For this study, it was hypothesized that the reaches and walking endurance of children with spastic CP were strengthened and reinforced after a physical therapy treatment is given to the subjects.
Chapter V. Theoretical Frame Work /Conceptual Framework
Pediatric Endurance and Limb Strengthening for children with Cerebral Palsy or “PEDALS” is one of four projects sponsored by the Physical Therapy Clinical Research Network (PTClinResNet), which is a member of the Inventory and Evaluation of Clinical Research Networks (IECRN). According to Fowler et al (2007), the PTClinREsNet was initially established in the year 2002, to espouse the research that investigated the effectiveness of physical therapy interventions. This national network reinforces the evidence-based study covering disabilities which connected the pool resources from across the country which corresponded to a wide-range of disciplines and has an affiliate center at the University of Southern California (Fowler et al, 2007). The PTClinResNet makes use of the International Classification of Functioning (ICF) framework to connect the outcome assessments of all projects (Fowler, 2007). The ICF covers three domains of human function which include the body function and structure, activity and participation. The body functions and structure relates to the physiological performance of the entire body system, together with the various parts of the body. The activity shall include the carrying-out of an undertaking or encounter of one individual. The term participation shall mean the involvement of a person in the life situation. The framework will also cover the some environmental and personal contextual factors (Fowler, 2007).
Research Paradigm
Chapter VI. Methods and Designs
This study is based on Randomized Controlled Trial (RCT), by examining the effects of physical therapy in children with CP, who are between ages 2 and 10 years. All the children were evaluated before (Baseline) and after (follow up) the intervention period. This evaluation included Gross Motor Function Classification System (GMFCS), as well as physical head to toe examination of the child. According to research conducted by Palisano, Rosenbaum, Galuppi et al. (1997), the Gross Motor Function Classification System for cerebral palsy is based on self-initiated movement with particular emphasis on sitting (truncal control) and walking. At the same time when defining a 5 level Classification System, the primary criterion provided the distinctions in motor function between levels must be clinically meaningful (Campanozzi, 2007).
The distinctions between the levels of motor functions were based on functional limitations and there is a need for the employment of assistive technology which includes mobility devices and mobility through the use of a wheelchair (Palisano, Rosenbaum, Galuppi et al., 1997). In such a case, the patient has to resort to devices to enhance his motor functions through the use of canes, walkers and crutches.
The children who were accepted in this study covered only those whose GMFCS levels are from I, II or III. The children possessing GMFCS levels IV and V were disqualified from the analysis. This study took place in a group setting covering one hour each day, five days a week for period of four weeks. The interventions were performed and conducted by physical therapists. An evaluation was set to test the knowledge and skills of physical therapist, who participated in this study. The physical therapists were blinded to subject group randomization. They were given written manual guidelines and procedures which specified either the evaluation or intervention protocols. The performances of the children with CP were recorded by using a video recorder. The scores of the children were provided by members of a standard committee through the use of a checklist containing the vital components for each protocol. Therapists were mandated to receive a score of 90% in order to be able to participate in this study.
For this study, the level I included children with neuromotor impairments whose functional restrictions are reduced than what is generally associated with cerebral palsy, and those children who were previously diagnosed with minimal severity cases of cerebral palsy conditions. Based on the study of Palisano, Rosenbaum, Galuppi et al. (1997), the distinctions between levels 1 and 2 are not as definite as the distinctions between the other levels. This is particularly evident in children who are of two years of age or less.
According to Gage, Schwartz, Koop et al., (2009), there are considerations taken on accepting only the young child who are diagnosed with CP from birth to 6 years of age. Based on the perspective of the International Classification of Functioning (ICF), those children with CP are currently suffering from impairments in the bodily function and structure such as muscle tone, strength, reflexes and range motion. Studies have shown that children who are classified as GMFCS levels I-III have less impairment than those children in the levels IV and V. The important activity limitations were also identified which included dressing, feeding and functional mobility, together with other restrictions in the participation in social and community roles of the child such as playing on his own or interacting with his friends inside the classroom. There are also environmental factors that have to be taken into consideration because the young child is expected to live in a natural environment of a home consisting of loving parents or adult caregivers. As the child reaches the ages 3 to 5 years, it is seen that child enters school and shall develop relationships with his or her classmates. It is assumed that the environment is limited due to the overall development and the expected levels of independence of the child (Gage, Schwartz, Koop et al., 2009).
