ENParents of a child with cerebral palsy rarely come to Germany for a diagnosis made years ago, but to ask what else could help the child sit, stand, walk, hold a spoon or speak more clearly. Cerebral palsy does not go away: the brain injury happened once and does not progress, but its effects change with growth, so the programme is revisited every few years.
Below: assessment before a block, what rehabilitation for children with cerebral palsy in Germany consists of, managing raised tone, when orthopaedic surgeons step in, and travelling with an accompanying parent. Overview: rehabilitation in Germany.
What is assessed before the therapy block
Assessment records what the child can do now; no block is prescribed «for cerebral palsy», a label covering very different children, from those who walk unaided, almost like classmates, to those who cannot hold their head up. German specialists use international scales: GMFCS for gross motor function (five levels, from independent walking to complete dependence on help), MACS for hand use; speech and swallowing are assessed separately. Goals follow that level, not parents’ hopes; results are measured against it. See treatment of children in Germany.
The examination covers tone by muscle group, joint range and existing shortening, foot position, sitting in a wheelchair or chair, hands, vision and hearing. Seizures, pain, sleep and feeding are asked about separately: a hungry, tired or hurting child gains nothing from therapy. Specialist centres sometimes record walking in a movement laboratory, where sensors show what the child does instead of a normal step; contested surgical decisions require this.
Studies may be repeated or ordered: brain MRI if none was done or it dates from infancy; hip X-rays, because the head of the femur can gradually slip out of the joint, which must be caught on images, not complaints; a spine check for curvature; EEG with seizures. A guideline from German societies for social paediatrics and child neurology covers unilateral spastic cerebral palsy; its version for parents is German-only.
What a block of therapy consists of
A block combines physiotherapy, occupational therapy and speech therapy. Physiotherapy works on posture, weight shifting, standing up and walking; Bobath and Vojta approaches are widespread in Germany, but a named method is a school of practice, not a guarantee. Occupational therapy covers hands and independence: grasping, holding, bringing food to mouth, dressing, writing. Speech therapy also covers swallowing: for some children, a matter of safe eating, not clear words. See physiotherapy in Germany and occupational therapy in Germany.
Equipment and aids are part of therapy, not souvenirs: ankle-foot orthoses, standing frame, walker with pelvic support, individually fitted seat, treadmill training with partial body-weight support and, where available, a gait robot. The robot allows far more repetitions of a correct step per session than a therapist’s hands can, but neither replaces therapy nor works alone.
A block in Germany usually means several sessions a day, six days a week, yet its real value is not those weeks but the programme parents take home and do daily. Parents are therefore trained in positioning the child, stretching, lifting and transferring without hurting their own back, and handling orthoses.
What is done about raised muscle tone
Tone is lowered so the child stops spending strength fighting their own tension: a permanently tight muscle eventually stops stretching and pulls the joint with it. Botulinum toxin weakens selected muscles for a few months, a window used to practise movement in therapy and orthoses. Other drugs lower tone body-wide. In severe generalised (whole-body) spasticity, specialist centres discuss a baclofen pump delivering the drug directly to the spinal cord. Each option has its own limits and reversibility; a doctor sets doses and regimens.
Selective dorsal rhizotomy, the neurosurgical option, cuts some sensory nerve roots of the spinal cord to remove leg spasticity. It suits a narrow group chosen by strict criteria, needs long rehabilitation afterwards and is decided by a multidisciplinary team, not one specialist.
When orthopaedic surgeons become involved
Orthopaedic surgeons step in once tone and growth have changed bones and joints: surgery treats not the palsy itself but its consequences — shortened tendons, a dislocating hip, a deformed foot, a curving spine. Germany favours one multi-level operation where possible over separate operations years apart, with a long recovery afterwards, planned from gait analysis and images, not age. Examples include Prof. Alexander S. Spiro, head of the deformity and tumour orthopaedics section in the department of paediatric and adolescent orthopaedics at Altona Children’s Hospital in Hamburg, and PD Dr Kiril Mladenov, acting lead physician of the same department.
Parents should know beforehand that a child temporarily loses some abilities after surgery: an expected step, not a complication. Recovery takes months and needs rehabilitation arranged before the operation, not after. See paediatric orthopaedics in Germany and physiotherapy in Germany.
Frequently asked questions
Will my child walk after the block?
No centre can promise that. Each block’s goal follows the child’s current level: steps in a walker for one child, steady sitting, holding a spoon or safe swallowing for another. Progress is measured on the same scales as at the start.
How often is the block repeated?
There is no fixed schedule; it depends on the goal and the child’s growth. Because the effects of cerebral palsy change with age, the programme is reviewed every few years, and between blocks the home programme and local therapist do most of the work.
Can the block be combined with botulinum toxin?
Yes: the injection weakens selected muscles for a few months, and the block uses that time to practise new movement in sessions and orthoses. A doctor decides after examination whether and where to inject; planned injections are agreed with the centre before travel.
How AlenMed arranges the rehabilitation
AlenMed sends discharge summaries, reports, images and video of the child moving to a department or centre specialising in paediatric neurological rehabilitation; the company has 86 partner hospitals in 38 German cities, 345 doctors and an office in Munich. We translate the summary, obtain the centre’s written programme and duration, and arrange invitations and medical visas for child and companion, the parent’s housing next to the child and an interpreter for sessions and programme review.
Before travelling, ask: what is the block’s goal and how will it be measured; how many daily sessions, with whom; who fits orthoses, and can they be made during the stay; what parents take home in writing; who follows the child at home between blocks; when to return.
This reference material is not an offer; a doctor decides the treatment plan at an in-person consultation.