupboard and to only take out what is needed for any child at any one time. Too many toys at once can be distracting and counter productive. The right containers for toys are also important so that all the toys do not end up in a jumble of mixed-up pieces. Jigsaw puzzles need to be kept separate wit all their pieces intact. A set of blocks should be kept in one container, a set of objects especially collected for texture in another. Toys that are broken or incomplete should be repaired or thrown away.” (Children with Cerebral Palsy: p. 138)

“For young children with cerebral palsy, one of the best ways to encourage movement is through the roughhouse play that other children instinctively make a part of their regular exercise. The touch and movement input that is so much a part of this type of play is essential to the development of normal tactile (touch) and vestibular (response to movement) systems. Furthermore, your child will enjoy roughhousing, so long as you keep in mind the principles of good handling and pay attention to your child’s body. For example, if throwing your child up in the air makes him stiff as a board, think of another, slower activity, involving some trunk rotation and leg dissociation (separation) to reduce his tone. A good alternative might be the human merry-go-round, in which you hold your child face-to-face with his legs straddling your waist and twirl around. Try to remember that low-tone children generally respond well to fast movements, while high-tone children respond better to a slower pace. Also remember that your child won’t break, so don’t be afraid to handle him.

Ideally, you will be able to make your child’s exercise a part of your daily routine by incorporating it into such activities as diapering, dressing, and feeding. Your child’s occupational and physical therapists can give you specific tips on how to do this, but here are two general guidelines: 1) Place objects far enough away from your child that he needs to reach for them or crawl to them. For example, if you are working a puzzle with your child, don’t simply hand him the pieces. Let him pick them up (or try to pick them up) from the table or tray. 2) Encourage your child to do all the physical activities he is capable of, even if it sometimes seems easier for you to do them. For example, if y our child has the movement skills to put his blocks away in his toy chest but takes a very long time to do it, try not to get impatient and do it for him…."(Children with Cerebral Palsy: p. 123-126)

“When the child with cerebral palsy moves she may do so in a very strange or abnormal way. To some extent this should be allowed, as long as the child is able to do things as best she can. But also show the child other ways to move in order to correct some of the abnormal positions that she repeats again and again.”
Disabled Village Children

“Play for the Child with Cerebral Palsy: Shows how play and having fun can also be a learning experience. Available in English, Hindi, Bengali.”
Indian Institute Publications

“Specifically, Toy Tech is a unique resource and lending library for children with cerebral palsy and other developmental disabilities ages birth to seven years and their parents.”
Toy Tech

“With an Early Intervention program, you'll probably be given exercises and therapeutic games to play. Anything that encourages crawling will be a big help - that probably means you'll be doing a lot of crawling yourself.”
Children’s Disabilities Information



	A bridge to feeling confident and accepted in the context of a debilitating condition often begins with an ability to examine life in the context of play and metaphor. Play is the laboratory for your youngster to explore the possibilities and limitations of his or her world. The excerpts and links below offer a number of options for you to sort through which paths best represent fruitful opportunities.