Physiotherapy for children with cerebral palsy

In a pilot study 7 children received an increased amount of standard physiotherapy over a 3 week period on a withdrawal ABA single case experimental design with the children acting as their own controls. Two realistic and useful short term goals were chosen for each child. The goals were specific and measurable. Progress was assessed on the Gross Motor Function Measure (G.M.F.M.). The progress made towards some of the goals during the intensive period was maintained when treatment was reduced in the subsequent 3 week period, in other cases it was lost. Goals associated with daily functional activities understood by the child and not requiring increased assistance from the carer tended not to regress.In a group of 4 children with apparently normal intellect using an ABAA or AABA randomised design over a 20 week period, progress was again increased during intensive treatment in both the goal and non-goal dimensions of the G.M.F.M. but there were some behavioural problems in some children.Changes in motor function during the trial were assessed by an independent masked assessor using the G.M.F.M. Goal-directed physiotherapy produced a statistically significant increase in those dimensions of the G.M.F.M. in which specific goals had been set (p=0.046) when compared with aim-directed physiotherapy and this was a better result than was achieved by more intensive therapy (p=0.055) compared with conventional therapy. The best results occurred in children who had both specific goal-directed and intensive therapy.These results give some support to the view that the use of specific precise functional goal setting and more intensive treatment accelerates the acquisition of motor skills if continued for 2 weeks.