The previously held beliefs which are related to the treatment techniques that covers the therapeutic interventions such as physical therapy aids in the enhancement of motor control, learning control and dynamic systems theory. The change in the philosophy has been caused by factors which include the present status of health status, family-centered ideologies and enhanced ideologies of motor control and motor learning. Based on the dynamic standpoint, the adaptation of the environment is considered as a reasonable answer to a motor problem than emphasizing on changing the body functions and structures by assuming that the changes in this level will produce modifications on the capability of the child. Gage, Schwartz, Koop et al., (2009) have clarified that this can be achieved by one randomized control trial that shall involve a process that shall compare the child-centered approach to intervention with a task-centered approach.
It is important to identify the differences between child-centered approach and the task-centered approach. In the child-centered approach, the therapist is seen to be in charge in setting the goals and objectives on modifying the body functions and structure with the presumption that the changes in this level cause the jumpstart the changes in the level of activity and participation. The change in the ability of the child is first determined to see if there is success in this level, after which the environmental adaptations are thereafter considered. Even if there is focus on the writing goals that are practical and assessable for each child, there is still evidence that typical movement patterns shall form part of the criteria (Gage, Schwartz, Koop et al., 2009).
On the part of the task or context-focus approach, it is the interest of the child in the motor-based tasks that is determined and considered as the limiting factors. With this method, the child was given the confidence that he or she needed to become successful in achieving the functional task and not to give full concentration on the quality of the movement. Based on the latest research by Gage, Schwartz, Koop et al., (2009), infants and young children from birth and until they reach the age three (3) are initially involved during the initial intervention program. One team shall be engaged in the determination and evaluation of the plan of care that will be followed which will be dependent on the needs that have been identified, the interest of the family, and finally for the primordial consideration of the child’s interest and the family’s goals and objectives. The treatment for the child with CP was usually done in his home because it is considered as the most natural environment for the child. On the other, the children who are aged 3 to 6 were to be placed in a center-based program where a physical therapy was provided to afford the child an opportunity to participate in an educational environment in the fullness of his capacity (Gage, Schwartz, Koop et al., 2009). In some instances, there is additional therapy that may be given to the child in an outpatient facility for children 3 to 6 years from the various service providers who join forces to ensure that the functional activities across the diversity of settings.
Regardless of the framework, the objective of the physical therapy is functional mobility and majority of therapists use unique mixture of interventions. Although there is minimal evidence which has surfaced to measure the optimum amount of intervention, studies have shown that a comparison of the intensity produced a small difference after the lapse of a six-month period. There were allowed be given support to the child and the family to enable them to shorten the term in order to complete the intensive treatment regime. However, episodic care was based on the motivation of the child to learn a new motor skill and pointed of the out at level I-III GMFCS (Gage, Schwartz, Koop et al., 2009). The treatment of intervention included stretching and casting to intensify the power and endurance to maintain the range of motion and alignment and the practice of functional activities.
Chapter VII. Subjects
During the study, it included children between ages 2 and 10, who were able to follow simple verbal directions and have good motor control to at least one lower limb. Those children who were experiencing chronic pain or have uncontrolled seizures were excluded from the study. We have made advertising papers and brochures and sent them out to parents of children with CP. We asked therapists who worked with the children with CP, to talk to parents regarding the study and give each of them an advertising paper. We also asked the teachers of the subjects to put an advertising paper, in each child’s back pack, and asked for the response of their parents. If needed, the candidates were to contact the investigator, wherein phone interviews are performed, in order to screen inclusion and exclusion criteria. Appropriate candidates were invited for GMFCS assessments. If the subject qualified for the study during person screening, they moved toward next step. The investigator explained about risks and benefits of the study. He or she explained the informed consent, medical release, and photo consent to their parents or guardians. When the parents decided to participate in the study, enrollment process was performed. For this study, 20 children diagnosed with CP, have participated (15 intervention and 5 controls).
The 20 subjects of this study were composed of 18 females and 2 males who had been diagnosed with cerebral palsy by agencies that were associated with this study. Their ages ranged from 2 years old to 10 years old, when this study was performed. This study was based on Randomized Controlled Trial (RCT), by examining the effects of physical therapy in children with CP, for a period of 4 weeks which was conducted by physical therapists. All of the children were evaluated before (Baseline) and after (follow up) the intervention period using the Gross Motor Function Classification System (GMFCS), as well as physical head to toe examination of the child. The characteristics of each subject were summarized in Tables I, II, III, V and V.
