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Targeted Physical Therapy Combined with Spasticity Management Changes Motor Development Trajectory for a 2-Year-Old
Corri L Stuyvenberg1, Shaaron E Brown2, Ketaki Inamdar3
1Rehabilitation Science Graduate Program, University of Minnesota Medical School, MMC 388, 420 Delaware St. SE, Minneapolis, MN 55455, USA.
Insights
This study shows that combining Botulinum toxin-A (BoNT-A) with the START-Play therapy improved gross motor skills in a child with cerebral palsy. The intervention surpassed clinically important differences, suggesting potential benefits for children with CP.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Developmental Pediatrics
Background:
- Cerebral palsy (CP) therapies often lack intensity, child-led engagement, and embodied approaches.
- The START-Play intervention emphasizes these components with intensive family involvement.
- START-Play was initially developed for infants but its principles apply to broader age ranges and skill levels.
Abstract:
Therapies for children with cerebral palsy (CP) often fail to address essential components of early rehabilitation: intensity, child initiation, and an embodied approach. Sitting Together And Reaching To Play (START-Play) addresses these issues while incorporating intensive family involvement to maximize therapeutic dosage. While START-Play was developed and tested on children aged 7-16 months with motor delays, the theoretical construct can be applied to intervention in children of broader ages and skills levels. This study quantifies the impact of a broader START-Play intervention combined with Botulinum toxin-A (BoNT-A) and phenol on the developmental trajectory of a 24 month-old child with bilateral spastic CP. In this AB +1 study, A consisted of multiple baseline assessments with the Gross Motor Function Measure-66 and the Assessment of Problem Solving in Play. The research participant demonstrated a stable baseline during A and changes in response to the combination of BoNT-A/phenol and 12 START-Play sessions during B, surpassing the minimal clinically important difference on the Gross Motor Function Measure-66. The follow-up data point (+1) was completed after a second round of BoNT-A/phenol injections. While the findings suggest the participant improved his gross motor skills with BoNT-A/phenol and START-Play, further research is needed to generalize these findings.
