BackgroundThe effects of intensive training for children with cerebral palsy (CP) remain uncertain. The aim of the study was to investigate the impact on motor function, quality of movements and everyday activities of three hours of goal-directed activity-focused physiotherapy in a group setting, five days a week for a period of three weeks.MethodsA repeated measures design was applied with three baseline and two follow up assessments; immediately and three weeks after intervention. Twenty-two children with hemiplegia (n = 7), diplegia (n = 11), quadriplegia (n = 2) and ataxia (n = 2) participated, age ranging 3-9 y. All levels of Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) were represented. Parents and professionals participated in goal setting and training. ANOVA was used to analyse change over repeated measures.ResultsA main effect of time was shown in the primary outcome measure; Gross Motor Function Measure-66 (GMFM-66), mean change being 4.5 (p < 0.01) from last baseline to last follow up assessment. An interaction between time and GMFCS-levels was found, implying that children classified to GMFCS-levels I-II improved more than children classified to levels III-V. There were no main or interaction effects of age or anti-spastic medication. Change scores in the Pediatric Evaluation of Disability Inventory (PEDI) ranged 2.0-6.7, p < 0.01 in the Self-care domain of the Functional Skills dimension, and the Self-care and Mobility domains of the Caregiver Assistance dimension. The children's individual goals were on average attained, Mean Goal Attainment Scaling (GAS) T-score being 51.3. Non-significant improved scores on the Gross Motor Performance Measure (GMPM) and the Quality of Upper Extremities Skills Test (QUEST) were demonstrated. Significant improvement in GMPM scores were found in improved items of the GMFM, not in items that maintained the same score.ConclusionsBasic motor abilities and self-care improved in young children with CP after goal-directed activity-focused physiotherapy with involvement of their local environment, and their need for caregiver assistance in self-care and mobility decreased. The individualized training within a group context during a limited period of time was feasible and well-tolerated. The coherence between acquisition of basic motor abilities and quality of movement should be further examined.
Blocks of intensive therapy can be an alternative to regular dosage of physiotherapy, but until further studies are conducted, the physiotherapy intervention, intensity, and frequency should be tailored to meet the needs of each individual infant and family.
The aim of this study was to examine observer reliability of the Gross Motor Performance Measure (GMPM) and the Quality of Upper Extremity Skills Test (QUEST) based on video clips. The tests were administered to 26 children with cerebral palsy (CP; 14 males, 12 females; range 2-13y, mean 7y 6mo), 24 with spastic CP, and two with dyskinesia. Respectively, five, six, five, four, and six children were classified in Gross Motor Function Classification System Levels I to V; and four, nine, five, five, and three children were classified in Manual Ability Classification System levels I to V. The children's performances were recorded and edited. Two experienced paediatric physical therapists assessed the children from watching the video clips. Intraobserver and interobserver reliability values of the total scores were mostly high, intraclass correlation coefficient (ICC) 1,1 varying from 0.69 to 0.97 with only one coefficient below 0.89. The ICCs of subscores varied from 0.36 to 0.95, finding 'Alignment' and 'Weight shift' in GMPM and 'Protective extension' in QUEST highly reliable. The subscores 'Dissociated movements' in GMPM and QUEST, and 'Grasp' in QUEST were the least reliable, and recommendations are made to increase reliability of these subscores. Video scoring was time consuming, but was found to offer many advantages; the possibility to review performance, to use special trained observers for scoring and less demanding assessment for the children.Quality of movement refers to how well a movement is performed. Due to an early disorder in the brain, children with cerebral palsy (CP) often have problems with accomplishment of tasks, as well as impaired quality of movements. Increased quality of movements such as faster speed, improved stability, and a more coordinated movement pattern are considered important in order to improve functional ability and safety, as well as to decrease effort. Better alignment may also prevent secondary muscle and joint problems. A two-dimensional model of therapy based on motor learning principles to promote accomplishment of tasks and activities to prevent secondary problems, has recently been proposed. 1 This is in line with parents' concerns about their children's ability to carry out everyday activities, as well as their movement quality. 2,3 Two complementary measurement tools are available to assess quality of movements in children with CP; the Gross Motor Performance Measure (GMPM) 4 and the Quality of Upper Extremity Skills Test (QUEST). 5 The GMPM was developed to evaluate change in performance over time in gross motor activities such as walking, sitting, and crawling. The QUEST was developed to evaluate change in quality of upper extremity activities such as grasp, weight bearing, and protective extension. The tests are observational and criterion referenced, and the children are compared with themselves over repeated measurements. Both tests have been used as outcome measures in intervention studies. [6][7][8][9][10] Previous studies, primarily performed by the test devel...
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