Photo courtesy of Cubro

• Early interventions assist with your child’s development, if there are delays or concerns about how they are progressing.
• Early health and education intervention services may work together.
• There are choices of early intervention providers, dependent on which region you live in (see examples in the table below).

Child Development Services across NZ

Health NZ, Te Whatu Ora provides early health interventions across NZ through Child Development Services. Information on services in each region are found at www.healthpoint.co.nz

Child Development Services offer a range of assessment and intervention services, depending on the needs of your child and whānau. The age range for services is different for each region in NZ.

The Child Development team will work alongside your whānau to improve your child’s independence in everyday activities.

Team members generally visit your home to see you and your child, or they could see you at the hospital or clinic.

Your child can be referred through your GP, other health professionals and health providers such as Well Child.

The Child Development Service will work with you and your child:

• To understand your child’s and whānau needs
• To support you with early learning and activity opportunities
• To help plan how activities can be included in everyday life for your whānau.

Key points when looking for interventions:

• Interventions help your child and whānau work towards a goal or focus
• Interventions should be centred around your child and whānau
• Interventions should be about fun, play, moving, exploring and learning
• Interventions encourage your child to take part in everyday life activities suitable for your child’s age and stage
• Interventions need to become more challenging as your child develops skills.

Early activity ideas

Play

Play and toys may need to be adapted for your child. A therapist can also help you work out activities and toys that are fun for your child, to fit their needs.

Ideas to consider when looking for toys:

• Think about different sensory aspects – does your child like textures, noise or pop-up toys that give a reaction after a button or similar is pushed
• Toys with high colour contrast or that encourage active movement of hand, fingers, or body
• Toys that can be used in different environments and positions such as when your child is lying on their tummy or side, or when standing
• Toys that need ‘two hands’ to make them work, like pulling apart toys stuck together with velcro
• Toys that encourage the use of different hand grips, like picking up small objects between fingers and thumb or using the whole hand
• Toys and activities that encourage two hands working together or two hands being in the middle of the body – like clapping hands or holding a ball or soft toy
• Holding the affected or weaker hand when walking with whānau
• Placing or giving toys to the affected or weaker hand so your child learns to hold, play or pass to the other hand
• Check out Toy libraries in your area: Toy Library Federation of New Zealand
  • General Toy Libraries: www.toylibrary.co.nz
  • Christchurch toy library for special needs:  www.learningneedslibrary.co.nz
  • Waikato toy library for special needs: https://www.ccsdisabilityaction.org.nz/toy-library

Setting up for play, activities and feeding

If needed, think about using cushions, tri pillows and/or therapy equipment, even for a short time, to help your child use toys, play and engage with others and be more independent.

If it is needed, a therapist can provide or give advice on equipment to help with:

• Feeding – modified highchairs
• Bathing and showering
• Seating – at home, in the community, in the car – for example, corner chairs
• Standing and walking
• Orthotics – for legs and arms. These can be used from early in development to help standing and moving.

Tips on eating and drinking with infants

Make sure anyone else who looks after your child (ie daycare, school) knows if they need help with opening their lunchbox, drink bottle or any packets.
Straws and modified Sippy cups can assist independent drinking and feeding.

Hand activities for children 2 years and over

If your child has hemiplegia, where one side of the body is more impacted or weaker than the other, you may want to encourage play and everyday activities that use both hands.

The therapy team can give advice on specific therapy programs for hand and arm use. These may include types of play that include concepts of constraint induced therapy and/or bilateral hand therapy.

• Constraint therapy encourages the use of the weaker hand by limiting movement of the stronger hand for short periods, by putting a mitt, glove or sock over the stronger hand. This may be used if children are not actively using their hands together and is a step towards doing two-handed play and activities.
• Bilateral hand therapy – is finding activities that promote using two hands together. This can include a wide range of everyday tasks such as dressing, eating, messy play and clapping.

Communication and learning

Your baby learns sound recognition and interaction from plenty of early face-to-face nurturing attention, talking, singing and other sounds to build communication skills.

If there are delays with your child’s communication a therapist can help look for possible causes and then discuss what you can do. Delays may be due to movement, communication or understanding problems, or all these things.

A Speech Language Therapist (SLT) can talk with you about options that can help your child and family communicate. An SLT can also help you understand how your child communicates. This could include specific parent–baby programmes.

Equipment and technology can help promote your baby’s early communication. Make an early connection with TalkLink Trust to help you with the right assistive technology for your child: www.talklink.org.nz

Tips to encourage communication until your child can communicate with words and sounds include:

• Talking, singing, reading and playing with your baby
• Creating easy hand signs or ‘baby sign’ between you and your baby to communicate
• If needed, an SLT can talk with you about using simple picture boards for pointing
• Check out information on infant speech: www.kidshealth.org.nz/speech-sound-development

Sleep

Good sleep routines are helpful for all children, whether they have CP or not. Safe sleeping and a safe place to sleep is needed for all babies and children, with each whānau achieving this in different ways depending on your beliefs, values and sleep practices.

Sleep for children with complex needs can be affected by increased muscle tightness as well as a lack of ability to move freely.

Working towards good sleep can involve a team effort to assist you, your child and whānau to find what works best. This can involve managing wider issues that can impact sleep including comfort, position, physical abilities, room lighting and temperature, moving and handling, and management of medical related conditions such as muscle tone, epilepsy, reflux and breathing difficulties.

See: www.plunket.org.nz/caring-for-your-child/safe-sleep

Check out this link on advice around sleep and activity times for children with CP: www.onlinelibrary.wiley.com/action/downloadSupplement?doi=10.1111%2Fdmcn.14654&file=dmcn14654-sup-0001-FigS1.pdf

From: Verschuren, O., Hulst, R. Y., Voorman, J., Pillen, S., Luitwieler, N., Dudink, J., & Gorter, J. W. (2021). 24-hour activity for children with cerebral palsy: a clinical practice guide. Developmental medicine and child neurology, 63(1), 54–59. www.doi.org/10.1111/dmcn.14654

Toileting

Therapists can help with toileting equipment if needed for daycare, pre-school or school.

The Continence NZ website has a range of useful resources:

• www.continence.org.nz/pages/Continence-Information-Disability-and-Medical-Conditions/274/
• www.continence.org.nz/pages/Toilet-Training-for-Children-with-Autism-Spectrum-Disorders,-and-Learning-Disabilities/89/

Activities in the community

• Your child can obviously take part in any community activity that they and you enjoy.
• The Halberg Trust and Parafed are national organisations (see contact details below) that:
  • give advice on how to include people with disabilities in sports
  • work with sports groups, early childhood centres and schools to achieve this
  • give advice on existing activities in your region.

Examples of community organisations specific for people with disabilities:

Age range	Organisation and location	Details
Preschool and School age	Halberg Trust – NZ wide	Promotes people with disabilities being included and finding joy in taking part in sports throughout New Zealand. www.halberg.co.nz
Preschool and School age – from about 4 years onwards	NZ Riding for Disabled Association (NZRDA) – NZ wide	Provides therapy through horse riding for children with physical and cognitive needs. www.rda.org.nz
Preschool and School age	Wilson Home Trust Hydrotherapy – Auckland	Therapy in water. www.wilsonhometrust.org.nz/child-and-family-support/programmes
School age	Parafed – NZ wide	Network of sports and recreation opportunities for people with disabilities. www.parafednetwork.co.nz
School age	Circability – Auckland	Circus programmes for people with disabilities. www.circability.org
All ages	CP Society – getPhysical – NZ wide	Funding support towards a range of activities for members of the CP Society. www.cerebralpalsy.org.nz/member-services/programmes/getphysical
All ages	Gymnastics – Auckland	Gymnastics programmes for people with different abilities. www.tristar.org.nz/diverse-ability-gymnastics
All ages	Functional Adaptive Movement™ (FAM™) – Auckland and Christchurch	Strength and conditioning programmes for people with disabilities. www.functionaladaptivemovement.com

What helps us learn?

Neuroplasticity is the brain’s ability to change and adapt through growth and reorganising.

Think about when you last learnt a new skill. Everyone needs to practise and have opportunities to practice so our brain and muscles can learn what to do. If we aren’t successful the first time, we get feedback so we know what we need to do differently next time so we can improve and be successful.  

When babies and children move, play and explore they are practising and learning skills and getting feedback for next time. For children who have difficulty moving or controlling their muscles they may not have as much opportunity to practise moving, playing with toys and having social interactions on their own, so therapists can help you and your whānau make this easier for your child to do.

Learning new skills for babies works best when:

• They have the essentials such as good sleep, good nutrition, a safe environment, are pain free and their whānau are well.
• Whānau involvement is key to including activities as part of everyday life and engaging with other children of the same age.
• Learning is fun, short and engaging. Regular practice for the child keeps it fun.
• The child is actively taking part – where possible, the child is doing movements by themselves or helping making decisions about what to do.
• Learning needs to be challenging enough to learn new skills but not so hard it is too much.

Therapy/health terms you may hear

Terms	Meaning
Enriching the environment	Having an environment that helps someone learn. This can include being in social, indoor, outdoor environments and use of different sensory textures, colours, and toys. You know your child best and a busy environment might be too much for them or they might need quiet time.
Goal directed	Therapy works best when there is a clear goal or task that you and your child want to do. This keeps therapy relevant, and you can track if things are not working and need to change.
Intensive or intensives	This is about the amount of time or number of hours a day a child takes part in a therapy. This is based on the idea that repeating activities is helpful for your child to learn new skills. The amount of practice that gives the best outcome for your child will be different depending on the task and your child. Remember, your child needs to be actively taking part in therapy and activities that are fun, engaging and functional.
Task specific	Learning works well when you can practise at ‘just the right’ level (not too hard, not too easy). Sometimes your child might start by learning and practising parts of the task. Other times your child might practise the whole task. For example, with dressing skills a child may start by doing the final part of pulling their trousers up independently, and then work ‘backwards’ to learn all the other steps needed to put their trousers on.
Repetition	When your child is learning a new skill, they will need to practise a lot. When children play and explore they are practicing and repeating a whole range of new skills. Children with movement impairments may not have the same opportunities to move, explore and play by themselves so therapy intervention can help to set up an environment allowing them to repeat practice and play more easily.
Neuroplasticity	This is the ability of the brain to change and adapt through growth and reorganising. Neuroplasticity happens during growth and development, and after an injury. To help with neuroplasticity children need lots of practice in activities that are engaging, active and fun.
Bimanual (both hands) or Bilateral (both sides) Therapy	The aim is to improve hand and arm use, with activities designed to encourage coordination using both hands to complete tasks, activities and play.
Constraint Therapy	The aim is to improve hand and arm use, especially for children with one side of their body weaker than the other. This therapy involves wearing a glove or mitt to restrict use of the stronger hand or arm during therapy, so the other hand or arm does more work and gets stronger.
Selective Dorsal Rhizotomy	Surgical procedure to reduce muscle tightness in the leg muscles in children with CP. The surgical process of cutting sensory nerve roots in the lower spinal cord is combined with intensive therapy and rehabilitation afterwards to get the best possible function. The surgery is not done in NZ, but doctors in NZ can advise on whether it may be suitable for your child.
Intrathecal baclofen	This is a treatment for children with a lot of muscle spasticity and tightness. Baclofen is a medicine that relaxes the muscles and can be delivered via a permanent pump in the child’s abdomen (tummy).
Botulinum toxin A called Botox®	This treatment is used to reduce muscle spasticity and tightness in children with CP. The treatment provides temporary reduction in muscle tightness to selected muscles. The child is given an anaesthetic and then the drug is injected into the muscle.