A daily PT program appears feasible and may improve overall development in young children with cerebral palsy in GMFCS level V.
The proposed project tests the principle that frequency of rehabilitation is an important regulator of therapeutic response in infants. Methods: We will randomize 75 infants with cerebral palsy, 6-24 months of age and GMFCS III-V (higher severity), to determine the short term and long-term effects of 3 dosing protocols consisting of an identical number of 2 hour sessions of the same motor learning based therapy applied over a different total number of calendar weeks. Results and Conclusions: The results will inform clinicians, families, and scientists about dosing and will provide needed recommendations for frequency of rehabilitation in order to optimize motor function and development of young children with cerebral palsy.
Cerebral palsy (CP) is the most common childhood motor disability. The dose of usual care for rehabilitation therapies is unknown. The purpose of this study was to describe current dosage of rehabilitation services for children with CP recruited from a paediatric hospital system in the USA. 96 children with CP were included in this cross-sectional survey. Parents reported frequency, intensity, time and type of therapy services. Weekly frequency was the most common. Children with CP received 0.9–1.2 hours/month of each discipline in the educational setting and 1.5–2.0 hours/month in the clinical setting, lower than the recommendations for improvements in motor skills.
Purpose: This case report highlights the potential value of delivering a high-dose physical therapy (PT) intervention for a child with a neurodegenerative disease. We include developmental outcomes for a 23-month-old toddler with biallelic TBCD gene mutations following daily outpatient PT. Summary of Key Points: The child had clinical improvements in gross and fine motor, cognition, expressive and receptive language, socioemotional, and adaptive behavior function as determined through Goal Attainment Scaling, Gross Motor Function Measure, and Bayley Scales of Infant and Toddler Development following daily PT intervention. Statement of Conclusion and Recommendations for Clinical Practice: High-dose outpatient PT may be beneficial for a child with a neurodegenerative disease at some time frames. In selected cases, if the neurodegenerative disease slowly progresses, high-dose PT may be a treatment option to promote motor change.
How should I apply this information?"The Muscle Power Sprint Test (MPST) has 2 main clinical applications in fitness testing for children with cerebral palsy (CP). First, anaerobic performance is an underevaluated area of assessment in children with CP. The MPST may allow for easier assessment of anaerobic power, given high concurrent validity with the Wingate Anaerobic cycling Test (WAnT). The MPST is a very quick test and can be administered without expensive equipment. To complete the MPST, an open space of 15 m, a stopwatch, and the ability to measure height and weight of the child are needed. The MPST can be used in a variety of clinical settings. Second, it is important to note that the authors also explore validity with the WAnT. The authors do not provide any evidence or suggestions related to referring, altering, or influencing physical therapy intervention options. Further it is important to address all aspects of fitness in an assessment, and it is necessary to include other tests, such as aerobic capacity tests, and to concurrently assess functional performance and use comprehensive outcomes. Measuring and improving fitness levels could have implications for wellness and function in all children with CP. The MPST may be particularly appropriate for children with goals to participate in sports or other physical activities. "What should I be mindful about when applying this information?"The results of this study are not generalizable to children with nonspastic CP, those outside the 7-to 18year age range, and those who are not levels I or II of the Gross Motor Function Classification System. The study participants were all recruited from a single school in the Netherlands. Furthermore, specific timing and instructions are included in the test procedure so children who have difficulty understanding or following directions may not be appropriate for this test. This test is based on maximal effort sprinting performance. The test may not be appropriate for children who have lower extremity musculoskeletal conditions, delayed running skills, or decreased motivation, as these conditions could cause inaccurate measurement of anaerobic performance. Anaerobic performance is measured by peak anaerobic power and mean anaerobic power. A calculation is needed to compute both values of power. The scores on the MPST cannot be used as direct comparisons to scores on the WAnT because the authors found that scores on the MPST are consistently lower. Additional studies may be necessary to determine the responsiveness to change and the minimal clinically important difference of this test to improve its use as an outcome measure.
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