A Path Model for Evaluating Dosing Parameters for Children With Cerebral Palsy

Abstract

Dosing of pediatric rehabilitation services for children with cerebral palsy (CP) has been identified as a national priority. Establishing dosing parameters for pediatric physical therapy interventions is critical for informing clinical decision making, health policy, and guidelines for reimbursement. The purpose of this perspective article is to describe a path model for evaluating dosing parameters of interventions for children with CP. The model is intended for dose-related and effectiveness studies of pediatric physical therapy interventions. The premise of the model is: Intervention type (focus on body structures, activity, or the environment) acts on a child first through the family, then through the dose (frequency, intensity, time), to yield structural and behavioral changes. As a result, these changes are linked to improvements in functional independence. Community factors affect dose as well as functional independence (performance and capacity), influencing the relationships between type of intervention and intervention responses. The constructs of family characteristics; child characteristics (eg, age, level of severity, comorbidities, readiness to change, preferences); plastic changes in bone, muscle, and brain; motor skill acquisition; and community access warrant consideration from researchers who are designing intervention studies. Multiple knowledge gaps are identified, and a framework is provided for conceptualizing dosing parameters for children with CP.

Caregiver satisfaction with a multidisciplinary community-based rehabilitation programme for children with cerebral palsy in South Africa

“…22 . Involving the community is also believed to enhance caregivers' satisfaction and rehabilitation outcomes 11 in providing holistic care to children with special needs.…”

“…3 Furthermore, satisfaction with rehabilitation intervention is an imperative outcome that is believed to influence the emotional well-being of carers and impacts on a child's psychology. 11 Scarcity in caregiver satisfaction and perception of rehabilitation is evident in resource-poor settings such as South Africa, thus this study is crucial in informing research for rehabilitation professionals involved in the management of children with CP. This study's emphasis was focused on caregivers of children with CP who were involved in rehabilitation within a task-shifting approach.…”

Functional Improvement after the Gross Motor Function Measure-88 (GMFM-88) Item-Based Training in Children with Cerebral Palsy

“…The authors emphasized that a higher dose of training has to be provided over shorter periods of time in order to achieve improved motor skills in children with CP. Gannotti et al 22 reported that intervention types focused on body structures, activity, or the environment acts on a child first through the family, then through the frequency, intensity, and time to yield structural and behavioral changes. As a result, these changes are linked to improvements in functional independence.…”

Intensive neuromotor therapy with suit improves motor gross function in cerebral palsy: a Brazilian study

“…A success of a therapy can be defined as one that can provide changes in activities and participation by the ICF (International Classification of Functioning, Disability and Health) model and best quality of life whom receive that (Damiano, 2009;Gannotti, Christy, Heathcock, & Kolobe, 2014) For CP, there is minimal evidence for the neurodevelopmental therapy. However, evidence for the best outcomes were for intensive training and practice task or functionally (Bailes et al, 2011;Bailes, Greve, & Schmitt, 2010;Damiano, 2009).…”