A randomized, single-blind cross-over design evaluating the effectiveness of an individually defined, targeted physical therapy approach in treatment of children with cerebral palsy

This pilot study was conducted to compare the effectiveness of an individual therapy program with the effects of a general physical therapy program. Ten ambulant children with bilateral spastic cerebral palsy, four to nine years old took part in the study. Participants were placed at random into a ten-week individually defined, targeted or a general program, followed by a cross-over. Evaluation was performed using the Gross Motor Function Measure-88 and three-dimensional gait analysis. General outcome parameters were Gross Motor Function Measure-88 scores, time and distance parameters, gait profile score and movement analysis profiles. Individual goal achievement was evaluated using z-scores for gait parameters and Goal Attainment Scale for gross motor function. No significant changes were seen in regards to gross motor function. Only following individualized therapy, step- and stride-length increased significantly (p = 0.022; p = 0.017). Change in step-length was higher after the individualized program (p = 0.045). Within-group effects were found for the pelvis in transversal plane after the individualized program (p = 0.047) and in coronal plane after the general program (p = 0.047). Between-program differences were discovered for changes in the knee in sagittal plane, in the advantage of the individual program (p = 0.047). A median difference in z-score of 0.279 and 0.419 was measured after the general and individualized program, respectively. Functional goal attainment was higher following the individual therapy program compared with the general program (48 to 43.5).

The results suggest slightly favorable effects towards the individualized program. To detect clinically significant changes, future studies must have a minimal sample size of 72 to 90 participants.

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