Goal-directed functional therapy: A longitudinal study on gross motor function in children with cerebral palsy

PURPOSE: To investigate gross motor function and goal attainment in children with cerebral palsy before, during and after goal-directed functional therapy (GDT), to evaluate body functions, and explore relationships. METHOD: Prospective longitudinal intervention study. Twenty-two children, uni- or bilateral CP, 1-6 years (mean: 46 months SD: 16 months), classified in GMFCS and MACS level I-IV participated. Outcome measures were Gross Motor Function Measure (GMFM-66), performed at seven occasions, Goal Attainment Scale, assessments of passive range of motion, spasticity and selective motor control (SMC). Baseline, the GDT-intervention and the follow-up period were 12 weeks each. RESULTS: Improvements were demonstrated in GMFM-66 during the intervention (mean difference: 5.07, CI: 3.8-6.4, p < 0.001). The baseline and follow-up assessments were stable. Evaluations of ankle dorsiflexion displayed small improvement (mean difference: 9 degrees , CI: 5-13, p < 0.001). Estimations of spasticity and SMC did not demonstrate significant changes. Goal attainment to the expected level or higher was achieved in 93/110 goals and further improved at the long-term follow-up (103/110). CONCLUSION: Gross motor function improved during GDT, and was maintained 12 weeks later. The goals were reached to a high extent, and the children gradually progressed towards their goals after the end of the intervention. The therapy did not induce any deterioration of body functions.