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Effect of Parent-Mediated Home-Based Rehabilitation Program for Enhancing Functional Outcomes and Participation in
Sandeep Khanna1, Ranganathan Arunmozhi1
1School of Physiotherapy and Allied Health Sciences, Sardar Bhagwan Singh University, Balawala, Dehradun, IND.
Insights
Parent-mediated home-based rehabilitation significantly improved participation and motor function in children with cerebral palsy (CP). This approach offers a practical solution for families facing barriers to traditional therapy, enhancing daily life activities for children with CP.
Area of Science:
- Rehabilitation Medicine
- Pediatric Physical Therapy
- Neurodevelopmental Disorders
Background:
- Children with cerebral palsy (CP) often face mobility and participation challenges.
- Access to consistent therapeutic services can be limited by financial and logistical factors.
- Home-based, parent-mediated interventions offer a potential solution for lifelong conditions like CP.
Purpose of the Study:
- To evaluate the impact of a 10-week parent-mediated home-based rehabilitation program.
- To assess improvements in participation, gross motor function, balance, and functional independence in children with diplegic CP (GMFCS levels II-III).
Main Methods:
- Prospective, non-consecutive case series involving 10 children (5-12 years) with diplegic CP.
- Customized home intervention program with parent training and supervision.
- Utilized outcome measures: COPM, WeeFIM, GAS, PBS, GMFM-66, and CEDL V2.
Main Results:
- Significant improvements observed across all measured areas post-intervention.
- Canadian Occupational Performance Measure (COPM) scores for performance and satisfaction increased.
- Child Engagement in Daily Life Measure Version 2 (CEDL V2), WeeFIM, GMFM-66, GAS, and Pediatric Balance Scale (PBS) scores all showed positive changes.
Conclusions:
- Parent-mediated home-based rehabilitation is an effective and practical approach for children with diplegic CP.
- This intervention enhances functional outcomes and participation, especially when access to traditional therapy is limited.
- Further research with larger cohorts is recommended to confirm long-term efficacy and broader applicability.
Abstract:
Children with cerebral palsy (CP) often experience limitations in mobility, participation, and engagement in home, school, and play-related activities. Many children with CP are unable to access the required therapeutic services due to a variety of reasons, including financial constraints and caregiver availability. As CP is a lifelong condition, the required activities and exercises have to be repeated many times a day; a once-daily session with a therapist might be insufficient. Considering the comprehensive outcomes of therapy in lifelong conditions is significant to analyze the impact of an intervention program. Parent-mediated home-based rehabilitation programs may serve as a practical and possible approach to improve functional outcomes and participation of individuals with CP in daily life. This prospective, non-consecutive case series aims to analyze the effect of a 10-week parent-mediated home-based rehabilitation program on participation, gross motor function, balance, functional independence, engagement, and functional outcomes in 10 children aged between 5 years and 12 years with diplegic CP. These children were classified at Gross Motor Function Classification System (GMFCS) levels II and III. The children presented with difficulties in independent mobility within their environment and reduced participation in day-to-day activities at home and in the community. The home intervention program was designed according to the needs and routines of each child. Parents were briefed at the onset of the program and provided hands-on training on how to conduct various tasks and exercises at home. Parents were supervised through two scheduled sessions during the intervention period of 10 weeks to ensure appropriate implementation of the program. To measure functional outcomes and participation, measures used included the Canadian Occupational Performance Measure (COPM), Functional Independence Scale for Children (WeeFIM), Goal Attainment Scale (GAS), Pediatric Balance Scale (PBS), Gross Motor Function Measure-66 (GMFM-66), and the Child Engagement in Daily Life Measure Version 2 (CEDL V2). Mean scores demonstrated improvement in all outcome areas following the 10-week intervention. COPM performance improved from 3.1 to 4.2, while COPM satisfaction improved from 3 to 4.6. CEDL V2 frequency scores increased from 24.89 to 29.37, and CEDL V2 enjoyment scores increased from 23.3 to 25.8. WeeFIM scores improved from 72.5 to 78.5. The mean GMFM-66 scores improved from 63.12 to 64.84. GAS score improved from 40 to 44. Improvements were also seen in PBS scores, increasing from 33.3 to 35.3. The findings suggest that the parent-mediated home-based rehabilitation may be an effective and practical intervention approach for enhancing functional outcomes and participation among children with diplegic CP wherever direct therapeutic services are not available. Further studies with larger sample sizes are recommended to establish long-term effectiveness and broader applicability.
