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Physical, occupational, and speech therapy for children with cerebral palsy
Sarah Westcott McCoy1, Robert Palisano2, Lisa Avery3
1Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
Insights
Family-centered rehabilitation therapies focusing on play and well-being enhance development in children with cerebral palsy (CP). The amount of therapy did not impact outcomes, highlighting the importance of therapy quality over quantity.
Area of Science:
- Pediatric Rehabilitation
- Developmental Pediatrics
- Neurology
Background:
- Cerebral palsy (CP) affects child development, necessitating effective rehabilitation strategies.
- Understanding the impact of therapy characteristics on developmental outcomes is crucial for optimizing interventions.
Purpose of the Study:
- To investigate the relationship between various aspects of rehabilitation therapies and developmental progress in children with CP.
- To identify specific therapy components that promote better outcomes in balance, walking endurance, self-care, and participation.
Main Methods:
- A prospective, longitudinal study of 656 children with CP, assessed over two years.
- Therapist-administered standardized measures of balance and walking endurance, alongside parent-reported data on therapies and child's functional performance.
- Analysis using multinomial models to correlate therapy characteristics (amount, focus, family-centeredness, needs met) with developmental changes across GMFCS levels.
Main Results:
- Family-centered therapies, those meeting children's needs, and a focus on structured play/recreation were linked to greater 'more than expected' progress in participation.
- A focus on health and well-being positively influenced participation and self-care outcomes.
- The total amount of therapy received did not predict developmental outcomes.
Conclusions:
- Rehabilitation therapies for children with CP should be family-centered, individualized to the child's needs, and incorporate structured play, recreation, and health/well-being components.
- These tailored approaches appear more beneficial for enhancing developmental progress than simply increasing therapy duration.
Aim:
To explore the relationship between rehabilitation therapies and development in children with cerebral palsy (CP).
Method:
We conducted a prospective, longitudinal study involving 656 children with CP (mean age [SD] 6y [2y 8mo] at study entry; 1y 6mo-11y 11mo; 287 females, 369 males), and their parents. Children were assessed two to five times over 2 years by therapists using standardized measures of balance and walking endurance. Parents completed questionnaires on demographics, rehabilitation therapies, and their children's performance in self-care and participation in recreation. Therapists and parents collaboratively classified children's Gross Motor Function Classification System (GMFCS) levels. We created longitudinal graphs for each GMFCS level, depicting change across time using centiles. Using multinomial models, we analyzed the relationship between therapies (amount, focus, family-centeredness, and the extent therapies met children's needs) and whether change in balance, walking endurance, and participation was 'more than' and 'less than' the reference of 'as expected'.
Results:
Children were more likely to progress 'more than expected' when participating in recreation when therapies were family-centered, met children's needs, and focused on structured play/recreation. A focus on health and well-being was positively associated with participation and self-care. The amount of therapy did not predict outcomes.
Interpretation:
Therapy services that are family-centered, consider the needs of the child, and focus on structured play/recreational activities and health/well-being may enhance the development of children with CP.
What This Paper Adds:
Family-centered rehabilitation therapies were positively associated with greater participation in family/recreation activities and walking endurance. Parental perception that rehabilitation therapies met children's needs was associated with greater participation in family/recreation activities. Structured play, recreational activities, and health/well-being are important for self-care and participation when planning rehabilitation therapy. The amount of rehabilitation therapy was not related to developmental outcomes.
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