Goal-directed functional therapy: A longitudinal study on gross motor function in children with cerebral palsy

Abstract

Purpose. To investigate gross motor function and goal attainment in children with cerebral palsy before, during and after goal-directed functional therapy (GDT), to evaluate body functions, and explore relationships.

Method. Prospective longitudinal intervention study. Twenty-two children, uni- or bilateral CP, 1–6 years (mean: 46 months SD: 16 months), classified in GMFCS and MACS level I–IV participated. Outcome measures were Gross Motor Function Measure (GMFM-66), performed at seven occasions, Goal Attainment Scale, assessments of passive range of motion, spasticity and selective motor control (SMC). Baseline, the GDT-intervention and the follow-up period were 12 weeks each.

Results. Improvements were demonstrated in GMFM-66 during the intervention (mean difference: 5.07, CI: 3.8–6.4, p < 0.001). The baseline and follow-up assessments were stable. Evaluations of ankle dorsiflexion displayed small improvement (mean difference: 9°, CI: 5–13, p < 0.001). Estimations of spasticity and SMC did not demonstrate significant changes. Goal attainment to the expected level or higher was achieved in 93/110 goals and further improved at the long-term follow-up (103/110).

Conclusion. Gross motor function improved during GDT, and was maintained 12 weeks later. The goals were reached to a high extent, and the children gradually progressed towards their goals after the end of the intervention. The therapy did not induce any deterioration of body functions.

Keywords:

• Children
• motor function
• cerebral palsy

Acknowledgements

We gratefully acknowledge all children and their families for participating. We also thank our colleagues at Handicap & Habilitation for their enthusiastic contribution. We are most grateful to Lanie Gutierrez-Farewik for extensive assistance and suggestions that improved this manuscript! The study was supported by major long-term contribution from Ad Infinitum Foundation. Grants were also received from Linnea & Josef Carlssons Foundation, Norrbacka-Eugenia Foundation, Pick-Up –Stockholm County Council, Sunnerdahl Foundation, Jerring Foundation, Odd Fellow Foundation, Majblomman Foundation and Jerring Foundation.