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Infants and Toddlers With Moderate-To-Severe Cerebral Palsy Receive Very Low Doses of In-Person Rehabilitation
Rachel Bican1, Jill Heathcock2
1Division of Physical Therapy, Ohio University, Athens, Ohio.
Insights
Infants and toddlers with cerebral palsy (CP) receive insufficient rehabilitation. The amount of physical therapy (PT) provided does not correlate with age or motor function, indicating a need for personalized early intervention plans.
Area of Science:
- Pediatric rehabilitation
- Developmental pediatrics
- Neurology
Background:
- Optimizing developmental outcomes for children with cerebral palsy (CP) relies on adequate rehabilitation service dosage.
- Current understanding of in-person rehabilitation doses for infants and toddlers with CP is limited.
- The relationship between rehabilitation dose and functional outcomes in this population requires further investigation.
Purpose of the Study:
- To quantify the dose of in-person rehabilitation services received by infants and toddlers diagnosed with CP.
- To examine the association between physical therapy (PT) dose, patient age, and gross motor function.
Main Methods:
- A cohort of 53 participants aged 6 months to 2 years with moderate-to-severe CP (Gross Motor Function Classification System levels III-V) were enrolled.
- Parent-reported outpatient and early intervention PT, occupational therapy, and speech-language pathology service data were collected over 6 months.
- Monthly service doses were calculated, and motor function was assessed using the Gross Motor Function Measure (88-item).
Main Results:
- Participants received minimal doses of therapy across all disciplines, averaging less than 9 total in-person hours per month.
- Mean monthly rehabilitation service hours per discipline ranged from 0.4 to 3.0.
- No statistically significant relationship was observed between the total PT hours received and the child's age or gross motor function score.
Conclusions:
- Infants and toddlers with moderate-to-severe CP are receiving low doses of in-person rehabilitation services.
- Current physical therapy dosing does not appear to be tailored to the child's age or functional severity.
- There is a critical need for more individualized, intensive, and family-centered rehabilitation strategies in early childhood for children with CP.
Background:
Dose of rehabilitation services is important for optimizing developmental outcomes for children with cerebral palsy (CP). However, little is known about how much in-person rehabilitation infants and toddlers with CP currently receive, and how dose relates to function. The purpose of this study is to describe the dose of in-person rehabilitation services received by infants and toddlers with CP and to evaluate the relationship between physical therapy (PT) dose, age, and gross motor function.
Methods:
We enrolled 53 participants (6 months-2 years old) with moderate-to-severe CP, defined as Gross Motor Function Classification System levels III-V. Parent-reported data on outpatient and early intervention PT, occupational therapy, and speech-language pathology services over the past 6 months were used to calculate monthly service dose. The Gross Motor Function Measure, 88-item was administered to quantify motor function.
Results:
Participants received very low doses of therapy across disciplines. The mean total hours of rehabilitation services the participants received were between 0.4 and 3.0 hours per discipline per month. Combined in-person services averaged less than 9 total hours per month. There was no relationship found between the total hours of PT the child received and their age (P = 0.27, F = 1.22) or gross motor function (as measured by the Gross Motor Function Measure, 88-item) (P = 0.82, F = 0.05).
Conclusions:
Infants and toddlers with moderate-to-severe CP receive low doses of in-person rehabilitation, and the dose of PT does not appear to be individualized based on age or functional severity. These findings suggest a need for more tailored, intensive, and family-centered rehabilitation planning in early childhood.
