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

Figures & data

TABLE 1.  Descriptive Information for Children and Therapists

	Intervention
	Standard therapy	Child-focused	Context-focused	Total group
Video
N	18	16	15	49
Therapist
Discipline
Physical therapy	8	8	6	22
Occupational therapy	2	5	7	14
Years of experience (years), mean (SD)	14.1 (8.5)	18.4 (10.9)	21.6 (9.5)	18.4 (10.0)
Therapist–child ratio	1.8	1.2	1.2	1.4
Child
Age (month), mean (SD)	39.6 (6.0)	38.1 (7.0)	42.5 (4.6)	40.1 (6.1)
Sex
Male	15	9	5	29
Female	3	7	10	20
GMFCS level
I	10	7	9	26
II	3	3	1	7
III	2	2	4	8
IV	3	3	2	8

Note: SD: standard deviation; GMFCS: Gross Motor Function Classification System.

TABLE 2.  Items of the Child- and Context-Focused Domain of the Paediatric Rehabilitation Observational measure of Fidelity (PROF)

Child-focused domain
1. The therapist focuses on remediating the child's movement or skills.
2. The therapist focuses on if the child completes activities in a specific way.
3. The therapist focuses on the quality of the child's movement and/or skills.
4. The therapist facilitates repetition in the practice of movements or motor skills addressed in the intervention session.
Context-focused domain
5. The therapist focuses on changing the environmental constraints that influence the child's activity performance.
6. The therapist focuses on adapting an activity to enable the child to complete the activity.
7. The therapist provides opportunities for the child to practice activities for the purpose of completion.
8. The therapist focuses on the most efficient way that best suits the child to perform the activity.

Figure 1. Box-plot of mean scores on the child-focused domain of the Paediatric Rehabilitation Observational measure of Fidelity for the three types of interventions.

Figure 2. Box-plots of mean scores on the context-focused domain of the Paediatric Rehabilitation Observational measure of Fidelity for the three types of interventions.

TABLE 3.  Item Scores for the Paediatric Rehabilitation Observational measure of Fidelity (PROF) According to Intervention Type

	Intervention
	Standard therapy			Child-focused			Context-focused
	Median	Range (min–max)	Inter-quartile (25–75%)	Median	Range (min–max)	Inter-quartile (25–75%)	Median	Range (min–max)	Inter-quartile (25–75%)
Child-focused domain
1. Remediation	3	1–5	2–4	4	2–5	3–4	2	1–3	1–2
2. Specific way in completion	3	1–5	2–3.3	3	2–5	3–4	2	1–3	1.3–2
3. Quality of movements or skills	2	2–3	2–3	3	2–4	2–3	2	1–3	2–2.8
4. Repetition in practice	3	1–3	2.8–3	4	1–5	2–4	1	1–3	1–2
Context-focused domain
5. Changing the environment	1	1–1	1–1	1	1–2	1–1	1	1–5	1–2
6. Adapting activity	1	1–2	1–1	1	1–2	1–1	1	1–3	1–1
7. Purpose of completion	3	1–4	2–3.3	2	1–4	2–4	4	2–5	4–5
8. Most efficient way	3	1–5	2.8–4	2	1–4	2–4	4	1–5	4–5

Note: Min: minimum; max: maximum. Sores representing: 1 = not at all, 2 = a little (i.e., once or twice), 3 = somewhat (i.e., half of the time), 4 = considerably (i.e., most of the time), and 5 = extensively (i.e., too many to count).