Designing Home Therapy Programs

For home-based therapy, therapists can create a home program for each participant. This document will provide suggestions on movements and activities to practice each week. The home program is a guide, with flexibility for caregivers to modify activities as needed.

The home program may include a practice diary for caregivers to track practice time. It may help to encourage caregivers to write notes to share with their therapy team. Notes should include any questions, challenges, or successes experienced while practicing at home.

A home program template can be downloaded here.

Designing the home-based therapy requires identification of goals. The movements and activities selected should target these goals. 

Family-centred, Individualized Goals

All content in the home program should be family-centred and individualized. Caregiver-identified goals should be used to tailor therapy to each child and family’s needs and desires for therapy. The Canadian Occupational Performance Measure (COPM) can be used. Caregivers identify individualized functional goals that are meaningful for them and their child.

The collaborative approach section discusses how to set goals with caregivers.

Therapist-identified Goals

COPM goals are very useful for individualizing therapy content for each child and family. However, the COPM goals may be generic and more focused on participation. Goal Attainment Scaling goals can be set by a therapist to tie the COPM goals to the possibilities of therapy content.

If appropriate, the COPM goals can be used as GAS goals, or the therapist can identify goals that are precursors to accomplishing the COPM goals. These can be impairment-focused goals based on the child’s limitations or strengths and the potential of the intervention.

Motor learning broadly refers to changes in movement performance due to changes in the brain’s control of movement. Motor learning is necessary for sustained skill improvements. To promote motor learning, practice should be repetitive and progressive, with a variety of activities in a real-life setting.  

Brainstorming strategies to reinforce target movements and emerging skills with caregivers is important for generalization and translation of skills beyond therapy sessions. For example, selecting a sippy cup with handles and offering it on the assisting side may encourage supination with grasp during mealtimes.

Repetitive Practice

Repetition is a key ingredient for motor learning. The more a movement is practiced, the greater the opportunity for the brain to improve and strengthen control of that movement. The home program should focus on promoting as many repetitions of target movements as possible. This may require suggestions of different activities that elicit the same movement, as young children may or may not engage when asked to do the exact same movement multiple times.

Progressive Activities

Increasing the challenge promotes continued improvements in the brain’s control of movement. Activities can be progressed by targeting the “just-right” challenge. Motor learning is incremental; as a result, careful grading of activities is important for optimal child engagement and ultimately for therapy to be successful.

Targeting the just-right challenge will require suggestions for the caregiver to grade activities up or down. Some ideas include changing the object (e.g., size, texture, weight), changing where the object is presented (e.g., closer or farther away, from a surface or dangling, object orientation). Another way to adjust the challenge is for the caregiver to be more or less involved in the activity. For example, helping a child move a rattle (i.e., physical support) decreases task difficulty compared to pointing at the rattle as a cue for the child to grasp it (i.e., gesture).

Here is an example for the target movement of sustained grasp. The activity is squeezing sponges filled with water.

Ideas to grade up (progress):

• Caregiver prompts the child to squeeze sponges with forearm in neutral rather than in pronation
• Child uses smaller sponges or harder sponges
• Number of sponges to squeeze is increased

Ideas to grade down:

• Child stabilizes forearm on a table
• Caregiver positions wrist in neutral to slight extension to provide active assisted facilitation for a power grasp
• Child uses sponges that are easier to squeeze
• Caregiver places sponge in child’s hand

Variety of Activities

Practicing movements in a variety of real-life activities can promote motor learning transfer (generalization). Transfer is the application of a learned skill in a new context. If a child learns a skill in only one context, it will be more challenging to transfer that skill. If they learn the skill in a variety of contexts, the skill will be more easily transferred.

Selected activities in the home program will depend on the child’s interests, age, and skill level. Activities should be easy to do, so caregivers don’t need a lot (or any) set-up or clean-up time. The best activities are simple things that the caregiver may already know how to do. This will make it easier for the caregiver to teach their child.

Sensory activities may be appropriate, as sensory processing can be more challenging for children with CP. Often the focus is on senses of touch, sight, and sound. Children need practice using their senses to learn how adjust movements for a variety of objects. Sensory activities also help increase awareness of the assisting hand, which can in turn increase use. Sensory play may include things like water play, handling textured balls, or poking play-dough.