Intensive Physical Therapy Helps Preserve Motor Skills in CP Children, Study Shows

Intensive Physical Therapy Helps Preserve Motor Skills in CP Children, Study Shows

Children with cerebral palsy may benefit significantly over the long-term from intensive physical training that prevents deterioration of their motor skills.

The study with that finding, “Factors Associated with Enhanced Gross Motor Progress in Children with Cerebral Palsy: A Register-Based Study,” was published recently in the journal Physical & Occupational Therapy In Pediatrics.

Cerebral palsy is caused mainly by perinatal brain injury due to oxygen deprivation. It can manifest with different symptoms and severity of degrees, including mental retardation, seizure, speech delay, and behavioral problems. But the major feature of this condition, and the most challenging, is motor disability.

Gross motor function is fundamental for children to explore and interact with their surroundings. As such, it becomes crucial to identify which factors influence gross motor progress and are of particular therapeutic relevance for children with cerebral palsy.

“Some factors have shown to benefit short-term gross motor progress, but possible long-term influences are still unclear, and longitudinal studies based on large cohorts of children have been requested,” researchers wrote.

This study focused on the evaluation of potential associations between physical activity interventions and gross motor progress in children with cerebral palsy.

Researchers collected information from the Cerebral Palsy Follow-up Program (CPOP) and The Cerebral Palsy Register of Norway (CPRN), which together comprise data on 90 percent of children with cerebral palsy in Norway. The team analyzed the clinical records of 442 children aged 2 to 12 years, of whom 256 were boys and 186 girls; they were followed for a mean period of 2.9 years.

Children who underwent three or more sessions per week of physical therapy, or participated in an intensive physical therapy program, were the ones who experienced enhanced progress on their gross motor function during the study period.

As in previous studies, the team found this positive effect is dependent on the number of training periods. While one period with intensive training enhanced gross motor progress by 3.3 percentiles, two periods could enhance gross motor progress by 6.6 percentiles.

Intellectual disability was found to be a strong negative prognostic factor, as it was associated with lower gross motor function abilities — on average 24.2 percentiles below that reported on others. Also, eating problems and ankle contractures negatively impacted long-term progress of gross motor function in these children.

According to researchers “intensive training enhances gross motor progress in all children with cerebral palsy … the results give reasons to recommend intensive training independent of intellectual ability or any of the other factors included,” they wrote.

One comment

  1. Dr. Susan Hastings, PT, DPT, PCS says:

    Without describing the nature of the therapeutic intervention strategies, this study supports increasing physical therapy services for children with CP. In the United States, families of children with CP and their therapists face reductions in funding for therapy services nationwide after deep tax cuts were granted to the already wealthy among us. The need for more therapy and the diminishing funds are colliding.
    TheraTogs orthotic undergarment and strapping systems were developed by an experienced pediatric physical therapist as a means of multiplying therapy services by enhancing the wearer’s functioning trunk and limb alignment in daily life between treatment sessions. After addressing and optimizing standing foot and ankle alignment with customized ankle-foot orthoses, the first concern addressed by TheraTogs is to optimize trunk alignment and trunk and hip stability. TheraTogs systems support the treatment principles of Neurodevelopmental Treatment (Bobath therapy), Dr. Shirley Sahrmann’s Movement Systems Analysis, and apply the sciences of sensorimotor development, and of physiologic adaptation to a use history of bones, joints, muscles, fascia, and the brain. Massed practice in purposeful contexts is now known as a necessary component of neuromotor training, and sensory input is the essential information stream for motor learning.
    The recognition by the authors of the value of ankle mobility in gross motor development is interesting. I must, however, stress the importance of protecting calf muscle strength as an essential component of building walking ability. Injury does not promote optimum use. There is no support by long-term outcome researchers for making already weak calf muscles weaker by any means, including botulinum toxin-A injections or surgical lengthenings of any kind. There are effective strategies for improving ankle mobility that do not injure or weaken the muscles.
    Cerebral palsy is not a short-order problem. Management throughout skeletal growth is required. No therapy program consists of one strategy. In my 22 years of experience working with children, I find that Functional Electrical Stimulation (FES), Neuromuscular Electrical Stimulation (NMES), and Whole Body Vibration (WBV) work effectively in concert with TheraTogs to increase strength, ROM, and function in all muscles targeted. Using these modalities may “bridge the gap,” while more studies are done on therapy frequency, so current patients do not fall through the cracks of the system. All children I have seen using these 3 methods together, for several years each in most cases, have increased their GMFCS level by at least one level, and continue to improve in strength and ROM, even being seen only 1-2 times per week. These patients are between ages 3-15 years, and almost all do a home program of keeping alignment by wearing TheraTogs daily until they can maintain their alignment while participating daily life and community activities, and by using daily NMES and WBV. This approach has worked to significantly improve the lives of the children and their families to the point they are compliant with their daily use in the home program. Until further studies are done, and the system changes, these methods are the only ones I have found to improve ROM, strength, balance, and motor skills over the years.

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