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Additional therapy for young children with spastic cerebral palsy: a critical appraisal

Posted on January 24, 2017

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Additional therapy for young children with spastic cerebral palsy: A randomised controlled trial. 

Background

Cerebral Palsy (CP) refers to a range of neurological conditions that affect movement and coordination. CP is a very common acquired disability of the central nervous system (CNS), affecting around 2 children in every 100. Children with CP routinely receive physiotherapy to improve or maintain gross motor function. Currently in the UK, physiotherapists treat children with CP with neurodevelopmental therapy that has been developed following the principles of Bobath (Bobath 1980). A number of studies (e.g. Harris; 1988, Hur; 1995) have been carried out to assess the efficacy of physiotherapy for children with CP. However, it is difficult to come to a clear conclusion about the efficacy of physiotherapy, due to problems with the design of the studies.

What was the study?

The study looks at young children with spastic cerebral palsy. The purpose of the study was to determine the effects of additional neurodevelopmental therapy on motor function (i.e. movement and actions of the muscles). The intervention consisted of a control group receiving standard physiotherapy and support, and two intervention groups. One intervention group received an extra hour of physiotherapy and the second intervention group received a weekly home visit from a family support worker.

The inclusion criteria were: being younger than 4 years old and having spastic CP of perinatal origin (i.e. from around the time of birth). Spastic CP is the most common time of CP, characterised by stiff movements. Participants were referred via their paediatrician or a senior paediatric physiotherapist and then screened for eligibility. Ninety families were recruited. However 2 families withdrew, leaving 88 participants in the study.

What were the results?

There was no evidence that increasing therapy improved gross motor function (e.g. the large movements one can make, such as running or jumping). However, as will be discussed, the study was unpowered, making it impossible to say whether there truly was no difference between the groups or whether an effect could not be identified. 

What were the strengths and weaknesses of the study?

In order to evaluate the study and interpret the results effectively, the CASP Randomised controlled trial (RCT) tool was used.

Conclusion

Given that the study was underpowered, it is difficult to conclude whether increasing intensity of physiotherapy really does have no effect on improving motor functioning. Therefore, this study arguably did not produce any clinically relevant results. So the question regarding the most effective level of care to provide the best outcome for children with cerebral palsy and their families remains unanswered by this study. Further research is necessary, (ensuring adequate sample sizes), to determine appropriate treatment intensity to maximise developmental progression.

References 

Bobath K. A neurophysiological basis for the treatment of cerebral palsy. Clinics in Developmental Medicine No 75. London: SIMP with Heinemann Medical:Philadelphia, PA: Lippincott; 1980.

Harris SR. Early intervention: does developmental therapy make a difference? Top Early Child Spec Educ 1988;7:20–32.

Hur J. Review of research on therapeutic interventions for children with cerebral palsy. Acta Neurol Scand 1995;91:423–32.

WEINDLING, A., CUNNINGHAM, C., GLENN, S., EDWARDS, R. and REEVES, D., 2007. Additional therapy for young children with spastic cerebral palsy: A randomised controlled trial. Health Technology Assessment. May, vol. 11, no. 16,

Sandie Ferguson

A physiotherapy student from Queen Margaret University in Edinburgh.

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Additional therapy for young children with spastic cerebral palsy: a critical appraisal by Sandie Ferguson is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Unless otherwise stated, all images used within the blog are not available for reuse or republication as they are purchased for Students 4 Best Evidence from shutterstock.com.

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