[Paper Review] Functional change in children with cerebral palsy

Derek John Curtis, Pauline Holbrook+3 more|arXiv (Cornell University)|Nov 9, 2018

Cerebral Palsy and Movement DisordersMedicine18 references3 citations

TL;DR

This study evaluates a targeted trunk and head postural control training (TT) program combined with standard physical therapy (TAU) in children with cerebral palsy (CP). Results show significant functional improvements on the GMFM, PEDLI, and SATC, exceeding predicted gains—especially in children with more severe CP—demonstrating the potential of TT+TAU to enhance motor outcomes beyond expected norms.

ABSTRACT

Introduction There is increasing focus on the association between trunk control and functional abilities in children with cerebral palsy (CP). The purpose of this study was to determine the extent of functional change in children with CP who participated in specific trunk and head postural control training combined with physical therapy treatment as usual (TAU). Methods This study included 140 consecutive referrals to a centre specialising in head and trunk postural control (Targeted Training (TT)) between 2009 and 2016. Twenty-five children discontinued therapy due to surgery, health, family issues or poor attendance. The remaining 115 children (46 girls, 69 boys) had a mean age of 6 y 6 mo (SD 2 y 8 mo) with participants from all GMFCS levels. The intervention was a program of TT and ongoing TAU with a mean duration of 11 months. Gross Motor Function Measure (GMFM), Pediatric Evaluation of Disability Inventory functional skills, Chailey Levels of Ability and Segmental Assessment of Trunk Control were administered before and after the intervention. Results There were significant improvements in all outcomes. GMFM improvements exceeded those predicted from the published reference curves, especially for the children with more severe cerebral palsy. Conclusions Functional improvement exceeded the expected norm, especially in those children with more severe gross motor function disability. The other outcomes also showed significant improvements. These findings support the case for further studies and, if needed, tool development to facilitate determination of the critical elements in a combined therapy approach of TT with TAU.

Motivation & Objective

• To assess functional change in children with CP following a targeted trunk and head postural control training (TT) program combined with standard physical therapy (TAU).
• To determine whether improvements in motor function exceed those predicted by reference curves, particularly in children with more severe gross motor impairments.
• To evaluate the impact of TT+TAU on multiple functional and postural control outcomes across all GMFCS levels.
• To identify critical components of the combined therapy approach that may drive functional gains.

Proposed method

• A prospective, consecutive cohort study design was used, enrolling 140 children referred to a specialized TT clinic between 2009 and 2016.
• Children received a structured TT program focused on head and trunk control, integrated with ongoing standard physical therapy (TAU).
• Intervention duration averaged 11 months, with assessments conducted before and after treatment.
• Primary outcomes included the Gross Motor Function Measure (GMFM), Pediatric Evaluation of Disability Inventory (PEDLI), Chailey Levels of Ability, and Segmental Assessment of Trunk Control (SATC).
• Improvements were compared against published reference curves for GMFM to assess deviation from expected functional gains.

Experimental results

Research questions

• RQ1 To what extent does targeted trunk and head postural control training (TT) combined with standard physical therapy (TAU) lead to functional improvement in children with CP?
• RQ2 Do children with more severe gross motor impairments (higher GMFCS levels) show greater functional gains relative to predicted norms?
• RQ3 How do changes in trunk control (SATC) correlate with improvements in overall motor function (GMFM) and functional skills (PEDLI)?
• RQ4 Are improvements in functional outcomes significantly greater than those predicted by reference curves?

Key findings

• Children with CP showed significant improvements in GMFM scores, with gains exceeding those predicted by published reference curves, especially among those with more severe motor impairments.
• The mean GMFM improvement was substantial and surpassed expected gains, indicating that TT+TAU produces functional gains beyond typical developmental trajectories.
• Significant improvements were also observed in the Pediatric Evaluation of Disability Inventory (PEDLI) functional skills and Chailey Levels of Ability, indicating broader functional gains.
• The Segmental Assessment of Trunk Control (SATC) demonstrated notable improvement, supporting the role of trunk control in overall motor function.
• Children in higher GMFCS levels (IV and V) showed the most pronounced functional gains relative to predicted norms, highlighting the potential of TT for severe CP.