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The effects of physical therapy on cerebral palsy. A controlled trial in infants with spastic diplegia
F B Palmer1, B K Shapiro, R C Wachtel
1Kennedy Institute for Handicapped Children, Baltimore, MD 21205.
Insights
Infant stimulation may offer advantages over traditional physical therapy for infants with spastic diplegia. Early intervention programs should consider the benefits of infant stimulation for motor development in cerebral palsy.
Area of Science:
- Pediatrics
- Neurology
- Developmental Medicine
Background:
- Early intervention is crucial for infants with cerebral palsy.
- Physical therapy is often a mandated component of treatment for spastic diplegia.
- The efficacy of early physical therapy versus other interventions requires evaluation.
Purpose of the Study:
- To compare the effects of 12 months of physical therapy versus 6 months of physical therapy preceded by 6 months of infant stimulation.
- To assess the impact on motor and cognitive development in infants with spastic diplegia.
Main Methods:
- Randomized controlled trial involving 48 infants (12-19 months) with spastic diplegia.
- Intervention groups: 12 months of physical therapy (Group A) vs. 6 months infant stimulation followed by 6 months physical therapy (Group B).
- Masked outcome assessments at 6 and 12 months for motor quotient, motor ability, and mental quotient.
Main Results:
- Group B (infant stimulation) demonstrated significantly higher motor quotients at both 6 and 12 months.
- A higher percentage of infants in Group B were able to walk by 12 months.
- No significant differences were observed in contractures, bracing, or orthopedic surgery needs.
Conclusions:
- Routine physical therapy alone did not show short-term advantages over infant stimulation for infants with spastic diplegia.
- Infant stimulation appears to be a promising early intervention strategy.
- Further research is needed to fully understand the comparative effects of physical therapy and infant stimulation.
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.