Exploring Physiotherapists’ Use of Motor Learning Strategies in Gait-Based Interventions for Children with Cerebral Palsy

Abstract

Aim: This study investigated physiotherapists’ experiences using motor learning strategies (MLS) in gait-based interventions for children with cerebral palsy (CP). The objectives were to explore how child characteristics, physiotherapist decision-making, and treatment approach influenced intentional MLS use.

Methods: Semi-structured interviews were conducted with eight physiotherapists who provided gym- and/or Lokomat-based treatment to children with CP. Interviews were analyzed using directed content analysis and a modified constant comparison method.

Results: Three themes described their experiences: (1) MLS use is driven by the unique aspects of the child, physiotherapist, and intervention; (2) The use and description of motor learning content varies among physiotherapists; and (3) The Lokomat is “the same but different.” Child characteristics were at the forefront of MLS selection in both interventions. The terminology used to describe MLS use varied considerably among therapists. They used similar clinical decision-making in gym- and Lokomat-based interventions.

Conclusions: Conscious reflection on the factors affecting MLS use could facilitate related clinical decision-making in physiotherapy interventions for children with CP. Increased awareness of MLS and use of a structured framework for reporting MLS are required to promote intentional MLS use and generate CP-specific evidence-based MLS research.

Keywords:

• Cerebral palsy
• clinical decision-making
• motor learning
• motor learning strategies
• physiotherapy

Acknowledgments

The authors would like to thank the physiotherapist participants. We also extend our appreciation to Research Assistant Celia Cassiani and Research Manager Gloria Lee for their roles in data analysis and obtaining child/parent consent, respectively.

Disclosure statement

No potential conflict of interest was reported by the authors.

About the Authors

Jennifer Ryan, PT, Msc, is a clinical physiotherapist at Holland Bloorview Kids Rehabilitation Hospital and a PhD student at the Rehabilitation Sciences Institute, University of Toronto. Her research interests include optimizing motor learning in interventions for children with neuromotor disabilities and studying the effects of innovative technologies as adjuncts to traditional treatment approaches.

Virginia Wright, PT, PhD, is a senior scientist at Bloorview Research Institute and Professor in the Department of Physical Therapy, University of Toronto. Her research includes the design and evaluation of advanced gross motor skills outcome measures. She also evaluates clinically-integrated innovative interventions that promote functional mobility, physical activity, and participation in children and youth of diverse abilities.

Danielle Levac, PT, PhD, is Assistant Professor at Northeastern University and the Director of the Rehabilitation Games and Virtual Reality Lab. Her research focuses on the evidence-based integration of virtual reality in rehabilitation and evaluating how it promotes motor learning in children and adults with neuromotor disabilities.

Additional information

Funding

This study was funded by the Holland Bloorview Children’s Foundation Chair in Pediatric Rehabilitation.