BackgroundLittle is known about the efficacy and the working mechanisms of physical and occupational therapy interventions for children with cerebral palsy (CP). In recent years a shift from a child-focused intervention approach to a more context-focused intervention approach can be recognized. Until now the evidence on the efficacy and the working mechanisms of these interventions for children with CP is inconclusive. This study aims to evaluate the efficacy and working mechanisms of two intervention approaches compared to regular care intervention in improving mobility and self-care skills of children (2-3 years) with CP and their families: a child-focused intervention approach and a context-focused intervention approach.Methods/DesignA multi-centre, randomized controlled trial research design will be used. Ninety-four children with CP (Gross Motor Function Classification System (GMFCS) level I-IV; age 2 to 3 years), their parents, and service providers (physical and occupational therapists) will be included. During a period of six months children will receive child-focused, context-focused or regular care intervention. Therapists will be randomly assigned to deliver either a child-focused intervention approach, a context-focused intervention approach or regular care intervention. Children follow their therapist into the allocated intervention arm. After the six months study-intervention period, all participants return to regular care intervention. Outcomes will be evaluated at baseline, after six months and at a three months follow-up period. Primary outcome is the capability of functional skills in self-care and mobility, using the Functional Skills Scale of the Pediatric Evaluation of Disability Inventory (PEDI). Other outcomes will be quality of life and the domains of the International Classification of Functioning, Disability and Health - for Children and Youth (ICF-CY), including body function and structure, activities (gross motor capacity and performance of daily activities), social participation, environmental variables (family functioning, parental empowerment).DiscussionThis paper presents the background information, design, description of interventions and protocol for this study on the efficacy and working mechanisms of child-focused intervention approach and context-focused intervention approach compared to regular care intervention in mobility and self-care skills of children (2-3 years) with CP.Trial registrationThis study is registered in the Dutch Trial Register as NTR1900

Examining the effects of diapers and other external constraints on infants' leg movements may affect how we collect motor control research data, dress infants to allow optimal movement in the home, and administer therapeutic interventions for infants with motor impairments. To address this issue we supported 12 healthy infants (2-4 months) on an infant-sized treadmill in each of 4 conditions: wearing nothing (None), a swim diaper (Swim), a disposable diaper (Diaper), or a combination of diaper and research recording equipment (All). We recorded the trials with a digital video camera and behavior coded number of steps and step type (alternating, parallel, double, or single steps) to assess both quantity and quality of movements. Infants produced similar numbers of steps in a predominantly alternating step pattern (high quality) during the None, Swim and Diaper conditions, but both quantity and quality of stepping decreased in the All condition. Our results suggest that diapers alone do not alter stepping patterns significantly, but sufficient additional weight and clothing beyond the diaper can affect movement frequency and quality in young infants.Everyone who has worn tight, uncomfortable clothing can attest to how these items affect both movement amplitude and willingness to produce some types of actions. Popular magazines contain numerous articles on how to select clothing that will allow comfortable movement (Meyer, 1997), wick away sweat from the body during exercise (Olsson, 1998), improve sport performance (O'Driscoll, 2008), assist in weight loss (Enamait, 2008;Johnson, 2005) or protect from the elements (Beers, 2006;Thein, 1995). Despite the wealth of informal observations, scientific publications on how clothing constrains movement in adults are sparse, and in infants nonexistent. Researchers have investigated how clothing constrains movement only in cases of specialized clothing for the military or fire fighting, where limitations on movement cost lives (Malley et al., 1999;Patton, Bidwell, Murphy, Mello, & Harp, 1995). Infancy is another crucial time when bulky clothes and diapers could constrain movement enough to delay exploration and performance of nascent motor skills. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Advertisers of disposable diapers claim that their brand reduces bulk around the legs so infants can crawl or walk better than in competitors' styles, but research either has not been conducted or is not publicly available. Advancements in diaper technology, including contouring and development of absorbent materials have reduced the bulk aroun...

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