1. Intervention to Advance Postural Transitions and Problem Solving Ability in Children With Cerebral Palsy
Xin Zhang 1, Swati M. Surkar 2, Regina T. Harbourne 2, Sandra Willett 2, Max J. Kurz 2, Lynne M. Capoun 2
1University of Nebraska Medical Center, Physical Therapy Education, Omaha, Nebraska
2University of Nebraska Medical Center, Munroe Meyer Institute, Omaha, Nebraska
INTERVENTION:
PMA emphasized child-directed, self-initiated movement in various sitting positions, with suggestions from the therapist for variability. This approach focuses on helping the child to obtain a functional goal, which may not necessarily lead to “normal” movement pattern. The expectation is that the child will chose the movement strategy rather than the therapist.
BWS was provided by suspension system or by physical therapy assistance to maintain an erect body position for standing or walking. Each therapy session included a total of thirty minutes of walking. Body weight support was reduced gradually as tolerated by each child.
PMA intervention:
BACKGROUND INFORMATION:
Early movement skills have been implicated in early cognitive development, but the relationship is not well understood.
In typically developing infants, crawling has been linked to the ability to perceive object permanence. However, no studies have specifically examined movement and the progression of cognitive skill in children with neuromotor disorders.
The ability to learn about objects partly relies on motor abilities, and should be reflected in problem solving ability.
PURPOSE:
The purpose of this pilot study was to compare the effects of a perceptual motor approach (PMA) and a body weight support (BWS) intervention in advancing postural transitions and problem solving skills in children with CP. The PMA, which focuses on enhancing complexity of movement variability, was shown to improve sitting control and play skills in a previous study (Harbourne et al, 2010).
The scores of EPSI explores and functions decreased in BWS group (-0.50±.051, -0.83±10.72 and -1.5±5.71); conversely, the scores of explores and functions in the PMA group increased (3.00±10.56 and 7.17±11.44).
CONCLUSIONS:
BWS training and perceptual motor approach are both useful in promoting gross motor skill advancement.
Considering the limited sample size, statistical differences between two interventions could not be detected.
The descriptive data imply that BWS intervention was more helpful in advancing dynamic motor abilities, such as crawling and walking. In contrast, the perceptual motor approach was more beneficial in improving static posture control, such as sitting and standing.
Surprisingly, the BWS group decreased in problem solving skills from pre to post intervention, while the PMA group improved during the intervention.
CLINICAL IMPLICATIONS FOR INTERVENTION:
Specificity of practice appeared to affect the skills expected for each intervention group; practicing walking and crawling advanced those skills, while practicing postural skills advanced sitting and standing.
Problem solving skills appeared to improve only in the group focused on perceptual motor skill, and gaining controlled variability of sitting and standing skills.
PARTICIPANTS:
Twelve children with mild to moderate CP, 6 in each therapy group
Between the ages of 9 months to 3 years (17.8 months for BWS
& 18.2 months for PMA intervention)
Children entered the study when they were able to sit for one
minute alone
Intervention was twice weekly for 12 weeks, for 60 minute sessions
Environment set up to require small changes in skill, to provide “rich” perceptual information. Increased variability of active movement is encouraged, and abnormal movements are not blocked or discouraged. Self-initiated, functionally directed movement is the focus of intervention. Passive movements are not used.
Treadmill or overground supported walking or crawling, with guidance provided by the therapist for patterns of movement considered part of typical developmental sequences.
RESULTS:
METHODS:
Gross Motor Function Measure-88 (GMFM), sitting/ crawling/standing/walking dimensions.
The Early Problem Solving Indicator (EPSI) was used to measure cognitive skill (Greenwood et al, 2006). The EPSI assessment includes play with 3 standard toys: pop-up pets, stacking cups, and gumball machine. Infants are offered those toys for 6 mins, 2 mins each. Manipulation events (look, explore, function and solution) are coded from videotaped sessions.
Data collected pre-intervention and post-intervention
EPSI toys:
REFERENCES:
Harbourne, RT, Willett, S, Kyvelidou A, Deffeyes J, Stergiou N. (2010). A comparison of interventions for children with cerebral palsy to improve sitting postural control. Physical Therapy, 90,
Greenwood, Charles R.; Walker, Dale; Carta, Judith J.; Higgins, Susan K. Developing a General Outcome Measure of Growth in the Cognitive Abilities of Children 1 to 4 Years Old: The Early Problem-Solving Indicator. School Psychology Review, Vol 35(4), 2006,
The GMFM in all dimensions significantly increased overall from pre to post intervention (P=0.006, P=0.008, P=0.004 and P=0.031).
The change scores of the GMFM in crawling and walking dimensions in the BWS group are larger (19.67±18.11% and 5.67±5.47%, respectively) than the perceptual motor group (15.00± 22.19% and 3.17±5.38%)
The change scores in the sitting and standing dimensions are smaller in the BWS group (13.83±12.95% and 4.50±5.96%) than in the perceptual motor group (18.501±11.86% and 10.50±9.91%).
Pop-up Pets Stacking cups Gumball machine
ACKNOWLEDGEMENTS:
This work was supported by American Physical Therapy Association, Section on Pediatrics.
Manipulate events of EPSI:
Look: infant faces or moves head toward a toy for any amount of time
Explore: infant touches, mouths, rubs, pulls, shakes or explores the toy
Function: infant performs a function of the toy or creates an effect intentionally
Solution: infant displays all the functions of the toy