Ann Rehabil Med.  2015 Aug;39(4):624-629. 10.5535/arm.2015.39.4.624.

Gross Motor Function Outcome After Intensive Rehabilitation in Children With Bilateral Spastic Cerebral Palsy

• Lee SH
• Shim JS
• Kim K
• Moon J
• Kim M

• KMID: 2148234
• DOI: http://doi.org/10.5535/arm.2015.39.4.624

Abstract

OBJECTIVE
To compare gross motor function outcomes in children with moderate to severe degrees of bilateral spastic cerebral palsy (CP) who received either intensive inpatient rehabilitation or intermittent rehabilitation on an outpatient basis.
METHODS
A non-biased retrospective chart review was done for patients diagnosed with bilateral spastic CP who received rehabilitation therapy. The intensive rehabilitation group (inpatient group) agreed to be hospitalized to receive 22 sessions of physical and occupational therapy per week for 1 month. The intermittent rehabilitation group (outpatient group) received four sessions of physical and occupational therapy per week for 3 months in an outpatient setting. Changes in the total score on the Gross Motor Function Measure (GMFM) between baseline and the follow-up period were analyzed.
RESULTS
Both groups showed significant improvements in total GMFM scores at the follow-up assessment compared to that at baseline (p=0.000 for inpatient group, p=0.001 for outpatient group). The increase in mean total GMFM score after 1 month was significantly greater in the inpatient group than that in the outpatient group (p=0.020). Higher increase in GMFM score was observed in younger subjects as revealed by the negative correlation between age and the increase in GMFM score after 1 month (p=0.002, r=-0.460).
CONCLUSION
Intensive inpatient rehabilitation therapy for patients with bilateral spastic CP of moderate to severe degree was more effective for improving gross motor function than intermittent rehabilitation therapy on an outpatient basis.

Keyword

Intensive rehabilitation; Cerebral palsy; The Gross Motor Function Measure; Age

MeSH Terms

Cerebral Palsy*
Child*
Follow-Up Studies
Humans
Inpatients
Muscle Spasticity*
Occupational Therapy
Outpatients
Rehabilitation*
Retrospective Studies

Figure

• 

  Fig. 1 Flow diagram of the study participants. CP, cerebral palsy; GMFCS, Gross Motor Function Classification Scale.

• 

  Fig. 2 Mean increase of total GMFM score after 1 month. GMFCS, Gross Motor Function Classification Scale; GMFM, Gross Motor Function Measure.

• 

  Fig. 3 Correlation between age and increase in the GMFM after 1 month. *Spearman correlation coefficient (p=0.002). GMFM, Gross Motor Function Measure.

Reference

1. Baxter P, Morris C, Rosenbaum P, Paneth N, Leviton A, Goldstein M, et al. The definition and classification of cerebral palsy. Dev Med Child Neurol. 2007; 49:1–44.

2. Beckung E, Hagberg G, Uldall P, Cans C. Surveillance of Cerebral Palsy in Europe. Probability of walking in children with cerebral palsy in Europe. Pediatrics. 2008; 121:e187–e192. PMID: 18070932.

3. Russell DJ, Rosenbaum PL, Cadman DT, Gowland C, Hardy S, Jarvis S. The gross motor function measure: a means to evaluate the effects of physical therapy. Dev Med Child Neurol. 1989; 31:341–352. PMID: 2753238.

4. Russell DJ, Avery LM, Rosenbaum PL, Raina PS, Walter SD, Palisano RJ. Improved scaling of the gross motor function measure for children with cerebral palsy: evidence of reliability and validity. Phys Ther. 2000; 80:873–885. PMID: 10960935.

5. Avery LM, Russell DJ, Raina PS, Walter SD, Rosenbaum PL. Rasch analysis of the Gross Motor Function Measure: validating the assumptions of the Rasch model to create an interval-level measure. Arch Phys Med Rehabil. 2003; 84:697–705. PMID: 12736885.

6. Ko J, Kim M. Reliability and responsiveness of the gross motor function measure-88 in children with cerebral palsy. Phys Ther. 2013; 93:393–400. PMID: 23139425.

7. Ko J, Kim M. Inter-rater Reliability of the K-GMFM-88 and the GMPM for children with cerebral palsy. Ann Rehabil Med. 2012; 36:233–239. PMID: 22639748.

8. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997; 39:214–223. PMID: 9183258.

9. Palisano RJ, Hanna SE, Rosenbaum PL, Russell DJ, Walter SD, Wood EP, et al. Validation of a model of gross motor function for children with cerebral palsy. Phys Ther. 2000; 80:974–985. PMID: 11002433.

10. Wood E, Rosenbaum P. The gross motor function classification system for cerebral palsy: a study of reliability and stability over time. Dev Med Child Neurol. 2000; 42:292–296. PMID: 10855648.

11. Palisano RJ, Cameron D, Rosenbaum PL, Walter SD, Russell D. Stability of the gross motor function classification system. Dev Med Child Neurol. 2006; 48:424–428. PMID: 16700931.

12. Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol. 2002; 44:633–640. PMID: 12227618.

13. Krageloh-Mann I, Petersen D, Hagberg G, Vollmer B, Hagberg B, Michaelis R. Bilateral spastic cerebral palsy: MRI pathology and origin. Analysis from a representative series of 56 cases. Dev Med Child Neurol. 1995; 37:379–397. PMID: 7768338.

14. Nelson KB. Causative factors in cerebral palsy. Clin Obstet Gynecol. 2008; 51:749–762. PMID: 18981800.

15. Tsorlakis N, Evaggelinou C, Grouios G, Tsorbatzoudis C. Effect of intensive neurodevelopmental treatment in gross motor function of children with cerebral palsy. Dev Med Child Neurol. 2004; 46:740–745. PMID: 15540634.

16. Shamir M, Dickstein R, Tirosh E. Intensive intermittent physical therapy in infants with cerebral palsy: a randomized controlled pilot study. Isr Med Assoc J. 2012; 14:737–741. PMID: 23393711.

17. Rosenbaum PL, Walter SD, Hanna SE, Palisano RJ, Russell DJ, Raina P, et al. Prognosis for gross motor function in cerebral palsy: creation of motor development curves. JAMA. 2002; 288:1357–1363. PMID: 12234229.

18. Alotaibi M, Long T, Kennedy E, Bavishi S. The efficacy of GMFM-88 and GMFM-66 to detect changes in gross motor function in children with cerebral palsy (CP): a literature review. Disabil Rehabil. 2014; 36:617–627. PMID: 23802141.

19. Russell DJ, Rosenbaum PL, Avery LM, Lane M. Gross motor function measure (GMFM-66 and GMFM-88) user's manual. London: Mac Keith Press;2002.