What the trials say about practicing OT goals at home, how much practice they used, and how to build a program with your child’s therapist that survives an ordinary school week.
An occupational therapy home program for cerebral palsy is a short set of goal-based activities that your child’s OT designs with you and that you carry out at home between sessions. In a 2009 randomized trial of 36 children, programs practiced about 17.5 times a month for 16.5 minutes a session improved function and parent satisfaction compared with no program.
Multiply those two figures and the total is just under five hours a month. That is less than most families expect. The harder part is keeping it going: parents in a 2020 Norwegian study called their home program beneficial and, over time, exhausting. This page covers what the trials measured, how to build a program with your therapist, and how to keep one running. For what OT involves more broadly, start with our guide to occupational therapy for cerebral palsy.
Home programs hold a green light, the top rating, in the 2019 State of the Evidence Traffic Lights review led by Iona Novak at the Cerebral Palsy Alliance. The strongest single trial behind that rating is also hers.
Novak, Anne Cusick and Natasha Lannin published it in Pediatrics in October 2009. Thirty-six school-aged children took part, with a mean age of 7.7 years, and they covered every GMFCS level: 47% at level I and 16% at level V. They were randomly assigned to an 8 week program, a 4 week program, or no program. The main outcome was the Canadian Occupational Performance Measure, a rating of the goals the family chose, taken 8 weeks after the start. Eight weeks of home practice produced statistically significant gains in function and in parent satisfaction with that function.
The 4 week group produced the trial’s most human result. Those parents were told to stop at week four. They did not stop. They kept going to week eight, and their children improved as well, so the trial could not answer whether four weeks is enough.
An earlier pilot, published in the American Journal of Occupational Therapy in 2007, followed 20 children aged 2 to 7 with spastic hemiplegic CP and found significant changes on Goal Attainment Scaling, the PEDI and the QUEST after a home program. It had no control group. It also found no relationship between how much a family practiced and how much the child gained, a finding worth remembering before anyone concludes that more minutes are always better. Our page on occupational therapy assessments explains what each of those measures records.
The traffic lights review also says what the effective approaches share. In its words, they involve “practice of real-life tasks and activities, using self-generated active movements, at a high intensity, where the practice directly targets the achievement of a goal set by the child (or a parent proxy if necessary).” That sentence is a good test for any home program sheet a family is handed.
The dose that worked in the Novak trial was modest: 16.5 minutes a session, about 17.5 sessions a month. Intensive home programs ask for far more, and they are aimed at narrower goals.
The clearest intensive example is H-HABIT, a caregiver-directed version of hand arm bimanual intensive therapy. In a 2017 randomized trial by a team at Teachers College, Columbia University, 24 children aged 2 years 6 months to 10 years with unilateral spastic CP practiced at home for 2 hours a day, 5 days a week, for 9 weeks. That is 90 hours. Caregivers were trained first and supervised remotely. Compared with a control group doing the same hours of leg training, the H-HABIT children improved on the Box and Block test of dexterity and on their own COPM goals. They did not improve on the Assisting Hand Assessment, which measures how well both hands work together.
A Norwegian program for children with bilateral CP sat in between. It used daily goal-directed training adding up to 25 to 33 hours over eight weeks, with a weekly visit from the occupational therapist. Parents and therapists in focus groups published in 2020 reported better hand use in daily activities. They also described the training as challenging and exhausting over time.
These numbers do not compete. A 16 minute program aimed at the goals a family picked and a 90 hour hand program for a child with one affected side are different treatments. Ask your therapist which study the dose in your child’s program comes from, and whether it can be delivered in your house on a normal week. For hand-specific approaches such as constraint therapy and bimanual training, see fine motor skills and CP.
The programs that worked in trials were built with parents, not handed to them. A 2019 UK paper quotes the Novak trial’s definition: a home program targets problems “identified collaboratively by the parents and therapist.”
Not every therapist runs them. In a 2019 national survey of 123 occupational therapists in the United Kingdom, 74 (60%) used home programs for children with CP, and respondents named time constraints, gaps in training and insufficient support as barriers. If your child’s OT has not offered one, ask. The setup usually runs in this order:
Support is the part families say matters most. In interviews with 10 parents published in 2011, Novak found that ongoing support from the therapist was vital for motivation, and that parents wanted that support without pressure to comply. Remote support can work: a Brazilian telehealth home program for 144 children at every GMFCS level, published in 2024, reported COPM gains that held three months after it ended, though it had no comparison group.
