Long-term change of gross motor function in children with cerebral palsy; an observational study of repeated periods of intensive physiotherapy in a group setting

Purpose: To examine change in gross motor function in children with cerebral palsy (CP) following repeated periods of intensive physiotherapy in real-life group-settings, with expected motor development taken into consideration. Material and methods: This prospective, observational study included 120 children with CP. They participated in 2-10 periods of intensive goal-directed, activity-focussed group training. The intervention model was pragmatic, taking GMFCS-level and other knowledge of the participating children into consideration. They typically attended groups of 4-6 children, lasting 2-2.5 h/d, 3 d a week over 6 weeks. Fifty children participated in at least four successive training periods. They were included in the analysis of longitudinal change, assessed by the Gross Motor Function Measure (GMFM-66), and analysed by repeated analysis of variance and multiple regressions. Results: Mean scores relative to age-related development curves improved after separate intensive training periods, but dropped somewhat between periods. Longitudinal change was explored in a subsample of 50 children who participated in at least four successive training periods. Statistical significant improvement (p < .05) in pre-test scores beyond age-related development curves was demonstrated from period 1-3, and 1-4 (mean 25 months, SD 11), including children at all levels of the Gross Motor Function Classification System (GMFCS). Conclusions: At least two periods of intensive group training was needed in children with CP to obtain improvement of gross motor function above what can be expected from natural development over time.