Motor training for young children with cerebral palsy: A single-blind randomized controlled trial.

AIM: To compare the effect of iMOVE (Intensive Mobility training with Variability and Error) therapy with dose-matched conventional therapy on gross motor development and secondary outcomes in young children with cerebral palsy. METHOD: This single-blind, randomized controlled trial included repeated assessments of gross motor function (using the Gross Motor Function Measure) and secondary outcomes during a 12- to 24-week intervention phase and at three follow-up points after treatment. Treatment was delivered three times per week in both groups. Forty-two children aged 12 to 36 months were stratified by age and motor function to ensure equivalence between groups at baseline. RESULTS: Thirty-six children completed treatment and follow-up phases. Treatment fidelity was high and adherence was equivalent between groups (77.3% conventional therapy, 76.2% iMOVE). There were no group differences on the primary (gross motor function after 12 weeks p = 0.18; after 24 weeks p = 0.94) or any secondary (postural control p = 0.88, caregiver satisfaction p = 0.52, child engagement p = 0.98) measure after treatment or at the follow-up points. However, one-third of total participants exceeded predicted change after 12 weeks and 77% exceeded predicted change after 24 weeks of treatment. INTERPRETATION: Our observations indicate a potential dose-response effect of rehabilitation therapy. We further demonstrated that individual therapeutic ingredients can be manipulated. When delivered consistently, both iMOVE and conventional therapy interventions might both be more effective than standard care. WHAT THIS PAPER ADDS: Those receiving iMOVE therapy demonstrated more independent practice time, error, and child-initiation than those receiving the dose-matched control. iMOVE therapy was not superior to the control (conventional physical) therapy. Most participants exceeded predicted change after 24 weeks of treatment.

The Use of Dynamic Weight Support with Principles of Infant Learning in a Child with Cerebral Palsy: A Case Report.

AIMS: Typical infant movement is characterized by a high degree of motor exploration, error, and variability. However, children with cerebral palsy (CP) often cannot create these experiences due to their neuromotor impairments. The purpose of this case study is to describe a 6-month course of physical therapy (PT) incorporating principles of infant motor learning using dynamic weight support (DWS) in a child with CP. METHODS: The child was a 27-month-old girl with diplegic CP who functioned at Gross Motor Function Classification System Level IV. The child received 68 PT sessions over a six-month period. DWS was used during therapy to encourage motor practice. The therapy area was arranged to encourage active exploration, motor variability, and error experience. Gross motor function, postural control, parent perception of performance, and parent satisfaction were measured before, during, and after the course of therapy. RESULTS: Gross motor function increased during the treatment beyond the level predicted from natural progression. Postural control fluctuated and demonstrated no appreciable improvement. Parent-perceived performance and satisfaction improved on three of four goals. CONCLUSIONS: Using DWS to incorporate principles of infant learning may have facilitated the development of gross motor skills in a child with diplegic CP.