The twenty first (21st) and sometimes a twenty second (22nd) subject participated during the sessions, but no data were collected from these children because they did not exert effort to complete the stretching and walking exercise.
Settings and Materials:
The sessions were performed in the parking lot of the school covered area with approximately measures 600 yards. The materials that were used were visible markers that served as a guide for the subjects to finish the task. The visible markers included bright yellow cones were positioned in the perimeter of the path where the participants were required to walk.
A kinematic laboratory was set-up in a room which was adjacent to the physical therapy department of the school. In this set-up, it gave the subjects an opportunity to participate in their school with minimum inconvenience on their part. This arrangement is vital to the successful completion of this study. (Dunn, 2008).
Source of Data:
The subjects employed in the study were selected employing a non-random sampling technique. Using this method the subjects were deliberate selected with the single criterion that they were all diagnosed with Cerebral Palsy at the time of the study and their age ranges from 2 years to 10 years of age. The distribution and profile of the subjects by age; sex, civil status and length of experiencing the medical condition of CP are shown in Tables 1 and 4.
Instrumentation and Data Collection:
The main tool used in data gathering is the questionnaire. This questionnaire was constructed as closed or fixed type according to the problems that have risen during the course of the study. The researchers distributed questionnaire among the respondents that have been approached for the study. The nature and purpose of the study were explained to the subjects. Questionnaires were retrieved on the time appointed and agreed upon between the researchers and the subjects. When the questionnaires were all collected data were sorted and tabulated and were subjected to analysis and interpretation.
Outcome Measures:
The primary outcome measures are:
Gross Motor Function Measure (GMFM) and 500 distance walking measure. Therapist will be provided with certain instruction to perform the movements that therapist believed had the greatest potential for improvement. These included strengthening and stretching exercises in both lower and upper extremities. Parents were also encouraged to join the therapy and to support their children to perform the movements. New assessments were performed at the end of each week, after the base line evaluation.
Based on the chart above, it can be shown that there was an improvement in the GMFM of the subjects after undergoing the physical therapy treatment for four weeks. Children aged 2-3 have the ability to use their hand and support their balance, while creeping on their stomach and crawling with the use of their hands and needs. Based on the study conducted by Anittila, H., Autti-Ramo, I., Suorantam J. et al. (2008), the infant simulation program included learning games, or part of the curriculum which was formulated to respond to a wide range of infant developmental domains. Some of this shall include the defined and illustrated cognitive, sensory, language, and motor activities that worked for the advancement of intricacies which are suitable for children with CP from the time they are born until they reach the age of 3 years. Part of the fine motor activities were in the form of block-building tasks, matching of shapes and forms, puzzles and crayons (Anittila, H., Autti-Ramo, I., Suorantam J. et al., 2008) .
For children aged, 3-4, there was an improvement of on the GMFM of the subject by meeting the baseline on the first week and continuous to improve until the fourth week.
For children aged 4-5 years, although there was a slow movement on the on the GMFM, there is still an improvement that can be seen throughout the entire 4 weeks that the physical therapy was administered to the subjects. Towards the fourth week, it can be seen that the subjects were able to meet the GMFM baseline 66.
For ages 6 to 10, it can be seen during the first week until the third weeks, there was a slow rise in the GMFM after physical therapy was administered to the subjects although towards the end, it can be seen that they were not able to meet the GMFM baseline of 66.
Hence, it can be presumed that consistent application of physical therapy improved the motor function of the subjects. Based on Anittila, H., Autti-Ramo, I., Suorantam J. et al. (2008), physical therapy is putting emphasis on the motor development which is intended to optimize expression of components of establishing balance and equilibrium which is held to be essential for the constant progress of gross motor landmarks.
