Physical Therapy and Cerebral Palsy

Clinical Rehabilitation published a review of the literature on the effectiveness of physical therapy interventions for young adults and adults (ages 16 and up) with cerebral palsy. Intially 675 articles were found on the topic. Only 13 studies could be included for review from earliest available time through March 2009. No articles meet the criteria for high methodological criteria. No articles had blinded therapists or subjects. Evidence was found of moderate quality on the use of progressive resistance strength training and gait. Following work station interventions, evidence of low quality was found on balance and strength training. In addition, low quality evidence was found for strength training effects on gross motor capacity. Finally, there was very low quality evidence found for strength training and its effects on range of motion.

The researchers recommend well designed physical therapy trials for this population of adults with cerebral palsy.

Reference: Jeglinsky, J. Surakka, E. Brogren Carlberg, and I. Autti-Rämö
Evidence on physiotherapeutic interventions for adults with cerebral palsy is sparse. A systematic review Clin Rehabil September 2010 24: 771-788, first published on July 6, 2010 doi:10.1177/0269215510367969

Effects of Goal Directed, Activity Focused Group Physical Therapy for Kids with CP

BMC Pediatrics published a research study on the changes of basic motor abilities, quality of movement and everyday activities after intensive, goal directed, activity focused physical therapy is a group setting for children with cerebral palsy. Twenty two children (mean age 5 years, 6 months), hemiplegia (7), diplegia (11), quadriplegia (2) and ataxia (2), participated in goal directed, activity focused group physical therapy for five days a week for three weeks. Each session was three hours.

The sessions consisted of:

1. functional goal directed training practicing specific activities

2. family centered practice

3. carry over training to parents and other persons associated with the child's everyday life

4. motor learning techniques regarding motivation, environments and variation.

Immediately following treatment, the Gross Motor Function Measure scores significantly improved. Children in GMFCS Levels I and II improved more that Levels III-V. Positive changes were seen on the Quality of Upper Extremity Skills Test but no significant difference was found. The Pediatric Evaluation of Disability Inventory scores displayed significant improvement in the self care int he functional skills dimension, self care and mobility dimension and the Caregiver Assistance dimension. Goal Attainment Scales were developed for the children. Following the intervention, on average the children reached the pre-determined goals. Seventy one percent of the activity goals, 50% of the movement goals and 80% of the combined goals were reached.

The researchers concluded that intensive training in a group setting may be a cost effective method to optimize function in young children with cerebral palsy.

Reference: Anne Brit Sorsdahl1, Rolf Moe-Nilssen1, Helga K Kaale, Jannike Rieber, Liv Inger Strand Change in basic motor abilities, quality of movement and everyday activities following intensive, goal-directed, activity-focused physiotherapy in a group setting for children with cerebral palsy BMC Pediatrics 2010, 10:26 doi:10.1186/1471-2431-10-26