Use of outcome measures in children with severe cerebral palsy: A survey of U.K. physiotherapists.

OBJECTIVES: To investigate the use of outcome measures for children with cerebral palsy (CP) by paediatric physiotherapists (PTs) who are based in the United Kingdom, as limited research exists regarding their use in this population, and to explore therapists' use of measures within different Gross Motor Function Classification System (GMFCS) levels and for different types of CP. METHODS: A six-item online survey was advertised through two paediatric therapy special interest groups inviting physiotherapists to participate. Descriptive statistics (range, frequencies, and percentages) were used to analyse survey data. RESULTS: Two hundred and seven physiotherapists returned completed survey questionnaires. One hundred and seventy-six (85%) therapists reported using a wide variety of outcome measures (57). Eighty-one per cent of therapists' responses for having "most difficulty" in identifying responsive outcome measures were for children with impaired mobility at GMFCS Levels IV-V and children with more significant body involvement (76%), for example, spastic quadriplegia or dyskinesia. Eighty-six per cent of therapists' responses for having "greatest ease" of identifying responsive outcome measures were for children within GMFCS Levels I-III and for children with less significant body involvement (72%), for example, hemiplegia. The variety of outcome measures used by therapists with children within GMFCS IV-V was less (16). CONCLUSIONS: The majority (85%) of the PTs surveyed used outcome measures with children with CP, but 81% perceived a difficulty in identifying responsive measures for children with more severe impairments who are classified as GMFCS IV-V. The reasons for this perceived difficulty warrant investigation and may suggest a need for training regarding relevant measures and/or a need to develop new measures for this group of children.

Marriage and fatherhood programs.

To improve the quality and stability of couple and father-child relationships in fragile families, researchers are beginning to consider how to tailor existing couple-relationship and father-involvement interventions, which are now targeted on married couples, to the specific needs of unwed couples in fragile families. The goal, explain Philip Cowan, Carolyn Pape Cowan, and Virginia Knox, is to provide a more supportive developmental context for mothers, fathers, and, especially, the children in fragile families. The authors present a conceptual model to explain why couple-relationship and father-involvement interventions developed for middle- and low-income married couples might be expected to provide benefits for children of unmarried parents. Then they summarize the extensive research on existing couple-relationship and father-involvement interventions, noting that only a few of the programs for couples and a handful of fatherhood programs have been systematically evaluated. Of those that have been evaluated, few have included unmarried couples as participants, and none has investigated whether interventions may have different effects when unmarried fathers live with or apart from the child. Furthermore, although the funders and creators of most programs for couples or for fathers justify their offerings in terms of potential benefits for children, the authors note that the programs rarely assess child outcomes systematically. Next, the authors consider whether interventions for working-class or middle-class fathers or couples that have shown benefits for family members and their relationships might be helpful to fragile families, in which the parents are not married at the time of their child's birth. Because evidence suggests that couple-oriented programs also have a positive effect on father involvement, the authors recommend integrating couple and fatherhood interventions to increase their power to reduce the risks and enhance the protective factors for children's development and well-being. The authors emphasize the need for more research on program development to understand the most effective ways to strengthen co-parenting by couples who are the biological parents of a child but who have relatively tenuous, or already dissolved, relationships with one another. In closing, the authors summarize how far the family-strengthening field has come and offer suggestions for where it might go from here to be helpful to fragile families.

Evaluation of the functional effects of a course of Bobath therapy in children with cerebral palsy: a preliminary study.

This study aimed to evaluate functional effects of Bobath therapy in children with cerebral palsy (CP). Fifteen children with a diagnosis of CP were recruited (9 males, 6 females; mean age 7 years 4 months, SD 2 years 8 months; age range 2 to 12 years). Types of motor disorder were as follows: spastic quadriplegia (n=9); spastic diplegia (n=4); athetoid quadriplegia (n=1), and ataxia (n=1). Participants were distributed across the following Gross Motor Function Classification levels: level I, n=1; level II, n=4; level III, n=5; level IV, n=4; and level V, n=1. Children awaiting orthopaedic intervention were excluded. A repeated measures design was used with participants tested with the Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory (PEDI) at 6-weekly intervals (baseline, before and after Bobath therapy, and follow-up). As the data were of ordinal type, non-parametric statistics were used, i.e. Wilcoxon's test. Participants showed a significant improvement in scores in the following areas following Bobath therapy compared with the periods before and after Bobath therapy: GMFM total score (p=0.009); GMFM goal total (p=0.001); PEDI self care skills (p=0.036); and PEDI caregiver assistance total score (p=0.012). This demonstrates that in this population, gains were made in motor function and self care following a course of Bobath therapy.