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23-08-2011 | Physical rehabilitation | Article

Right environment important for development in children with CP


Free abstract

MedWire News: An environment-based strategy is equally as effective as a child-focused approach for aiding development in young children with cerebral palsy (CP), say researchers.

Traditionally, children with CP are given "child-" or "family-focused" therapy aimed at improving the child's muscle tone, posture, range of motion, and general physical abilities.

Mary Law (McMaster University, Hamilton, Ontario, Canada) and colleagues investigated whether changing environment could be another strategy for aiding the development of children with CP.

To give an example, a child learned to finger-feed himself Cheerios® with the help of a therapist who first put peanut butter on the tips of his fingers so the Cheerios would stick to them. Following initial success he learnt to do this without the help of the peanut butter.

For this study, the researchers enrolled 128 children with CP, aged 3 years and 6 months on average.

Occupational and physical therapists from 19 children's rehabilitation centers were randomly assigned to give either child- or context- (environment) focused treatment, and the children they were treating were assigned to the same study arm.

The children received either child- (n=71) or context-focused (n=57) therapy over a period of 6 months, returning to their normal therapy routine at 6 to 9 months after enrollment.

Effects of the interventions were primarily assessed using the Pediatric Evaluation of Disability Inventory (PEDI) at baseline, 6, and 9 months.

Both groups improved their PEDI scores from baseline, but no significant differences in PEDI measurements were observed between the two treatment groups, other than a small difference in favor of the child-focused approach between baseline and 9 months on the Caregiver Assistance Mobility subscale.

The children also showed improvement on other scales of motion such as the Gross Motor Function Measure and the Assessment of Preschool Children's Participation, but again, there were no significant differences in the level of improvement between the two groups.

"This study provides evidence that each intervention approach yields equivalent important change after a six-month intervention," said Law.

She explained that the finding that both approaches appear to be equally effective means that therapists and families can discuss which treatment approach would best suit the individual child and their family.

Law and team conclude: "Further evaluation is required to identify the various 'dose-response' relations of amount of treatment and changes in functional abilities.

"The family's preference for intervention frequency also needs to be considered."

The results of this study are published in the journal Developmental Medicine and Child Neurology.

By Helen Albert

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