Child-Focused and Context-Focused Behaviors of Physical and Occupational Therapists during Treatment of Young Children with Cerebral Palsy

ABSTRACT

Aims: To (1) describe the child- and context-focused behaviors of physical and occupational therapists, and (2) compare the behaviors of therapists in a standard therapy session with those of therapists trained to deliver child- and context-focused services. Method: Videos of 49 therapy sessions provided by 36 therapists were analyzed using the intervention domains of the Paediatric Rehabilitation Observational measure of Fidelity (PROF) to examine the therapeutic behaviors of physical and occupational therapists with young children with cerebral palsy (CP) (24 to 48 months) in a Dutch rehabilitation setting. The PROF ratings of 18 standard therapy sessions were compared with the ratings of 16 child- and 15 context-focused therapy sessions. Results: Therapists who provided standard therapy demonstrated a mix of child- and context-focused behaviors. PROF ratings indicated fewer child- and context-focused behaviors during standard therapy sessions compared with sessions where therapists were instructed to use either child- or context-focused behaviors. Conclusions: A sample of Dutch physical and occupational therapists of young children with CP demonstrated a mix of child- and context-focused therapy behaviors during standard therapy. Further research is recommended on clinical reasoning and the effect of setting to better understand therapists’ use of child- and context-focused behaviors during therapy sessions.

KEYWORDS.:

• Active ingredients
• children
• cerebral palsy
• occupational therapy
• physical therapy
• therapist behaviors

ACKNOWLEDGMENTS

The authors gratefully acknowledge all children and their parents, and the participating rehabilitation centers for their willingness to participate in this study. We are grateful to Professor E. Lindeman for her contribution to the research program.

Declaration of Interest: The authors declare that they have no competing interests with respect to the research, authorship, and/or publication of this article.

FUNDING

This study is part of the Dutch national LEARN 2 MOVE research programme and is supported financially by ZonMw (Grant number 89000002), Johanna Kinderfonds, Stichting Rotterdams Kinderrevalidatie Fonds Adriaanstichting, Revalidatiefonds, Phelps Stichting, Revalidatie Nederland, and the Nederlandse Vereniging van Revalidatieartsen.

ABOUT THE AUTHORS

Anne J. A. Kruijsen-Terpstra, PhD PT, is Professor, associated with Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, and the Partner of NetChild, Network for Childhood Disability Research in the Netherlands, Utrecht, The Netherlands. Mariëlle Ellens, MSc, is associated with Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands. Marjolijn Ketelaar, PhD, is Associate Professor, associated with Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, and the Partner of NetChild, Network for Childhood Disability Research in the Netherlands, Utrecht, The Netherlands. Olaf Verschuren, PhD, PT, is Assistant Professor, associated with Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, and the Partner of NetChild, Network for Childhood Disability Research in the Netherlands, Utrecht, The Netherlands. Briano Di Rezze, PhD, OT, is associated with CanChild Centre for Childhood Disability Research, McMaster University, and the School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. Jan Willem Gorter, PhD, MD, FRCPC, is Professor, associated with Partner of NetChild, Network for Childhood Disability Research in the Netherlands, Utrecht, The Netherlands, and the CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada. Anne M. A. Visser-Meily, MD, PhD, is associated with Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, and the Partner of NetChild, Network for Childhood Disability Research in the Netherlands, Utrecht, The Netherlands. Marian J. Jongmans, PhD, is Professor, associated with Partner of NetChild, Network for Childhood Disability Research in the Netherlands, University Medical Center Utrecht; Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; and the Department of Child, Family and Education Studies, Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands.