Group-Based Task-Related Training for Children with Cerebral Palsy

Abstract

This pilot study examined the feasibility of a 6-week group-based, task-related training program in children 6 to 14 years-old with spastic diplegia. Eight children were randomized to lower limb training and seven to an upper limb dexterity training program. There were no statistically significant differences in lower limb outcomes between children who received the lower limb training and children who received the upper limb dexterity training after completion of the interventions or at a 6-week follow-up. Children who received the upper limb training demonstrated a greater improvement on measures of manual dexterity compared with children who received the lower limb training program. Children who received the lower limb training demonstrated a trend toward walking a longer distance in 10 minutes immediately following intervention, that was not sustained at the 6-week follow-up. The group setting appeared to motivate the children and enhance their participation in the training programs. The pilot study provides data for the calculation of effect size and sample estimates for future studies.

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

“…five sessions a week over six months [11], five sessions a week over four weeks [12], or several daily sessions over five months [9]. There is no consensus regarding the optimal dose of training, and there are only a few studies examining the outcome of intensive physiotherapy training in a group setting [10,13,14]. …”

Effectiveness of functional hand splinting and the cognitive orientation to occupational performance (CO-OP) approach in children with cerebral palsy and brain injury: two randomised controlled trial protocols

“…The CO-OP approach can be utilised in a group format [29] and task-specific training intervention provided in a group setting has been shown to be effective in this population [5,44]. The benefits of group intervention may include improved motivation and participation [44]. The treating therapist will apply generalised therapeutic considerations during the groups, as would be applied in standard practice.…”

“…The 3 upper limb tasks identified as most important will be set as the goals for therapy. There is strong evidence to support the internal consistency reliability, content and construct validity and responsiveness of the COPM when used in paediatric rehabilitation [44,50]. The COPM has been shown to be responsive to change, with a 2 point improvement on performance scores recognised as clinically significant [49,51].…”

GRIN: “GRoup versus INdividual physiotherapy following lower limb intra-muscular Botulinum Toxin-A injections for ambulant children with cerebral palsy: an assessor-masked randomised comparison trial”: study protocol

“…Additionally, intervention should incorporate: (1) collaborative, individualized, realistic and specific goal setting which span across all domains of the ICF [7,29]; (2) specificity of task and training [30,31]; (3) repetition and practise within a functional “just right” context [32,33]; (4) environmental adaption [34] and (5) strategies to increase motivation and engagement [35,36]. This approach will facilitate rehabilitation focused on each child’s specific goals and functional needs [6,33,37].…”

“…There is potential for greater promotion of autonomy by allowing choice (personal goal setting), and through enjoyment, having fun and behaviour modelling to master activities [36,51]. A sense of competence may be fulfilled through scaffolding activities to promote skill development, and providing opportunities for peer learning [52-54] and healthy competition [30,36]. Social support and working with children with similar needs may also increase the feeling of relatedness [36,55].…”