Implementation of goal directed therapy and assistive devices as part of the Akwenda Intervention Program for children and young people with cerebral palsy in Uganda.

Abstract

To describe the implementation of goal-directed therapy (GDT) and provision of assistive devices (ADs) within the Akwenda Intervention Program, a structured community-based rehabilitation program, and to examine goal attainment, AD use, and caregiver perspectives in a rural setting in eastern Uganda. This study included 50 children and young people aged 2-23 years with cerebral palsy. The intervention formed part of an 11-month multi-component program including caregiver training, therapist-led sessions, communication and advocacy, GDT, and AD-provision. Therapists received structured training in collaborative goal setting using Goal Attainment Scaling (GAS). ADs, including wheelchairs, standing frames, posture support chairs, walkers, orthoses, and toileting devices, were provided with training and follow-up. Goal attainment was evaluated using GAS, while AD use and caregiver satisfaction were assessed through usage diaries and a structured questionnaire. A total of 146 goals were set, of which 63% were achieved. Most goals targeted activity (56%) and participation (32%). Participants with milder motor impairments demonstrated higher goal attainment than those with more severe impairments (<i>p</i> = 0.04). Goal attainment was moderately associated with reduced caregiver assistance in self-care (<i>r</i> = 0.41, <i>p</i> = 0.006) and reduced caregiver burden (<i>r</i> = 0.40, <i>p</i> = 0.008), but not with other child-related outcomes. Twenty-four participants received 66 ADs, of which 85% remained in use after six months. Caregiver satisfaction exceeded 80% across domains. GDT and AD-provision were feasible to implement within a community-based rehabilitation program in a rural Ugandan setting, supporting meaningful functional outcomes.