Targeted Physical Therapy Combined with Spasticity Management Changes Motor Development Trajectory for a 2-Year-Old with Cerebral Palsy

Corri L Stuyvenberg; Shaaron E Brown; Ketaki Inamdar; Megan Evans; Lin-Ya Hsu; Olivier Rolin; Regina T Harbourne; Sarah Westcott McCoy; Michele A Lobo; Natalie A Koziol; Stacey C Dusing

doi:10.3390/jpm11030163

Targeted Physical Therapy Combined with Spasticity Management Changes Motor Development Trajectory for a 2-Year-Old with Cerebral Palsy

J Pers Med. 2021 Feb 27;11(3):163. doi: 10.3390/jpm11030163.

Authors

Affiliations

¹ Rehabilitation Science Graduate Program, University of Minnesota Medical School, MMC 388, 420 Delaware St. SE, Minneapolis, MN 55455, USA.
² Department of Physical Therapy, Virginia Commonwealth University Health System, 1300 East Marshall Street, PO Box 980419, Richmond, VA 23298, USA.
³ Rehabilitation and Movement Science Program, College of Health Professions, Virginia Commonwealth University, 900 E. Leigh Street, Richmond, VA 23298, USA.
⁴ College of Health Professions, Virginia Commonwealth University, 900 E. Leigh Street, Richmond, VA 23298, USA.
⁵ Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, 1959 NE Pacific Street, Box 356490, Seattle, WA 98195, USA.
⁶ Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health Sciences, 1223 E. Marshall Street PO Box 980677, Richmond, VA 23298, USA.
⁷ Rangos School of Health Sciences, Physical Therapy, Duquesne University, 600 Forbes Ave., Pittsburgh, PA 15282, USA.
⁸ Department of Physical Therapy and Biomechanics & Movement Science Program, University of Delaware, 540 S. College Ave., Newark, DE 19711, USA.
⁹ Nebraska Center for Research on Children, Youth, Families & Schools, University of Nebraska Lincoln, 160 Prem S. Paul Research Center at Whittier School, Lincoln, NE 68583, USA.
¹⁰ Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar Street. CHP 155, Los Angeles, CA 90033, USA.

Abstract

Therapies for children with cerebral palsy (CP) often fail to address essential components of early rehabilitation: intensity, child initiation, and an embodied approach. Sitting Together And Reaching To Play (START-Play) addresses these issues while incorporating intensive family involvement to maximize therapeutic dosage. While START-Play was developed and tested on children aged 7-16 months with motor delays, the theoretical construct can be applied to intervention in children of broader ages and skills levels. This study quantifies the impact of a broader START-Play intervention combined with Botulinum toxin-A (BoNT-A) and phenol on the developmental trajectory of a 24 month-old child with bilateral spastic CP. In this AB +1 study, A consisted of multiple baseline assessments with the Gross Motor Function Measure-66 and the Assessment of Problem Solving in Play. The research participant demonstrated a stable baseline during A and changes in response to the combination of BoNT-A/phenol and 12 START-Play sessions during B, surpassing the minimal clinically important difference on the Gross Motor Function Measure-66. The follow-up data point (+1) was completed after a second round of BoNT-A/phenol injections. While the findings suggest the participant improved his gross motor skills with BoNT-A/phenol and START-Play, further research is needed to generalize these findings.

Keywords: Botulinum toxin-A; cerebral palsy; early intervention; phenol; physical therapy.

Publication types

Case Reports

Grants and funding

R324A150103/Institute of Education Sciences