This study reports the results of a field-based investigation of the effects of two motor intervention approaches-neurodevelopmental treatment and developmental skills-on children with two different diagnoses. The sample included 50 children, of whom 27 were diagnosed as having Down syndrome and 23 as having cerebral palsy. Children had a mean chronological age of 14 months at the beginning of the study. The severity of their motor impairment was assessed with the Gross Motor Function Classification System for Cerebral Palsy. Children's motor functioning was examined at entry into the study and after they received 1 year of motor intervention services. Dependent measures included children's general development, rate of motor development, and quality of movement. Pre-post comparisons indicated that children made significant changes in their motor development age and quality of movement over the course of intervention. However, there was no evidence that motor intervention accelerated development or improved quality of movement beyond what could be expected on the basis of maturation. Furthermore, no differential intervention effects were associated either with children's diagnosis or treatment model. Regression analyses indicated that the rate of motor development children attained after 1 year of intervention was highly related to their rate of development at the onset of intervention and, to a lesser degree, to the number of sessions of intervention children received. These results are discussed in terms of the need for the field of motor intervention to develop new treatment paradigms.
Parents and professionals who are not motor specialists often perceive motor interventions as homogeneous and uniformly beneficial to children and tend to assume that more is better.1 Yet in practice, there is substantial heterogeneity as to the theoretical models espoused (sensory motor integration, neurodevelopmental treatment [NDT] and developmental skills [DevS] models, and conductive education), the service models used (individual treatment, small groups, and consultation), the frequency of treatment delivery (once or twice a week or month), and the discipline of the interventionist (e.g., early intervention teachers, physical or occupational therapists, or adaptive physical educators). Yet, despite the importance and costs of these services, there has been relatively little research published examining interventions targeted specifically at motor outcomes2,3 and almost no research examining how variations in the manner services are provided in clinical, educational, or home settings affect these outcomes. Rather, services appear to be influenced by factors such as the historical traditions of a program, the treatment philosophy of an agency, the theoretical orientation of an agency's therapists or intervention staff, current case loads, and, without question, the requirements of the funding source for the services. Given these factors, it is challenging to conduct quality investigations that can inform program personnel about better practices. Nonetheless, such second-generation4 investigations are needed if program personnel are to make informed decisions that lead to better practices and cost-effective service models.
Children's Hospital Medical Center of Akron, Akron, Ohio (MAHONEY)
University of Colorado Health Sciences Center, Denver, Colorado (ROBINSON)
University of Miami School of Medicine, Miami, Florida (FEWELL)
Address for reprints: Gerald Mahoney, Ph.D., Children's Hospital Medical Center of Akron, One Perkins Square, Akron, OH 44308; e-mail: email@example.com.