The Effects of Physical Therapy on Cerebral Palsy

Abstract

Legislatively mandated programs for early intervention on behalf of handicapped infants often stipulate the inclusion of physical therapy as a major component of treatment for cerebral palsy. To evaluate the effects of physical therapy, we randomly assigned 48 infants (12 to 19 months of age) with mild to severe spastic diplegia to receive either 12 months of physical therapy (Group A) or 6 months of physical therapy preceded by 6 months of infant stimulation (Group B). The infant-stimulation program included motor, sensory, language, and cognitive activities of increasing complexity. Masked outcome assessment was performed after both 6 and 12 months of therapy to evaluate motor quotient, motor ability, and mental quotient. After six months, the infants in Group A had a lower mean motor quotient than those in Group B (49.1 vs. 58.1, P = 0.02) and were less likely to walk (12 vs. 35 percent, P = 0.07). These differences persisted after 12 months of therapy (47.9 vs. 63.3, P less than 0.01, and 36 vs. 73 percent, P = 0.01, respectively). We noted no significant differences between the groups in the incidence of contractures or the need for bracing or orthopedic surgery. Group A also had a lower mean mental quotient than Group B after six months of therapy (65.6 vs. 75.5, P = 0.05). The routine use of physical therapy in infants with spastic diplegia offered no short-term advantage over infant stimulation. Because of the limited scope of the trial, our conclusions favoring infant stimulation are preliminary. The results suggest that further study of the effects of both physical therapy and infant stimulation is indicated.

The role of parents in early motor intervention

“…In general, improvements were equivalent for children with Down syndrome and children with cerebral palsy regardless of whether they received the NDT or Developmental Skills treatment models. Consistent with findings from previous studies (Bower, Michel, Burnett, Campbell & McLellan, 2001;Harris, 1997;Palmer, 1997;Palmer, Shapiro, Wachtel et al, 1988), results from our study present a sobering picture of the benefits that infants with Down syndrome and cerebral palsy attain from participating in motor intervention. Whether children received services based upon the NDT or Developmental Skills treatment models, on average their rates of motor development did not change during intervention.…”

Early Diagnosis and Early Intervention in Cerebral Palsy

“…The study indicated that the higher dosage of NDT (once a week) was associated with better motor development. The Palmer et al study (123) was also carried out in the eighties of last century. This randomized controlled trial included 48 children aged 12–19 months with bilateral spastic CP (diplegic type).…”

“…Only part of the study was carried out with a randomized assignment to intervention or control group, which reduced the study’s validity. Overall, only one of the four studies, which evaluated the effect of early intervention that started after the age of 3 months CA provided evidence on the effect of early intervention; the Palmer et al study (123) provided moderately strong evidence that intervention by means of an infant-stimulation program provided twice per month was associated with better motor outcome than equally frequent intervention by means of NDT.…”

Recent Developments in Early Intervention Efficacy Research

“…In a recent, well-controlled study evaluating the effects of neurodevelopmental therapy on 12-to 19-month-old children with diagnosed spastic diplegia (Palmer et al, 1988), a number of surprising and potentially important implications for family involvement emerged. Using carefully described inclusion and exclusion criteria for their subjects, examiners randomly assigned children (stratified by level of cognitive development) to one of the following two groups in which they received either (a) 12 months of neurodevelopmental therapy (Bobath, 1967) or (b) 6 months of comprehensive infant stimulation followed by 6 months of neurodevelopmental therapy.…”

“…Technically, the Palmer et al (1988) investigation did not include a no-treatment control group. It is possible, although not likely, that neurodevelopmental therapy had an adverse effect on development and that infant stimulation really did not produce unusual effects.…”