A randomized, single-blind cross-over design evaluating the effectiveness of an individually defined, targeted physical therapy approach in treatment of children with cerebral palsy

Abstract

Objective: A pilot study to compare the effectiveness of an individual therapy program with the effects of a general physical therapy program. Design: A randomized, single-blind cross-over design. Participants: Ten ambulant children with bilateral spastic cerebral palsy, age four to nine years. Intervention: Participants were randomly assigned into a ten-week individually defined, targeted or a general program, followed by a cross-over. Main outcome measures: Evaluation was performed using the Gross Motor Function Measure-88 and three-dimensional gait analysis. General outcome parameters were Gross Motor Function Measure-88 scores, time and distance parameters, gait profile score and movement analysis profiles. Individual goal achievement was evaluated using z-scores for gait parameters and Goal Attainment Scale for gross motor function. Results: No significant changes were observed regarding gross motor function. Only after individualized therapy, step-and stride-length increased significantly (p = 0.022; p = 0.017). Change in step-length was higher after the individualized program (p = 0.045). Within-group effects were found for the pelvis in transversal plane after the individualized program (p = 0.047) and in coronal plane after the general program (p = 0.047). Between-program differences were found for changes in the knee in sagittal plane, in the advantage of the individual program (p = 0.047). A median difference in z-score of 0.279 and 0.419 was measured after the general and individualized program, respectively. Functional goal attainment was higher after the individual therapy program compared with the general program (48 to 43.5). Conclusion:The results indicate slightly favorable effects towards the individualized program. To detect clinically significant changes, future studies require a minimal sample size of 72 to 90 participants.

Gait analysis for individually tailored interdisciplinary interventions in children with cerebral palsy: a randomized controlled trial

“…15,25 However, our findings are equal to the results of a previous randomized controlled trial on the outcome of lower extremity orthopaedic surgery with and without gait analysis. Our findings are not in line with previous studies investigating the effectiveness of the use of gait analysis in individualized physiotherapy for children with CP.…”

“…Our findings are not in line with previous studies investigating the effectiveness of the use of gait analysis in individualized physiotherapy for children with CP. 15,25 However, our findings are equal to the results of a previous randomized controlled trial on the outcome of lower extremity orthopaedic surgery with and without gait analysis. 14 The lack of documented between-group differences in change scores may be attributed to our study population of relatively young and well-functioning children (GMFCS levels I and II), most of whom did not need or receive surgery.…”

“…10 In the CPUP, the child is classified according to the Gross Motor Function Classification System (GMFCS) and some children are tested with the Gross Motor Function Measure. [12][13][14] The effects of orthopaedic surgery and physiotherapy with and without gait analysis, to specify impairments in gait have been investigated in monodisciplinary settings with varying results; the use of gait analysis in planning physiotherapy has been reported to be superior to clinical examinations alone, 15 which is not always the case in orthopaedic surgery owing to lack of compliance with the recommended interventions. This can be done with three-dimensional instrumented gait analysis that provides objective measures of gait in three planes, identification of features, and the underlying impairments.…”

“…11 Studies have shown that gait analysis affects the decisions regarding orthopaedic surgical interventions, and that good agreement can be obtained between recommendations based on gait analysis and the surgery performed. [12][13][14] The effects of orthopaedic surgery and physiotherapy with and without gait analysis, to specify impairments in gait have been investigated in monodisciplinary settings with varying results; the use of gait analysis in planning physiotherapy has been reported to be superior to clinical examinations alone, 15 which is not always the case in orthopaedic surgery owing to lack of compliance with the recommended interventions. 14 Nonetheless, the effects of interdisciplinary interventions with and without gait analysis have not been investigated in children with CP.…”

Balance improvement after physical therapy training using specially developed serious games for cerebral palsy children: preliminary results

“…This can be explained by the fact that the CoP displacement that the patients have to reach during the games are less important that the displacement reached during the TCMS for dynamic sitting. In rehabilitation, especially in neurology, benefits are specific to the training [15]. During the games CP children trained CoP displacement is in a range more similar that those achieved during the static sitting testing than the dynamic one.…”