Pediatric Physical Therapy:
Clinical Bottom Line
University of Alabama—Birmingham (Christy)
Children's Health System, Birmingham, Alabama (Steed)
“How should I apply this information?”
This randomized controlled trial compared 2 groups of children with cerebral palsy, Gross Motor Functional Classification System (GMFCS) level III, who received intense physical therapy. One group wore a suit with resistance cords during therapy, and the other group wore a “control” suit. The Pediatric Evaluation of Disability Inventory (PEDI) and Gross Motor Function Measure (GMFM)-66 were administered at baseline, immediately after the 3-week session and again at 9 weeks. The authors concluded that the improvements in the PEDI and GMFM-66 seen in both groups could not be attributed to the suit.
A suit with resistance cords should be used only with a sound rationale, for example, using a suit to provide resistance in the lower extremities during high-level functional activities or as an “extra set of hands” to improve alignment. Clinicians should use sound judgment when using a suit as part of a therapy session and not as a packaged program or method. The results of this study also add to the body of knowledge regarding the value of intense practice of functional skills for children with cerebral palsy, since both groups who received the intense therapy improved on the PEDI and GMFM-66 at the 9-week assessment.
“What should I be mindful about when applying this information?”
Clinicians should be mindful that the children did not show improvements immediately after the 3-week intense therapy session. Both groups improved but not until the 9-week assessment. Effect sizes (ie, amounts of change) were small. Clinicians should consider other assessment tools to capture unique improvements noted by parents and clinicians after intense therapy. Clinicians should also be mindful of the possibility that children at GMFCS level III may have difficulty with functional upright activities in the suit, given their level of impairment. Therefore, the suit might be a better tool for children at GMFCS level I or II. Clinicians should consider the data collected from the parent surveys indicating that some parents thought the program was too intense. These data suggest that 4 hours per day, 5 days per week for 3 weeks could be too intense for some children. This excellent study begins to address the dosing issue. Obviously more research is needed to answer the many questions related to dosing of physical therapy interventions.
Jennifer Braswell Christy, PT, PhD
University of Alabama—Birmingham
Lisa Steed, MSPT
Children's Health System, Birmingham, Alabama