Hemiparesis in Children: Pitfalls and Rehabilitation Solutions from an Occupational Therapist

Hemiparesis in Children: Pitfalls and Rehabilitation Solutions from an Occupational Therapist

Whether you and your kiddo are just starting out in your therapy journey or you have been at it for years, problems and plateaus will occur. Occupational therapists are great resources to help troubleshoot you through a complex rehab journey. Check out these useful solutions to 3 common home therapy missteps:

Problem 1: Expecting too much too soon

No matter the type of disability, the brain and body of a kid are still developing. Smooth and controlled movements don’t happen overnight for anyone. Learning to use a weak or neglected arm can be as hard for your child as it would be for you to scale a cliff. Expecting too much too soon can lead to feelings of failure and frustration.

Solution 1: Find the “just right challenge”

OTs love this term. It means adapting any task to include a balance between “this is too easy, I’m bored” and “I can’t do this, I give up.” Often finding this balance takes some trial and error and is an ever-evolving process. The goal is for your child to walk away from the task feeling empowered after accomplishing something that was somewhat challenging but not impossible.


Problem 2: Trying to eliminate “cheating”

Everyone wants perfection, but often children with hemiparesis adapt to their deficits by finding wonky movement patterns that “get the job done.” This is called compensating, and everyone does it sometimes! Often parents and therapists want to see “normal” patterns of movement so badly that a child can get discouraged when they can’t perform as expected and eventually stop trying to use the weaker side.

Solution 2: Celebrate any movement of the “bad side!”

While it is important to develop optimal patterns of movement, it is more important to encourage children to keep attempting new tasks and using their weak side in daily life, even if it doesn’t look perfect. Rewarding play or task performance that uses the weak arm can teach a child to keep moving and keep practicing.


Problem 3: Expecting long periods of attention when “exercising”

Brain skills like willpower, self-control and long-term attention are not fully formed until adulthood. It can be incredibly challenging for a little one to maintain the focus needed for repetitive movement exercises to effectively change the brain and body over time. Many parents receive a handout from a therapist with exercises or stretches to be done 2-3 times a day for best results. Unfortunately convincing a child to participate in “boring” movements for 10 minutes 3 times a day can feel impossible or lead to tantrums and meltdowns.

Solution 3: Make home exercise fun again!

When therapy exercises are disguised inside games, toys for stroke rehab or part of desirable playtime activities children will invest much longer periods of time and energy with less resistance. Keep up to date on what activities your child naturally gravitates towards. Do they have a favorite cartoon character? Do they like video games? Or are sports more their thing? Pediatric OTs design sessions around the desired movements by creating desirable “games” where the rules require the child to use their weaker arm for reaching, pointing, grasping etc. Praise and rewards are added to already fun activities to further motivate participation.


We hope these solutions provide you with some helpful tips to keep your child motivated and progressing in their rehab journey.