Outcomes of a Modified Intensive Physical Therapy Program for a 4-year Old Child with Cerebral Palsy

Background & Purpose: A growing body of evidence supports the use of intensive physical therapy (PT) programs for improving body structure and function, activity, and participation in children with cerebral palsy (CP). The purpose of this case report is to assess the outcomes of a 6-week modified intensive PT program for a 4-year-old child with CP, Gross Motor Function Classification System (GMFCS) Level IV.

Case Description: The focus of this case report is on a 4-year old boy with spastic quadriplegic CP, GMFCS Level IV. He is Twin A of a 29-week pregnancy and was diagnosed with a left Grade 3 IVH and a right Grade 4 IVH shortly after birth. He had been receiving direct PT for 90 minutes/week for the 12 months leading up the 6-week intensive. His family reported that they wanted the child to improve his ability to sit and move more independently and utilize his right hand for play and self-help activities. The child’s age, diagnosis, current level of function, and clinical opinion of his treating physical therapist collectively informed the decision to utilize a 6-week, modified intensive model of PT to address these goal areas.

Outcomes: Upon completion of the 6-week PT intensive, the child’s performance improved on 5 of the 6 outcome measures utilized to assess baseline function and response to intervention. He was able to maintain short-sitting for 46.4 seconds and tailor sit independently on the floor for 60.02 seconds. His ability to hold a modified quadruped position increased fourfold. He continued to need moderate assistance at his pelvis and trunk to transition from sit to stand, but his time to perform a modified Five Time Sit to Stand Test decreased. Utilizing his right hand, the child was able to grasp and pull out 3 pegs from a modified 9-Hole Peg Test. With his shoulder flexed to 90 degrees, he lacked only 5 degrees of elbow extension, indicating improvement in active range of motion and functional upper extremity use. The child’s assisted walking ability did not improve.

Discussion: A 4-year old boy with spastic quadriplegia CP, GMFCS Level IV, completed a 6-week PT intensive. He received 240 minutes of PT per week, and each treatment session incorporated balance, transition and gait training; standing; whole body vibration; and constraint-induced movement therapy. The increased PT treatment time per week and ample opportunities for practice and motor learning are thought to have contributed to the child's improvement in functional gross motor skills over a relatively short period of time. He demonstrated improvements in sitting, transition skills, reaching, and upper extremity range of motion following completion of the intensive. The results should be interpreted with caution, as the outcomes of a single-subject study have limited generalization to a larger population; however, the outcomes suggest that alterations in the frequency, intensity, time and type of the PT intervention contributed to positive changes. Exploring the effectiveness of a longer duration intensive would be beneficial to determine if greater improvements in body structure and function, activity, and participation could be gained.