Defining Goal-Directed Training for Children with Cerebral Palsy: A Scoping Review and Framework for Implementation

Background/Objectives: This scoping review aimed to define goal-directed training (GDT) and its impact on outcomes for children with cerebral palsy (CP), and to develop a structured framework outlining its core components for effective implementation. Methods: Using the Arksey and O'Malley framework and PICO criteria, nine databases were searched and reference lists reviewed. Two reviewers independently screened and extracted data, which were analyzed using a qualitative descriptive approach. Results: From 1273 articles, 156 met inclusion criteria, including 112 efficacy studies (53 randomized trials, 53 non-randomized trials, 6 secondary analyses) involving 4708 children aged 3 months to 21 years (mean age 6.7 years). Interventions addressed all GMFCS and MACS levels. Ninety outcome measures across ICF domains were used. GDT was associated with improvements in motor function, hand use, self-care, communication, and participation. Findings were synthesized into an eight-step GDT framework highlighting collaborative goal setting, goal analysis, strategy determination, structured practice, feedback, re-evaluation, and generalization. This framework supports consistent, high-quality GDT implementation across settings and disciplines. Conclusions: In conclusion, GDT shows broad functional benefits and emphasizes individualized, client-centered care. The review offers a practical, evidence-informed framework to guide clinicians and researchers in delivering GDT with fidelity.