Gross motor function
A meta-analysis (Arpino et al, 2009) assessed whether intensive conventional therapy is more effective that non-intensive conventional therapy in children with CP as measured by the GMFM. A modest statistical effect in favor of children who underwent intensive therapy was demonstrated. Largest effects were noted for children with cerebral palsy under 2 years of age.
A high quality RCT (Christiasne et al, 2008) compared intermittent versus continuous delivery of physiotherapy on motor function in children with cerebral palsy. Both groups improved and no statistically significant differences were found between groups indicating that intermittent or continuous physiotherapy delivery does not result in different GMFM scores.
A quasi-experimental study (Van den Broeck et al, 2010) investigated the effectiveness of an individually defined physiotherapy program in children with cerebral palsy. GMFM scores improved after both programs but more so after the individually defined physical therapy program. No improvements in Dimension C of the GMFM as these scores achieved their maximum at baseline measurement of the study.
A pre-post study (Christy et al, 2012) investigated the effects of an intensive physical therapy program on children with cerebral palsy. A statistically significant increase on the GMFM-66 was noted after treatment (p<0.001) and improvement maintained at 3 months post intervention.
A quasi-experimental study (Sorsdahl et al, 2010) investigated the impact of intense rehabilitation in children with cerebral palsy. Results indicated an increase in basic motor abilities with intensive therapy as measured by the GMFM.
A quasi-experimental study (Ustad et al, 2009) compared the acquisition of gross motor skills in infants with CP following intense physical therapy versus the standard of care. The between-group findings were inconclusive. Trend towards increase in gross motor skill acquisition noted in both groups however there was no clear tendency towards gross motor skill acquisition acceleration second to intensive physical therapy.
A pre-post study (Yabunaka et al, 2011) investigated the effects of intensive physical therapy on children with cerebral palsy who are hospitalized for rehabilitation. At discharge GMFM-66 scores significantly higher in experimental group than hypothetical matched control indicating effectiveness of intensive physical therapy.
Conclusion: There is a high level of evidence (1a) from one meta-analysis demonstrating the positive effects of physical therapy on gross motor function in children with cerebral palsy.
Participation
A high quality RCT (Novak et al, 2009) investigated whether an occupational therapy home program provided to children with cerebral palsy was clinically effective compared to no home program. A statistically significant between group difference was found for the scores on the COPM performance and satisfaction components in favor of the home program group.
A pre-post study (Christy et al, 2012) investigated the effects of an intensive physical therapy program on children with cerebral palsy. COPM performance and satisfaction scores increased post treatment.
A quasi-experimental study (Sorsdahl et al, 2010) investigated the impact of intense rehabilitation in children with cerebral palsy. All subjects achieved individualized functional goals as measured by the Goal Attainment Scale after treatment.
Conclusion: Moderate evidence (level 1b) from one high quality RCT exists supporting the positive effects of physical and occupational therapy on participation outcomes in children with cerebral palsy.
Self-care
A quasi-experimental study (Sorsdahl et al, 2010) investigated the impact of intense rehabilitation in children with cerebral palsy. A statistically significant increase in PEDI scores were noted in the self-care functional and caregiver assistance scales (p<0.01).
Conclusion: Limited (level 2b) evidence from a single quasi-experimental study exists supporting the effect of intensive rehabilitation on self-care skills.
Upper extremity function
A high quality RCT (Novak et al, 2009) investigated whether an occupational therapy home program provided to children with cerebral palsy was clinically effective compared to no home program. A statistically significant group difference was found in the QUEST scores in favor of the home program group.
A quasi-experimental study (Sorsdahl et al, 2010) investigated the impact of intense rehabilitation in children with cerebral palsy. Although no statistically significant differences were found for QUEST scores, a general trend for improvement was noted.
Conclusion: Moderate evidence (level 1b) from one high quality RCT exists supporting the positive effects of rehabilitation on upper extremity function in children with cerebral palsy.
