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F-words and early intervention ingredients for non-ambulant children with cerebral palsy: A scoping review
Ana Carolina De Campos1, Álvaro Hidalgo-Robles2, Egmar Longo3
1Department of Physical Therapy, Federal University of São Carlos, São Carlos-, SP, Brazil.
Insights
Early interventions for young children with cerebral palsy (CP) in GMFCS levels IV-V should focus on fitness, family, and functioning. Assistive technology and parent training are effective, but evidence for fun, friends, and future is limited.
Area of Science:
- Pediatric Rehabilitation
- Developmental Pediatrics
- Clinical Neurology
Background:
- Cerebral palsy (CP) significantly impacts motor function in young children.
- Gross Motor Function Classification System (GMFCS) levels IV and V represent severe motor impairment.
- Early intervention is crucial for optimizing outcomes in children with CP.
Purpose of the Study:
- To identify the components of early interventions for young children (0-5 years) with CP classified as GMFCS levels IV or V.
- To determine which 'F-words' (functioning, fitness, family, fun, friends, future) are addressed by these interventions.
Main Methods:
- Systematic literature search across four electronic databases (2001-2021).
- Inclusion of experimental studies focusing on non-surgical, non-pharmacological interventions for children with CP (GMFCS IV-V).
- Analysis of interventions measuring outcomes across International Classification of Functioning, Disability and Health domains.
Main Results:
- Eighty-seven studies were reviewed, employing various quantitative and qualitative designs.
- Fitness, family, and functioning were the most frequently addressed 'F-words'.
- Interventions addressing fun, friends, and future had limited evidence. Environmental factors like service provision and therapy dose were also noted.
Conclusions:
- Family-centered care, including coaching and parental training, is effective for children with CP in GMFCS levels IV-V.
- Assistive technology can promote multiple 'F-words'.
- Future research should integrate these components into clinical practice and family contexts, particularly for fun, friends, and future.
Aim:
To explore the ingredients of early interventions provided to young children with cerebral palsy (CP) who are classified in Gross Motor Function Classification System (GMFCS) levels IV and V, and to identify the 'F-words' addressed by the interventions.
Method:
Searches were completed in four electronic databases. Inclusion criteria were the original experimental studies that fitted the following PCC components: population, young children (aged 0-5 years, at least 30% of the sample) with CP and significant motor impairment (GMFCS levels IV or V, at least 30% of the sample); concept, non-surgical and non-pharmacological early intervention services measuring outcomes from any of the International Classification of Functioning, Disability and Health domains; and context, studies published from 2001 to 2021, from all settings and not limited to any specific geographical location.
Results:
Eighty-seven papers were included for review, with qualitative (n = 3), mixed-methods (n = 4), quantitative descriptive (n = 22), quantitative non-randomized (n = 39), and quantitative randomized (n = 19) designs. Fitness (n = 59), family (n = 46), and functioning (n = 33) ingredients were addressed by most experimental studies, whereas studies on fun (n = 6), friends (n = 5), and future (n = 14) were scarce. Several other factors (n = 55) related to the environment, for example, service provision, professional training, therapy dose, and environmental modifications, were also relevant.
Interpretation:
Many studies positively supported formal parent training and use of assistive technology to promote several F-words. A menu of intervention ingredients was provided, with suggestions for future research, to incorporate them into a real context within the family and clinical practice.
What This Paper Adds:
Family-centred care (including coaching and caregiver-delivered interventions) and formal parental training are effective strategies for children in GMFCS levels IV and V. Assistive technology ingredients (power, mobility, supported, sitting, stepping, and standing) may promote several 'F-words' (functioning, fitness, family, fun, friends, and future). The lowest level of evidence was found for fun, friends, and future. Other factors (service provision, professional training, therapy dose, environmental modifications) are relevant for young children in GMFCS levels IV and V.
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