After the study was completed in a group setting that was performed one hour on a daily basis, five times a week which lasted for period of four straight weeks. The result of the study has revealed that children with CP who were randomly chosen to undergo group physical therapy has shown a considerable progress in strengthening their muscles while caused an improvement in their balance, walking endurance and gross motor function and enhanced the quality of life when compared to those children who did not go through therapeutic interventions
Based on the records that have been conducted, it was shown that from the start of week 1, there has been considerable amount of improvement in the gross motor function of the children after the physical therapy and other therapeutic intervention have been given to the patients. As the treatment of physical therapy for a period of 5 straight weeks which is equivalent to 1 hour per visit, based on the chart above, we can see an improvement on the GMFCs and the FMS respectively.
For children with who are aged 2 to 10 years old, the Functional Mobility Scale will be used to measure the functional mobility in children, by taking into account the range of assistive devices that a child shall use for walking. The scale can be used to identify the category of the child’s functional mobility, as the levels may change from time to time depending on the therapeutic interventions that were resorted to. In this case, the distance of 500 yards walking measure shall be used to represent the child’s mobility in the home, school, or community setting. It provided an account on the child’s mobility at home, in the school or the community setting (Graham, Harvey, Rodda, et al, 2004).
The assessments were made on the basis of interviews or questionnaires signed by the child’s parents or guardians. The walking ability of the child is rated based on 500 yards according to the need of assistive devices such as crutches, walkers or wheelchairs. The Functional Mobility Scale (FMS) is a performance measure to be able to rate the mobility of the child and his or her progress in his motor function (Graham, Harvey Rodda, et al, 2004).
6- Independent on all surfaces. This means that the child does not need walking aids.
5-Independent on level surfaces. Does not use walking aids but requires wall for support.
4- Uses one or two sticks to walk.
3-Uses crutches without help of another.
2-Uses walker or frame without the help of another.
1- Uses wheelchair. The stand during transfers on his/her own and requires help of others.
C- Crawling. The child crawls for mobility.
N- The child does not complete the distance
According to Fowler et al (2007), it is through the 600 yard walk test which shall determine the walking and running endurance of the child with CP based on the activity level which was set by the ICF. This method will also serve as an implied measure to test the cardiorespiratory fitness of the child diagnosed with CP. It manifested the capability of the child to be involved in activities such as playing and other sports-oriented activities he or she can participate. This is vital to be able to conduct a physical fitness test to be completed by children with CP who were about to enter school. At the same time, it served as a measure to determine the intellectual ability of the child.
For this physical endurance test, the participants were directed to accomplish a 500 yard distance in as quickly as they can and they may either run or walk or combine both motor activities to complete the task. Before starting the test, the distance that was needed has been carefully explained to these children in order for them to be able to control their pace. There were visible markers that guided the subjects to finish the task. As a guide, there were bright yellow cones that were positioned in the perimeter of the path where the participants will walk. As the participants carried on with the physical test, they were given verbal encouragement to maintain their pace while walking until such a time that they were able to finish the distance of 500 yards. In the event that one of the participants failed to carry on with the task within a period of 20 minutes or did not move for at least ten seconds, the test was no longer resumed. Once the participants reached the finish line, a record of the speed and the time consumed has been noted down. The length of the distances completed which measured less than 500 yards; a measuring wheel was used to determine the distance. The result of the test contained the distance, the time within which the task was accomplished and the speed of each participant. This method or approach was adapted from the work of Fowler et al. (2007).
The result of the study has been analyzed. Statistical analysis was performed in Microsoft Excel Office. This was performed twice to secure the data quality. The method of “Constant Comparison” based on “Grounded Theory” was used in the analysis of data.
According to Schreiber and Stern (2001), grounded theory is a major qualitative analysis. Grounded theory as a method pertains to a particular approach to analyze a data that has originated from a specific theoretical perspective. It involves a distinct perspective or a means to conceptualize reality through the use of data, particular strategies and techniques which are formulated to arrive at analytic objectives. Based on the study of Glaser, although the data sources become less clearly determined for the grounded theory approach, the actual strategies and techniques that are used for data analysis shall be described in greater detail by grounded theorists than methodologists for any other qualitative method. Hence, grounded theory should be treated as a formal and mature qualitative method (Schreiber and Stern, 2001).
The phrase "grounded theory" relates to the theory that is developed inductively from a corpus of data. If done well, this means that the resulting theory at least fits one data set perfectly. This contrasts with theory derived deductively from grand theory, without the help of data, and which could therefore turn out to fit no data at all (Borgatti, 2008).
