Author: Doreen J. Bartlett, PT, PhD & Robert J. Palisano, PT, ScD
Source: Physical Therapy, March 2002, Volume 82, Number 3, pp 237-248
Accurately predicting the ability of infants and young children with cerebral palsy to learn basic motor activities like rolling, sitting, standing, and walking is difficult because we have so little research to help make these judgments. Experienced physicians and therapists who have followed children over a number of years often develop clinical impressions based on that experience. This study attempted to describe the factors that experienced physical therapists believe influence a child?s ability to learn basic motor activities. Fifty-seven Canadian physical therapists with an average of 13 years of clinical experience in pediatrics participated in one of 12 focus groups and 60 physical therapists completed a follow-up survey by mail. Participants agreed on 12 factors in four categories that they believe influence the acquisition of basic motor abilities in children with cerebral palsy. 1) Primary impairments (caused directly by cerebral palsy) including muscle tone, movement patterns, distribution of involvement, balance, and sensory impairments; 2) secondary impairments (resulting from the primary impairments) including range of motions/joint alignment, force production, health, and endurance; 3) personality characteristics, especially motivation; and 4) family factors including support for the child, family expectations and support for the family.
The authors suggest these factors influence decisions about goals for the child, and about the interventions that are recommended. Primary factors caused by the cerebral palsy may not respond to physical therapy treatment but may need to be managed to prevent or reduce the development of secondary impairments like joint contractures. Motivation may be important both as a characteristic of the child and also as a challenge to the therapist to recommend activities which keep the child interested and actively involved. Family factors speak to the importance of a family centered approach and support for the family as well as the child.
This research was described as a first step in identifying the factors to target for future research about predictors of outcomes for children with cerebral palsy. Although the results represent the collective opinion of experienced therapists they do not provide conclusive evidence that can be used to predict a child?s future abilities.
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