Activity focused and goal directed therapy for children with cerebral palsy--do goals make a difference?

Abstract

To compare the effects of goal directed functional therapy (GDT) to activity focused therapy (AT) for preschool children with cerebral palsy (CP) on everyday activities and gross motor function. Another aim was to evaluate goal attainment in the GDT group. A prospective intervention study comparing two types of intervention carried out in ecological settings. Forty-four children with CP, (25 boys, 19 girls; mean age 4 year 1 month [SD 1 year 5 month]), Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels I-IV participated. Twenty-two children were recruited to the GDT group and 22 to the AT group. Outcome measures were the Pediatric Evaluation of Disability Inventory (PEDI), and the Gross Motor Function Measure-66. Furthermore, goal attainment scaling (GAS) was used in the GDT group. The assessments were performed before and after an intervention period of 12 weeks. The children in the GDT group improved more in most aspects of everyday activities measured by the PEDI than the children in the AT group (p < 0.001). Only functional skills in social function did not differ between the groups. Furthermore, gross motor function improved more in the GDT group than in the AT group (p < 0.001). Goal attainment to the expected level or higher was achieved in 93/110 goals in the GDT group. The variance of improvements in the different PEDI scales in the GDT group could not be explained by either age, sex, distribution of CP, GMFCS or MACS levels. GDT demonstrated clear gains for children with cerebral palsy in everyday activities and gross motor function in comparison to AT.