Based on the study of Schreiber and Stern (2001), completed grounded theory projects have distinct style and form. The distinguishing characteristics of this theory include:
1. Grounded theory focuses on a process and trajectory which results in identifiable
2. It uses gerunds by providing an indication for any action or change;
3. It has core variable or category that ties phases and stages of the theory together; and
4. Grounded theory is abstract, but it is unique in such a way that it makes the synthesis of descriptive data which is evident on hand through its concepts and relational statements, and is usually aimed at producing mid-range theories (Schreiber and Stern, 2001).
The nature of theory on grounded theory is generally a substantive midrange theory. According to Glaser, the theory is focused on behavioral concept, such as trust, resilience, caring coping or other interesting behavioral phenomenon (Schreiber and Stern, 2001).
1. Look at document, such as field notes.
2. Look for indicators of categories in events and behavior - name them and code them in document.
3. Compare codes to find consistencies and differences.
4. Consistencies between codes (similar meanings or pointing to a basic idea) reveal categories so there is a need to categorize specific events.
5. Memo the comparisons and emerging categories.
6. Later on, the category eventually saturates when no new codes related to it are formed.
7. Eventually, certain categories direct more central focus particularly on axial categories and perhaps even core category. This will be done with a good word processor computer program. We will compare result of the study with base line information, which we will receive from our control group. The result will be reported to California Children Services (CCS), who provides funds to provide physical and occupational therapy for children with CP. Since “Regional Center” is another source of fund for the study, they were informed of the result.
8. In this study, we sought the help from an orthopedic doctor and a pediatric neurologist, who worked directly with children who are diagnosed with CP.
The Grounded Theory method was initially developed by Glaser and Strauss during the 1960s (Artinian, Giske and Cone, 2009). It is an inductive qualitative methodology which makes it possible for a researcher to identify the main concern of a group of subjects and the behaviors they use to resolve their main concern. The theory design of the grounded theory is quality unstructured interviews and participant observation are the usual data collection in formulating a general hypothesis. The other sources of data include sources such as journals, formal documents, newspaper reports, literature from the substantive area and other areas, and personal experience can be added to the data set in the form of memos.
There are three essential assumptions in this methodology and these are: First is both the underlying main concern and core category will emerge with consistent use of the method; Second is the social organization of the group exists and is available to be discovered; and Third is the concerns of the participants rather than those of a researcher shall be the emphasis of the research (Artinian, Giske and Cone, 2009). It is the method of targeting one core variable at one instance in order to develop a theory shall differentiate the classic grounded theory methodology from qualitative analysis. One more distinguishing factor identified by Glaser is the two-fold principle of (a) to enter the study of phenomenon with no preconceived ideas of what kind data shall be included; and (b) remaining to the data that are have been discovered. Based on the research of Artinian, Giske and Cone (2009), there can be no predetermined hypothesis or coding schemes that guided the analysis of the data. The third distinction following the approach of Glaser is the requirement to stay long enough in the setting to allow the researcher to ascertain the primary concern of the participants in order that the core category or process that forecasts the possible answer to the problem that is about to surface. In his theory, Glaser asserts that the theory must abide and expose the perspective of the subjects and not the one formulated by the researcher (Artinian, Giske and Cone, 2009).
In order to reveal the perspective of the subjects, there is a need to conduct multiple interviews. The most fundamental method of grounded theory of constant comparative analysis shall be based on theoretical sampling which includes: the concurrent collection, coding and analysis of data, which are to be used to direct additional data collection, which are required to develop the emerging theory. The grounded theory was advanced by constant comparison of one incident to another incident. The comparison of the incidents was recorded in the theoretical memos which comprised of the theories and ideas of codes and their relationships as they strike the analyst while coding. Through the recording of the comparisons through the use of the memos and theoretical codes, it will enable the researcher to develop the categories and hypothesizes the relationships among categories. The categories were then tested through the use of theoretical sampling until such a time that the categories are saturated as the core category materializes that shall express the behavior utilized by the subjects to find a resolution for their main concern. The goal of the grounded theory is to discover the core category (Artinian, Giske and Cone, 2009).
