Three studies have examined the efficacy of using play based therapies in the treatment of CP patients. The studies focused on different outcome measures and hence need to be addressed separately. The systematic review summaries pertaining to the questions posed in the qualifying research are listed below. Article summaries follow the conclusion.
| Question 1: | Does a program consisting of play-based educational art and drama classes affect cognitive, linguistic, socio-emotional and motor skills of children diagnosed with cerebral palsy? |
| Effective: | Yes |
| Level of Evidence: | None (Sackett = 5) |
| Number of Studies: | 1 |
Study Summary: One investigation has been done fusing play, art and drama together as a therapy and examining the outcomes on CP patients (Sparling et al.1984). The study was conducted as a pre-post design on fourteen children and thus did not produce convincing evidence that the observed progress was not due to factors not controlled for in the experiment.
Conclusion: Thus there is no evidence (Sackett = 5) that a play-based art and drama program provides significant improvements for CP patients as compared to other therapies.
Article Summaries:
Article 1
Sparling et al. 1984
Play techniques with neurologically impaired preschoolers
Level of Evidence: 4
Fourteen children with CP, aged between 3 and 6 years, participated in a prospective pre- post- study. The study investigated the effect of an educational play program on the cognitive, linguistic, social-emotional, and motor development of the participants. Subjects received 1 hour of educational drama class and 1 hour of educational art class every week for 7 weeks. Children were assessed prior to the start of the experiment in and were dealt individual developmental goals for the intervention.
Assessments were done before and after the intervention. Results are given for 13 of the original 14 subjects. A significant improvement in Vulpe Assessment Battery scores was found at the post-intervention assessment compared to baseline scores.
| Question 2: | Does a program consisting of land- and aquatic-based play sessions affect the range of motion in the lower extremities of female patients diagnosed with cerebral palsy? |
| Effective: | Yes |
| Level of Evidence: | None (Sackett = 5) |
| Number of Studies: | 1 |
Study Summary: One study investigated the effects of a play-based program consisting of aquatic and land activities on CP patients (Yaggie and Armstrong 2002). The study consisted of a pre-post design experiment on 3 girls and therefore could not produce convincing evidence that improvements observed during the study could be attributed to the therapy.
Conclusion: Therefore no evidence (Sackett = 5) is available exposing an advantage for using play-based, land and aquatic exercises for improving lower extremity range of motion scores in CP patients.
Article Summaries:
Article 1
Yaggie and Armstrong 2002
Flexibility outcomes of children with spastic cerebral palsy during a semester of play-based therapy
Level of Evidence: 4
Three girls with an average age of 8 years and diagnosed with mild to moderate spastic CP participated in a pre- post- design experiment. The girls attended a 2 hour play/activity session once a week. Nine sessions were completed over a period of 14 weeks. Each session was split into an hour of land-based play activities focusing on gross and fine motor skills and an hour of aquatic play activities concentrating on functional and swimming skills.
Assessments were done the week before the intervention and the week after intervention as well as before and after all 9 play sessions. Active range of motions (ROMs) in hip flexion, knee flexion, and ankle dorsiflexion and plantarflexion improved within each session. Dorsiflexion of the left and right ankles improved significantly from baseline scores over the nine sessions as did plantarflexion in the left ankles.
| Question 3: | How does play-based therapy affect the balance of patients diagnosed with cerebral palsy? |
| Effective: | Yes |
| Level of Evidence: | None (Sackett = 5) |
| Number of Studies: | 1 |
Study Summary: A pre-post single subject design experiment investigated the effects of a play-based program on the balance of a female CP patient (Yaggie and Armstrong 1999). The study lacked a sufficient design to produce convincing evidence that improvements observed during the study could be attributed solely to the therapy.
Conclusion: Therefore no evidence (Sackett = 5) is available supporting play-based therapy as more affective than other therapies in treating balance problems in CP patients.
Article Summaries:
Article 1
Yaggie and Armstrong 1999
The use of play-therapy in the treatment of children with cerebellar dysfunction
Level of Evidence: 4
A 7 year old girl with necrosis of the left cerebellar hemisphere from birth participated in a pre-post design study. The child attended 1 play session per week over an 11 week period. The intervention was split into 3 successive phases such that phase 1 (weeks 1-3) introduced simple skills, phase 2 (weeks 4-8) built upon those skills and phase 3 (weeks 9-11) consisted of the most integrated and difficult activities. The activities focused on bilateral balance and coordinated movements.
Three assessments were taken during the intervention and consisted of 3 balance tests each. The subject improved significantly over the experiment in F/A sway, M/L sway and vector displacement and thus improved the subject’s capacity to maintain functional balance.
