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A Physical Therapy Intervention to Advance Cognitive and Motor Skills

A Single Subject Study of a Young Child With Cerebral Palsy

Dusing, Stacey C. PT, PhD; Harbourne, Reggie T. PT, PhD; Lobo, Michele A. PT, PhD; Westcott-McCoy, Sally PT, PhD; Bovaird, James A. PhD; Kane, Audrey E. PhD, OTR/L; Syed, Gullnar BS; Marcinowski, Emily C. PhD; Koziol, Natalie A. PhD; Brown, Shaaron E. DPT

doi: 10.1097/PEP.0000000000000635

Background: Physical therapy interventions for children with severe motor impairments do not address the relationship between motor and cognitive development.

Purpose: Evaluate the potential of a physical therapy intervention focusing on enhancing cognitive and motor outcomes in a child with severe motor impairments.

Design: AB phase design without reversal.

Methods: One child participated in 8 assessments from 4 to 29 months of age. The START-Play intervention was provided for 3 months following 4 baseline assessments over 12 months. Total Gross Motor Function Measure (GMFM), Sitting, Reaching, and Problem Solving assessments were completed. Visual inspection, 2 standard deviation (SD) Band Method, and percent of nonoverlapping data methods evaluated change.

Results: This child had improved GMFM total and sitting scores, increased frequency of toys contacts, and increased rate of problem-solving behaviors following intervention.

Conclusion: START-Play shows promise for children with severe motor impairments. Additional research is needed to evaluate efficacy.

Video Abstract: For more insights from the authors, access Supplemental Digital Content 1, available at: (Pediatr Phys Ther 2019;31:347-352)

This study evaluated the change in motor and cognitive abilities of a single child during participation in the START-Play intervention.

Department of Physical Therapy, Motor Development Lab (Drs Dusing, Marcinowski, and Brown and Ms Syed), Department of Occupational Therapy (Dr Kane), Virginia Commonwealth University, Richmond, Virginia; Department of Physical Therapy (Dr Harbourne), Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania; Department of Physical Therapy (Dr Lobo), University of Delaware, Newark, Delaware; Department of Rehabilitation Medicine (Dr Westcott-McCoy), University of Washington, Seattle, Washington; Nebraska Center for Research on Children, Youth, Families, and Schools (Drs Bovaird and Koziol), University of Nebraska-Lincoln, Lincoln, Nebraska.

Correspondence: Stacey C. Dusing, PT, PhD, Department of Physical Therapy, Virginia Commonwealth University, 900 East Leigh St, Richmond VA 23298 (

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

Copyright © 2019 Academy of Pediatric Physical Therapy of the American Physical Therapy Association