This study aimed to determine whether motor function and performance is better enhanced by intensive physiotherapy or collaborative goal-setting in children with cerebral palsy (CP). Participants were a convenience sample of 56 children with bilateral CP classified at level III or below on the Gross Motor Function Classification System (GMFCS), aged between 3 and 12 years. A 2 × 2 factorial design was used to compare the effects of routine amounts of physiotherapy with intensive amounts, and to compare the use of generalized aims set by the child's physiotherapist with the use of specific, measurable goals negotiated by the child's physiotherapist with each child, carer, and teacher. Following the six-month treatment period there was a further six-month period of observation. Changes in motor function and performance were assessed by a masked assessor using the Gross Motor Function Measure (GMFM) and the Gross Motor Performance Measure (GMPM) at three-month intervals. There was no statistically significant difference in the scores achieved between intensive and routine amounts of therapy or between aim-directed and goal-directed therapy in either function or performance. Inclusion of additional covariates of age and severity levels showed a trend towards a statistically significant difference in children receiving intensive therapy during the treatment period. This advantage declined over the subsequent six months during which therapy had reverted to its usual amount. Differences in goal-setting procedures did not produce any detectable effect on the acquisition of gross motor function or performance.In our previous studies (Bower andMcLellan 1992, 1994b) we identified two elements that were widely believed by health care professionals and parents to be of particular importance in determining the rate of motor progress in children with cerebral palsy (CP). Both of these elements would be supported by basic principles of learning theory. One element was the intensity of physiotherapy treatment, i.e. the number of therapy sessions within a set time period. The other was the identification of precise objectives that were adopted and understood by the child and considered helpful by parents and carers.Physiotherapists often identify a set of general aims in relation to the treatment of their patients, such as improvement of trunk balance or gait pattern. While such aims reflect the general direction of changes in the patient's performance they do not define the achievement with any measurable precision. Such general aims can be contrasted with specific measurable goals of therapy collaboratively agreed upon by the child, parents, teacher, and therapist. Setting a treatment goal involves identifying and formulating standards of motor activity which are in advance of the child's current capacity or which retard deterioration (Bower and McLellan 1994a). Goals need to be formulated in such a way that there is no doubt as to the extent to which they have been achieved when performance is reviewed. Other studiesMcLaughlin...

This study aimed to determine whether motor function and performance is better enhanced by intensive physiotherapy or collaborative goal-setting in children with cerebral palsy (CP). Participants were a convenience sample of 56 children with bilateral CP classified at level III or below on the Gross Motor Function Classification System (GMFCS), aged between 3 and 12 years. A 2 x 2 factorial design was used to compare the effects of routine amounts of physiotherapy with intensive amounts, and to compare the use of generalized aims set by the child's physiotherapist with the use of specific, measurable goals negotiated by the child's physiotherapist with each child, carer, and teacher. Following the six-month treatment period there was a further six-month period of observation. Changes in motor function and performance were assessed by a masked assessor using the Gross Motor Function Measure (GMFM) and the Gross Motor Performance Measure (GMPM) at three-month intervals. There was no statistically significant difference in the scores achieved between intensive and routine amounts of therapy or between aim-directed and goal-directed therapy in either function or performance. Inclusion of additional covariates of age and severity levels showed a trend towards a statistically significant difference in children receiving intensive therapy during the treatment period. This advantage declined over the subsequent six months during which therapy had reverted to its usual amount. Differences in goal-setting procedures did not produce any detectable effect on the acquisition of gross motor function or performance.