Cerebral palsy (CP) is a disability that affects individuals throughout their lifespan. Adolescents and adults with CP are at risk for many secondary conditions that cause a loss of function and deterioration of quality of life. This article presents a review of the literature of musculoskeletal conditions of people with CP that can develop or worsen across the lifespan as a consequence of the primary neuromotor impairments. Health care behaviors of adolescents and adults with CP are discussed and their impact on secondary conditions is examined. Suggestions for how pediatric occupational therapists and physical therapists can assist children and adolescents to take responsibility for their own health and wellbeing are presented. Lastly, occupational therapists and physical therapists are encouraged to take responsibility for treating musculoskeletal impairments and disabilities in adults with CP.

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Many individuals with lifelong disabilities (LLDs) of childhood onset are living longer, participating in adult roles, and seeking comprehensive health care services, including physical therapy, with greater frequency than in the past. Individuals with LLDs have the same goals of health and wellness as those without disabilities. Aging with a chronic LLD is not yet well understood; however, impairments such as pain, fatigue, and osteoporosis often present earlier than in adults who are aging typically. People with LLDs, especially those living with developmental disabilities such as cerebral palsy, myelomeningocele, Down syndrome, and intellectual disabilities, frequently have complex and multiple body system impairments and functional limitations that can: (1) be the cause of numerous and varied secondary conditions, (2) limit overall earning power, (3) diminish insurance coverage, and (4) create unique challenges for accessing health care. Collaboration between adult and pediatric practitioners is encouraged to facilitate smooth transitions to health practitioners, including physical therapists. A collaborative client-centered emphasis to support the transition to adult-oriented facilities and promote strategies to increase accessibility should become standard parts of examination, goal setting, and intervention. This perspective article identifies barriers individuals with selected LLDs experience in accessing health care, including physical therapy. Strategies are suggested, including establishment of niche practices, physical accessibility improvement, and inclusion of more specific curriculum content in professional (entry-level) doctorate physical therapy schools.

Children with disabilities are not the sole clients of the pediatric physical therapy practitioner. However, research, best practice, and federal mandated legislation oblige therapists to transition from a traditional medical child-centered model o f intervention to a family-centered model. This model places an emphasis on instructing parents, guiding their development as the dominant change agent for their children. Viewing parents as the predominant learner during intervention sessions is hampered by the paucity of family-related and adult-learning content in the professional preparation programs in higher education. It is further inhibited by professional attitudinal beliefs that continue to place a higher value on child characteristics for clinical decision making. This qualitatative study explored the scope of four private practice pediatric physical therapists' role as a parent coach. Each therapist was videotaped with two young children diagnosed with movement dysfunction and their mothers. Using a 7 Learning Style of Learners 132 FIGURE 1 LIST OF FIGURES PAGE Therapeutic Reciprocal Interplay of Therapist, Parent, and Child 25 CHAPTER I