A 2025 systematic review of 21 home program studies named activities within the daily routine as a facilitator, and lack of time as a barrier. The practical answer is to hang practice on things that already happen.
The parents Novak interviewed in 2011 described home program practice as a part of life, and their advice to other parents included developing routines. In practice, the goal decides the routine. A dressing goal gets practiced while getting dressed for school, with a few extra minutes built into the morning. A two-handed goal fits bath time, pouring water between cups, or snack time, opening containers. A self-feeding goal belongs at meals, where our page on cerebral palsy and diet covers nutrition and our guide to self-care skills covers utensils and dressing.
Routine practice also answers the question of where the minutes come from. Sixteen minutes carved out of an evening is a chore. The same sixteen minutes spent doing up buttons before leaving the house is the morning, done slightly slower.
The same 2019 review gave a red light to sensory integration and to neurodevelopmental therapy in its original passive format, and a yellow light to passive stretching on its own. If a home program is mostly things done to your child rather than tasks your child does, ask the therapist what evidence supports it and whether an active, goal-based alternative would fit.
A home program rarely needs a catalog order. The effective approaches practice real tasks, so the equipment is mostly the real objects those tasks use, chosen by the therapist to suit your child’s hand function.
Adaptive equipment is a separate decision. A built up spoon handle, a splint or the mitt used in constraint-induced movement therapy changes how a hand is used, so it should be chosen and fitted with the therapist rather than bought on a guess. Our overview of assistive devices for cerebral palsy covers what exists and who pays for it. For activity ideas organized by goal and age, see OT activities for cerebral palsy.
Logs are part of how home programs were studied. The 2007 pilot measured practice through a parent self-report log, and the 2019 UK paper lists logbooks among the evidence-based components of the 2009 trial’s program.
A useful log is short. Date, minutes, which activity, how many tries, how much help your child needed, and one line on what went well or badly. Five columns on a sheet of paper will do. Bring it to every review. It turns “we did some of it” into a record the therapist can act on, and it shows quickly when a goal has stopped moving and the program needs to change.
Progress itself gets measured at the review, usually on the same goal scale used at the start, such as the COPM or Goal Attainment Scaling. Those scores are what showed the gains in the Novak trials. They also give the family a record to show anyone who asks whether therapy is working. If the program is also supporting physical therapy goals, our page on in-home physical therapy covers that side.
A short set of goal-based activities that your child’s occupational therapist designs with you and that you carry out at home between sessions. The goals come from the family and the child, the activities are real daily tasks, and the therapist reviews progress with you on a set date.
In the 2009 Novak trial, programs that improved function averaged 16.5 minutes a session, 17.5 times a month, which is under 20 minutes on most days. Intensive home programs such as H-HABIT ask for 2 hours a day, 5 days a week, for 9 weeks, so ask your therapist which dose your child’s program is based on and why.
Yes, by the standards of this field. A 2009 double blind randomized trial of 36 children in Pediatrics found that 8 weeks of a home program improved function and parent satisfaction compared with no program, and the 2019 State of the Evidence Traffic Lights review rated home programs green, its highest rating.
You can practice daily tasks with your child at any time, but the programs that worked in trials were built with a therapist, taught to parents directly, and reviewed on a schedule. The therapist’s part is choosing goals the child can reach, matching activities to hand function, and changing the plan when the log shows it has stalled.
Usually nothing specialized. Home programs practice real tasks, so the equipment is whatever those tasks use: the child’s own jacket, cups and jugs at bath time, containers at snack time, play dough, clothespins and beads. Adaptive items such as built up utensils or a constraint mitt should be chosen with the therapist.
Tie practice to goals your child chose and to routines that already happen, keep sessions short, and let the therapist know early when it is not working. Parents in a 2011 study said ongoing support from the therapist was what kept them going, and a 2025 review named activities built into the daily routine as a key facilitator.
Kelsey is an experienced surgical nurse who works extensively with pediatric patients and families navigating birth injuries and cerebral palsy diagnoses. She is licensed by the Missouri Board of Nursing and operates under the Nurse Licensure Compact, allowing her to practice across compact-member states. As both a mentor and patient advocate, Kelsey focuses on safety, communication, and compassionate care: helping families understand medical procedures, treatment options, and the realities of pediatric conditions.
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