According to the Artinian, Giske and Cone (2009), the major strength of the grounded theory method is the ability to move data from the descriptive level to transform the conceptual level. There are actually no set of exact formula in order to perform this task and some researchers have found the progression from the descriptive level to transform to a more complicated conceptual level. The benefit that redounded to the benefit of the researcher who undertakes a grounded theory study is that such individual can progress from knowing minimal information about the main concern that is being experienced by the participants to becoming experts or learned on the theory that accounts for the behavior of the subjects of the study. The theory that is combined with the core category that works to explain relative behavior in the substantive area has a bearing for the participants and the academic community, and matches the situation because it has been developed from the data that has been gathered from the participants. To explain further, the theory can be modified if a new data shall show fresh categories or categories of the property. The most challenging that is frequently encountered is the researcher’s unwillingness to give up preconceived ideas of how the subjects should respond to the given situation (Artinian, Giske and Cone, 2009).
It was shown in literature review that a physical therapy session consisted of a sequence of exercises which included making stretches, strengthening poses and also proper positioning of the body (In Step Physical Therapy, 2009). To enable the subjects to stretch the muscles, the arms and legs were moved in such a way that produced a slow, steady pull on the muscles and make them loose. It was presumed that the increased muscle tone of the CP subjects, they have the common tendency of tightening their muscles. Hence, it is very essential to execute daily stretches to make the arms and legs agile which allowed the subjects to move and function. The strengthening exercises worked on the particular muscle groups that allowed a better support for the body posture and enhanced functional activities (In Step Physical Therapy, 2009). The positioning compelled the body to be placed in a particular position to achieve prolonged stretches. Other positions aided to diminish unnecessary tone. The subjects used positioning in various ways. For this particular exercise, several position techniques were used such as bracing, use of pillows, application of knee immobilizers and wheelchair inserts (In Step Physical Therapy, 2009). In addition, the therapists also recommended sitting positions and other treatments which served as positioning procedures that formed part of the physical therapy given the patients with CP (In Step Physical Therapy, 2009). After the study, the hypothesis of this study was proven as the children with CP, who received physical therapy in their early ages, have shown significant improvements in the daily activities which included normal activities such as ambulation, feeding, bathing and grooming. They also have better muscle movements than those who did not receive any therapy.
Based on the results of the study, for the children whose ages are between two and four years of age, they can crawl on hands and knees, stand up and take steps while holding on to an object. The GMFCS for children of this age is level 1.
According to Gage, Schwartz, Koop et al., (2009), the treatment interventions which included casting and stretching to keep the motion alignment will increase power and endurance, gait training with appropriate assistive devise or treadmill and with the use of treadmill and potentially electrical simulation that is usually combined with other functional activities. The activities like stretching, positioning and casting are often the primary recommendations to a child who is diagnosed to have a medical condition known as hypertonia, which is based on the theory that the soft tissue tightness or contracture reacts to the passive stretching. The physical therapist can manually apply the stretching through the use of external devises such as a brace or equipment which is designed to provide an elongation after a longer period of time (Gage, Schwartz, Koop et al., 2009).
After conducting some tests, it has been shown that there was conflicting evidence whether passive stretching has the possibility to improve the passive range of motion in a joint and the results have indicated that the improvements manifested minimal effect in quantity. In fact there were some pieces of evidence which have shown that passive stretching reduces that spasticity in children with CP, but without carryover to functional activities, particularly walking. Although the significant statistical findings may not have any bearing, the minimal increase or the maintenance of joint range in young, growing children can be considered as clinically significant and may often direct towards better functioning (Gage, Schwartz, Koop et al., 2009).
The parents of the patients were informed of risks and benefits of the study. They have received hands out which explained the interventions to be taken. They were informed of HIPPA regulations, and were given the right to quit at any time they deemed necessary. This research needed the approval from CCS, and Regional center. In addition, the parent’s consent was required for enrollment. Participants in this study could be from any religion, culture, ethnicity and background. It is also important the privacy of the child and the parents shall be respected. Before any information about the subject shall be used publicly, it is important that the researcher must observe respect for the privacy of any sensitive information that may affect the interest of the child. It bears stressing that children with cerebral palsy are just like normal people do and such being the case, they must also be afforded the right to privacy.
It can be concluded that the experimental research that has been conducted for children with Cerebral palsy (CP) is critical for the improvement of the of our understanding that the administration of therapeutic interventions such as physical therapy that were centered on muscle strengthening have proven to cause an improvement on the functional ability of the child. The hypothesis of this study has been confirmed on the basis of the improvements that were recorded after the participants accomplished the 500-yard distance physical endurance test.
