Intensive Therapy Methodology

There is a growing body of evidence that is leading therapists to choose a more intensive approach to therapy when managing the child with cerebral palsy. Most of these intensive programs utilize the ‘motor learning’ theory along with progressive resistive exercise training and partial weight bearing gait training to structure the program’s sessions. The following are a list of references for further review on the methodology behind intensive therapeutic interventions.

Motor Learning Theory:

  1. Schmidt RA. Motor learning principles for physical therapy. In: Foundation for Physical Therapy. Contemporary Management of Motor Control Problems: Proceedings of the II-STEP Conference. Alexandria, VA: Foundation for Physical Therapy, 1991.
  2. Bar-HaimS, Harries N, Nammourah I, Oraibi S, Malhees W, Leoppky J, Perkins NJ, Belokopytov M, Kaplanski J, Lahat E. Effectiveness of motor learning coaching in children with cerebral palsy:a randomized controlled trial. Clin Rehabil. 2010 Nov;24(11):1009-20. Epub 2010 Jun 24.

***Motor Learning Theory describes the practice needed for motor skill acquisition. Practice needs to be intensive, varied in its context and appropriate feedback provided.

Treadmill Training:

  1. Chemg RJ, Liu CF, Liu TH, Hong RB, Su FC. Effects of gait training with treadmill and suspension in children with spastic cerebral palsy. ISB XXth Congress-ASB 29th Annual Meeting. 2009 July 31.
  2. Martin R. Schindl, Claudia Forstner, Helmut Kern, Stefan Hesse. Treadmill training with partial body weight supporting nonambulatory patients with cerebral palsy. Arch Phys Med Rehabil 2000 March;81:301-306.

**These articles reinforce the motor learning theory being used during acquisition of ambulatory skills in children with CP

***There are other articles that discuss the (CPG) Central Pattern Generators which originate in the spinal cord and can elicit a rhythmical stepping pattern.

Strength Training:

  1. Vanessa A Scholtes, Annet J Dallmeijer, Eugene A Rameckers, Olaf Verschuren, Els Tempelaars, Maartje Hensenand Jules G Becher. Lower limb strength training in children with cerebral palsy – arandomized controlled trial protocol for functional strength training based on progressive resistance exercise principles. BMC Pediatrics 2008, 8:41.
  2. Verschuren O, Ada L, Maltais DB, Gorter JW, Scianni A, Ketelaar M. Muscle strengthening in children and adolescents with spastic cerebral palsy: considerations for future resistance training protocols. Phy.Ther. 2011;91:(1130-1138)

*Both articles support the use of resistive strength training with children with CP.

**These articles describe how much of what we are doing in the 3 weeks of strengthening is most likely motor neuron adaption or recruitment of motor neurons. This is typical with any population when initiating strengthening exercises. Each new exercise takes practice to learn the motor component and with each set the body recruits more motor neurons. Our children with CP may take more time with this since learning new motor activities can be difficult, therefore more time and feedback is needed with each exercise to ensure minimal compensatory muscles are recruited during the exercise.

** The most recent article discusses treatment frequency for muscle strengthening being 2-3 days per week with 48-72 hrs between for recovery time. This being the case, muscles requiring more power and /or muscle mass are grouped and should not be trained on consecutive days. Postural muscles on the other hand require more ‘muscle endurance’ and therefore require more repetitions per set and less time to recover. (40-60hrs) These would follow the same rule as above and be the focus of the Ther Ex.Program opposite the days that power and muscle mass is being worked on.

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