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The effectiveness of intensive versus standard physical therapy for motor progress in children with spastic cerebral palsy

Abstract

Background

Cerebral palsy (CP) remains the most common cause of physical disability in children that results from a static brain lesion during pregnancy or early life. Although the brain lesion is static, the physical manifestations and medical issues may progress, leading to altered motor patterns.

Objective

The aim of the study was to assess gross motor progress in children with spastic (quadriplegic and diplegic) CP treated with intensive physical therapy (PT) as compared with a matched group treated with a standard PT regimen.

Patients and methods

Out of 45 patients with spastic CP aged 2-6 years, 25 patients were assigned to an intensive therapy group (group A), whereas 20 patients were assigned to standard therapy (control group B). Patients were classified according to the gross motor function classification system. The intervention program was administered for 16 weeks, with sitting and walking as the treatment goal. The gross motor function measures 88 and 66 (GMFM-88 and GMFM-66) and gross motor performance measure (GMPM) were used for assessment at baseline, at 8 weeks, and at 16 weeks after intervention.

Results

At baseline, there were no statistically significant differences between the two groups. After 8 weeks, there were significant differences between the two groups as regards the total scores of GMFM-88 and GMPM (P < 0.05). However, highly significant differences for GMFM-88 (P < 0.001) and only significant differences (P < 0.05) for GMPM were observed after 16 weeks. No statistically significant differences were found between the two groups as regards GMFM-66 scores after 8 weeks, and significant differences were found only after 16 weeks (P < 0.05). After 16 weeks, all dimensions of GMFM-88 were significantly increased in both groups (P < 0.001). Only sitting showed no statistically significant difference in group B (P > 0.05).

Conclusion

Intensive PT regimens were more beneficial than standard therapy in spastic CP, especially in children with a low functional level.

References

  1. Novak I, Hines M, Goldsmith S, Barclay R. Clinical prognostic messages from a systematic review on cerebral palsy. Pediatrics 2012; 130: e1285–e1312.

    Article  Google Scholar 

  2. Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007; 109:8–14.

    PubMed  Google Scholar 

  3. Tieman BL, Palisano R, Gracely E, Rosenbaum P. Gross motor capability and performance of mobility in children with cerebral palsy: a comparison across home, school and outdoor/community settings. Phys Ther 2004; 84:419–429.

    Article  Google Scholar 

  4. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39:214–223.

    Article  CAS  Google Scholar 

  5. Odman P, Oberg B. Effectiveness of intensive training for children with cerebral palsy –a comparison between child and youth rehabilitation and conductive education. J Rehabil Med 2005; 37:263–270.

    Article  Google Scholar 

  6. Brown GT, Burns SA. The efficacy of neuro-developmental treatments in children: a systematic review. Br J Occup Ther 2001; 64:235–244.

    Article  Google Scholar 

  7. Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of strength training programs for people with cerebral palsy. Arch Phys Med Rehabil 2002; 83:1157–1164.

    Article  Google Scholar 

  8. Anttila H, Autti-Rämö I, Suoranta J, Mäkelä M, Malmivaara A. Effectiveness of physical therapy interventions for children with cerebral palsy: a systematic review. BMC Pediatr 2008; 8:14.

    Article  Google Scholar 

  9. Morris C. A review of the efficacy of lower-limb orthoses used for cerebral palsy. Dev Med Child Neurol 2002; 44:205–211.

    Article  Google Scholar 

  10. Wei S, Su-Juan W, Yuan-Gui L, Hong Y, Xiu-Juan X, Xiao-Mei S. Reliability and validity of the GMFM-66 in 0- to 3-year-old children with cerebral palsy. Am J Phys Med Rehabil 2006; 85:141–147.

    Article  Google Scholar 

  11. Russell DJ, Avery LM, Rosenbaum PL, Raina PS, Walter SD, Palisano RJ. Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity. Phys Ther 2000; 80:873–885.

    Article  CAS  Google Scholar 

  12. Yokochi K. Motor function in non-ambulatory children with spastic diplegia and periventricular leucomalacia. Brain Dev 2001; 23:327–331.

    Article  CAS  Google Scholar 

  13. Bower E, Michell D, Burnett M,Campbell MJ, McLellan DL. Randomized controlled trial of physiotherapy in 56 children with cerebral palsy followed for 18 months. Dev Med Child Neurol 2001; 43:4–15.

    Article  CAS  Google Scholar 

  14. Mayston M. Physiotherapy management in cerebral palsy: an update on treatment approaches. In: Scrutton D, Damiano D, Mayson M, eds. Management of the motor disorders of children with cerebral palsy. London: MacKeith; 2004.147–159.

  15. Russell DJ, Rosenbaum PL, Cadman DT, Gowland C, Hardy S, Jarvis S. The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol 1989; 31:341–352.

    Article  CAS  Google Scholar 

  16. Boyce WF, Gowland C, Rosenbaum PL, Lane M, Plews N, Goldsmith CH, et al. The Gross Motor Performance Measure: validity and responsiveness of a measure of quality of movement. Phys Ther 1995; 75:603–613.

    Article  CAS  Google Scholar 

  17. Graham HK. Absence of reference to progressive musculoskeletal pathology in definition of cerebral palsy. Dev Med Child Neurol 2006; 48: 78–79.

    Article  Google Scholar 

  18. Tsorlakis N, Evaggelinou C, Grouios G, Tsorbatzoudis C. Effect of intensive neurodevelopmental treatment in gross motor function of children with cerebral palsy. Dev Med Child Neurol 2004; 46:740–745.

    Article  Google Scholar 

  19. Shamir M, Dickstein R, Tirosh E. Intensive intermittent physical therapy in infants with cerebral palsy: a randomized controlled pilot study. Isr Med Assoc J 2012; 14:737–741.

    PubMed  Google Scholar 

  20. Deppe W, Thuemmler K, Fleischer J, Berger C, Meyer S, Wiedemann B. Modified constraint-induced movement therapy versus intensive bimanual training for children with hemiplegia — a randomized controlled trial. Clin Rehabil 2013; 27:909–920.

    Article  Google Scholar 

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Correspondence to Mohammad A. Zakaria MD.

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Elgawish, M.H., Zakaria, M.A. The effectiveness of intensive versus standard physical therapy for motor progress in children with spastic cerebral palsy. Egypt Rheumatol Rehabil 42, 1–6 (2015). https://doi.org/10.4103/1110-161X.155622

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Keywords

  • cerebral palsy
  • intensive physical therapy
  • neurodevelopmental therapy
  • spastic cerebral palsy