Based on the research conducted by Sarnat, Menkes and Maria (2005), intensive physical therapy, which consists of 1 hour a day, 5 times a week has been considered as beneficial for children with spastic hemiparesis and spastic diplegia. It has been recommended that the effectiveness of the management can be monitored by gait analysis. The children who are affected with this kind of cerebral palsy were required to undergo regular treatments of physiotherapy from the time that they begin to learn how to walk, and by taking into consideration the application of contractures in the lower extremity.
Although this test was limited by a small sample size and large viability in the children’s movements, this study was able to develop dependent measures that are sensitive to the change and features of the therapy by taking into consideration the frequency of the treatment that can still be further developed (Dunn, 2008). The relationship of the changeable movement features was able to recognize the functional abilities of the children with spastic cerebral palsy. Based on the study, it was also revealed that after undergoing the group physical therapy, it manifested a considerable progress in strengthening their muscles while caused an improvement in their balance, walking endurance and gross motor function, and at the same time it enhanced the quality of life the subjects, when compared to those children who are randomized to the control group.
Based on the findings of this research with regard to the therapeutic practice, it has been shown that considerable changes have been shown after the physical therapists are trained in terms of functional physical therapy. Fong (2005) has identified that the problems of the child with CP and therapy goals can be well defined in terms of functional skills. The purpose of this study is to examine whether the motor abilities of the children with CP who received functional physical therapy have improved the motor abilities of the children who were subjects of this research, as they continue with their previous therapy based on the principle of the normalization of the quality of the movement (Fong, 2005). It is also important to take note the ability of the parents of the children with CP to carry out the home program and family functioning while providing physical therapy to their children.
After analysis of the results, it was revealed that the children who received physical therapy treatments improved their functional motor skills. Parents should be able to carry out the home program for their children with CP to provide a continuity of the therapy while improving the ability to function better. Fong (2005) has stated that parental involvement is important to be able to obtain a picture of the functional activities that a child is having a hard time dealing with because they can later on create bigger problems for the parents. Hence, it is recommended that the specific needs of the parents in order to improve the specific needs of their children must be given proper attention.
In some children with cerebral lesions, physical therapy is limited due to severe spasticity and pain. Based on the study of Fong (2005), there is a possibility that the minimal motor activity encompasses inadequate afferent input and might accentuate disturbances in autonomous activity and pain intensity. It has been proven that various approaches and treatments such as physical therapy, orthotics and surgical interventions have assisted children with cerebral palsy to perform better and enable to complete functional tasks. For children with CP, there are different modes of transcutaneous electrical stimulation that have been tried and tested to decrease spasticity and improve the function of the weak muscles which consist of tibilias anterior and quadriceps during rest or dorsiflexion exercises and spastic muscles consisting of triceps surae and hamstrings during gait (Fong, 2005). Although it was also proven that improvements were short term in majority of the cases of children with CP. The decrease of pain in muscle spasms will enable the children to make life easier and worthwhile.
It is also important that the opinion of the child should be considered in order to obtain the indication of activities that the child himself or herself will be able to perform independently. Hence, all environments should be addressed which includes the home, school or playground where the child performs activities (Fong, 2005).
Cerebral palsy is not a disease, it is not communicable, but unfortunately, it is a condition that cannot be cured. Since there is a wide range of symptoms and degree of severity, the objective of intervention is to formulate a specialized treatment which shall meet every child’s unique needs (Levine and Munsch, 2010). We are aware that there are several medications in the market that will stabilize seizures and muscle spasms. It has been identified that surgery will be able to lengthen the muscles and tendons that are too short to function normally. While physical therapy will be able to assist the child to develop necessary motor skills. The physical therapy session for a child with cerebral palsy can help improve the child’s motor abilities because it will improve his movement, flexibility and balance as proven by this study.
References:
Anittila, H., Autti-Ramo, I., Suorantam J. et al. (2008). Effectiveness of physical therapy interventions with Cerebral Palsy: A systematic Review. BioMed Central Pediatrics, 8(14). doi:10.1186/1471-2431-8-14.
Artinian, B.M., Giske, T. and Cone, P.H. (2009). Glaserian Grounded Theory in Nursing Research: Trusting Emergence. New York: Springer.
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