Established care
Goal-directed, task-specific training
Goals–Activity–Motor Enrichment, functional training
Not a brand of therapy but the principle underneath the ones that work: the child practises the actual task they are trying to learn, with enough repetition to matter.
Either a medicines regulator has licensed it for this use, or clinical practice guidelines recommend it on the strength of controlled trials. This is the standard everything else on the scale is measured against — and for most children, the treatments at this level are the ones that will actually change their day.
Where it stands, condition by condition
The same therapy can be well supported for one problem and completely untested for another. This is the single most common place families are misled.
| Condition | Evidence | What that means here |
|---|---|---|
| Cerebral palsy — motor function | Established care | The most consistently supported approach in cerebral palsy guidance across age groups. |
| Acquired brain injury | Established care | Same principle, same support. |
| Genetic and neuromuscular conditions | In clinical trials | Widely applied and biologically sensible; formal trial evidence is thinner in rarer conditions. |
What it is
The child, the family and the therapist agree a small number of specific, meaningful goals — drinking from an open cup, getting from the floor to standing, managing a zip — and then practise those exact tasks.
It replaces an older model in which a therapist moved the child's limbs through “normal” patterns and hoped function would follow. Passive handling on its own has not held up.
Three things make it work: the goal matters to the child, the task is just hard enough, and it is repeated often enough. Repetition is usually the part that is missing.
How it is meant to work
The brain strengthens the connections it uses. Practising the actual movement, in the actual context, is what drives that; practising a component of it in isolation transfers poorly.
This is why a goal chosen by the family generally beats a goal chosen from an assessment form — motivation determines how many repetitions the child actually does.
What has actually been tested
- Goal-directed, activity-based approaches are recommended across international cerebral palsy practice guidance and are the comparator most new interventions are measured against.
- Trials consistently show gains on individualised goal measures. Gains on broad developmental scales are smaller, which is expected: the child improves at what they practised.
- That is worth understanding before judging any treatment on this site. Specific practice produces specific gains. Any therapy promising broad, global improvement is promising something rehabilitation itself does not deliver.
What we still do not know
- How much practice is enough — dose–response is poorly defined and varies by child and goal.
- How best to maintain gains once a block of therapy ends.
- How to deliver sufficient intensity in systems that fund an hour a week.
Risks and costs
- Few physical risks. The costs are time, family energy and the frustration of goals set too high.
- A goal the child has no interest in will not be practised, and the programme fails quietly.
Questions to ask before you agree
A centre that is doing good work will welcome these questions and answer them in writing.
- What are my child's three current goals, written in their words or mine?
- How many repetitions a day does this need, and how do we fit that into real life?
- How will we measure the goal, and when do we review it?
More in this section
Early detection and early intervention
The single highest-value thing in this whole field, and the one least often discussed in clinics selling treatment. Cerebral palsy can be identified in the first months of life, and that is when therapy does the most.
Established careConstraint-induced therapy and bimanual training
For a child who uses one hand much more than the other, these are among the best-evidenced interventions in paediatric neurology — and both work, for different things.
Established carePhysiotherapy and strength training
Well supported when it is built around function and genuinely loaded — much weaker when it is passive stretching and generic exercise.
Established careOccupational therapy
The discipline that works on what the child actually does all day — dressing, eating, writing, playing, getting through a school morning.
Established careSpeech, language and communication
For a child who cannot speak clearly, giving them a way to communicate is among the most consequential interventions available — and the fear that it will stop them talking is unfounded.
Established careSpasticity and tone management
Medical and surgical treatment of tone, which works best when it is tied to a functional goal rather than to a number on a tone scale.
In clinical trialsTechnology-assisted rehabilitation
Useful mainly as a way of delivering more practice, not as a treatment in its own right — and that distinction decides whether it is worth the money.
In clinical trialsNamed physiotherapy approaches
Families are usually asked to choose between brands. The evidence says the brand matters far less than whether the session is active, goal-directed and repeated often enough.
In clinical trialsSensory therapies
Two things are sold under one word. Manualised Ayres Sensory Integration has been tested in trials; the sensory add-ons sold around it mostly have not.
Established careVision and cerebral visual impairment
The most commonly missed problem in children with brain injury. A child who cannot interpret what they see is often described as inattentive, uncooperative or more delayed than they are.