Activity focused and goal directed therapy for children with cerebral palsy – Do goals make a difference?

Löwing, Kristina; Bexelius, A; Carlberg, Eva Brogren

doi:10.1080/09638280902822278

Cited by 121 publications

(138 citation statements)

References 32 publications

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“…2,3 Several research studies have evaluated the effects of goal-setting in physical therapy of children with cerebral palsy. [4][5][6][7][8][9] The results of a recent systematic review, however, could not provide support for the effectiveness of goal-setting within an activity-focused approach on treatment outcome. 10 The authors of this review found that none of the included studies were designed specifically to determine the effect of goal-setting per se, as goalsetting was additional to guiding the interventions.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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“…In addition, such a program should incorporate the parents' needs. To achieve the best results in children with unilateral spastic CP, we assumed that training should (a) be focused on children with unilateral CP, (b) take place in a challenging environment, (c) be sufficiently intensive and given in a relatively short period, (d ) preferably take place among peers, (e) focus on meaningful activities, ( f ) start with unilateral training feasible for young children (mCIMT), and (g) end with goal-directed, 16,17 task-specific 18 bimanual training (BiT) to integrate the activated upper limb functions in age-appropriate skills. The objective of this study was, therefore, to investigate whether 6 weeks of mCIMT followed by 2 weeks of bimanual training (mCIMT-BiT) in children with unilateral spastic CP improves the spontaneous use of the affected limb in both qualitative and quantitative terms more than usual care (UC) of the same duration.…”

Section: Constraint Induced Movement Therapy (Cimt)mentioning

confidence: 99%

Effectiveness of Modified Constraint-Induced Movement Therapy in Children With Unilateral Spastic Cerebral Palsy: A Randomized Controlled Trial

Aarts

Jongerius

Geerdink

et al. 2010

Neurorehabil Neural Repair

157

190

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Background. In children with unilateral spastic cerebral palsy (CP), there is only limited evidence for the effectiveness of modified constraint-induced movement therapy (mCIMT). Objective. To investigate whether 6 weeks of mCIMT followed by 2 weeks of bimanual task-specific training (mCIMT-BiT) in children with unilateral spastic CP improves the spontaneous use of the affected limb in both qualitative and quantitative terms more than usual care (UC) of the same duration. Methods. Children with unilateral spastic CP with Manual Ability Classification System (MACS) scores I, II, or III and aged 2.5 to 8 years were recruited and randomly allocated to either the mCIMT-BiT group (three 3-hour sessions per week: 6 weeks of mCIMT, followed by 2 weeks of task-specific training in goal-directed bimanual play and self-care activities) or to 1.5 hours of more general physical or occupational weekly plus encouragement to use the affected hand for the UC group. Primary outcome measures were the Assisting Hand Assessment and the ABILHAND-Kids. Secondary outcomes were the Melbourne Assessment of Unilateral Upper Limb Function, the Canadian Occupational Performance Measure, and the Goal Attainment Scale. Results. Twenty-eight children were allocated to mCIMT-BiT and 24 to UC. Except for the Melbourne, all primary and secondary outcome measures demonstrated significant improvements in the mCIMT-BiT group. Conclusion. mCIMT followed by task-specific training of goal-directed bimanual play and self-care activities is an effective intervention to improve the spontaneous use of the more affected upper limb in children with relatively good baseline upper extremity function.

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“…Law et al' s 39 findings are consistent with other studies of functional therapy or task-based training EE approaches known to be effective in older children. 55,56 In line with the International Classification of Functioning, Disability, and Health, functional therapy or task-based training EE approaches deliberately consider the impact of the environmental context in the design and implementation of therapy. The difference with Law et al' s 39 context-focused study is that 2 novel approaches are compared: "hands off and hands on."…”

Section: Figurementioning

confidence: 99%

Enriched Environments and Motor Outcomes in Cerebral Palsy: Systematic Review and Meta-analysis

2013

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BACKGROUND AND OBJECTIVES: Neuroplasticity evidence from animals favors an early enriched environment for promoting optimal brain injury recovery. In infants, systematic reviews show environmental enrichment (EE) improves cognitive outcomes but the effect on motor skills is less understood. The objective of this review was to appraise the effectiveness evidence about EE for improving the motor outcomes of infants at high risk of cerebral palsy (CP). METHODS:A systematic review was conducted. Cochrane Central Register of Controlled Trials (PubMed), Cumulative Index to Nursing and Allied Health Literature, Education Resource Information Center, SocINDEX, and PsycINFO databases were searched for literature meeting inclusion criteria: randomized controlled trials; high risk of /diagnosis of CP; .25% participants #2 years; parent or infant interventions postdischarge; and motor outcomes reported. Data were extracted using the Cochrane protocol regarding participants, intervention characteristics, and outcomes. Methodological quality was assessed using risk of bias assessment and GRADE.RESULTS: A total of 226 studies were identified. After removing duplicates and unrelated studies, 16 full-text articles were reviewed, of which 7 studies met inclusion criteria. The risk of bias varied between studies with the more recent studies demonstrating the lowest risk. Enrichment interventions varied in type and focus, making comparisons difficult. A meta-analysis was conducted of studies that compared enrichment to standard care (n = 5), and totaled 150 infants. A small positive effect for enrichment was found; standardized mean difference 0.39 (95% confidence interval 0.05-0.72; I 2 = 3%; P = .02)CONCLUSIONS: EE looks promising for CP, and therefore high-quality studies with well-defined EE strategies are urgently required. Ms Morgan and Dr Novak were involved in quality assessment, data extraction, data analysis, and manuscript preparation; Dr Badawi was involved in quality assessment and manuscript critique. All authors were involved in study conception and design, interpretation of data, critical revision, and final approval of the submitted manuscript. Children with cerebral palsy (CP) reach ∼90% of their gross motor potential by age 5 and even younger for the more severely impaired, 1 so effective interventions for optimizing early motor development are vital. As with typically developing children, the first 2 years are critically important for cognitive and motor development 2 because the brain is experiencing continuous spontaneous plasticity. Pediatricians, who are responsible for making the diagnosis of CP and referral to rehabilitation, therefore require up-todate evidence about effective early interventions for children with CP.The value of enriched environments in enhancing brain recovery at both structural and chemical levels has been repeatedly demonstrated in animal studies. 3,4 Effects of enrichment include improved memory and motor function. 4 Replication of animal data findings within humans is still...

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Activity focused and goal directed therapy for children with cerebral palsy – Do goals make a difference?

Abstract: GDT demonstrated clear gains for children with cerebral palsy in everyday activities and gross motor function in comparison to AT.

Cited by 121 publications

References 32 publications

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

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

Effectiveness of Modified Constraint-Induced Movement Therapy in Children With Unilateral Spastic Cerebral Palsy: A Randomized Controlled Trial

Enriched Environments and Motor Outcomes in Cerebral Palsy: Systematic Review and Meta-analysis

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