Feasibility of an Intensive Therapeutic Program for Cerebral Palsy

Sonoran UCEDD faculty, Dr. Burris "Duke" Duncan, is conducting a feasibility study designed to see if parents with a child with CP will accept and involve their child in such an intensely administered comprehensive package of care consisting of physical, occupational, and hydro-therapy given five days a week for 12 weeks (we are not including acupuncture).

We will enroll ten children with cerebral palsy who are between the ages of 12 and 36 months.  As soon as the diagnosis is made the intense program will begin.  The primary purpose is to test how accepting and how compliant the parents are.  Their attendance at scheduled therapy visits will be monitored and they will be asked to fill out a questionnaire three times over the 12 week period.  The questionnaire will assess the level of their satisfaction with the intensity of the physicotherapy  We will also evaluate the progress the children make by measuring their gross motor and fine motor function similar to what we did in the study in China.  With such a small number of children we will not be able to reach any definitive statistically valid conclusion about their progress but we will compare the changes with the results we found in the China study.

Cerebral palsy (CP) is the most frequent cause of childhood disability and is usually diagnosed within the first two years of life.  Despite vast improvements in health care, the rate at which this condition occurs has not changed.  It remains more than 3 in every 1000 live births. The condition is the result of an injury to the brain when the brain is being developed.  The injury could occur prior to delivery, at the time of delivery, or shortly thereafter.  Regardless of when the injury occurred, most people with this condition have an imbalance in muscles around joints.  Muscles that flex the limb are usually stronger than the muscles that extend the limb.  The result of the imbalance is a joint that cannot be extended fully; a contracture.  More than 400,000 individuals in the United States have cerebral palsy and it is estimated that the lifetime health care costs of a person with CP is over $900,000.  

Despite the valiant efforts of physical and occupational therapists to prevent the complications that develop from this muscle imbalance, braces of all sorts and surgical procedures are often necessary to make the child more independent and to aid in sitting balance and walking.  CP is not only important because of the disability it causes, but also because of emotional and financial burdens it places on families and society at large.

To prevent these complications and the cost, physicians at the Beijing Children’s Hospital (BCH) and in most of the large children’s hospital throughout China have instituted a ‘standard of care’ that is initiated as soon as the diagnosis is made.  The package of care consists of physical, occupational, and hydro-therapy, deep massage and acupuncture administered each weekday for 12 weeks; 60 treatments of each therapy.  The intensity of this approach is far different than the accepted standard of care in the U.S.  Numerous reports from physicians in China indicate that as a result of this intense comprehensive package of care children with CP improve their gross and fine motor function.  We have just completed a three-year collaborative investigation with colleagues at BCH that involved 91 children with CP.  It was a randomized clinical trial designed to determine if their approach, when subjected to close scientific scrutiny does indeed improve function.  Half of the children received the entire Chinese package of care and the other half received only the therapies we are more used to in the U.S. but the children in both treatment groups received their respective therapies with the same intensity.  All of the treatments were done at BCH.  We evaluated gross motor function as well as fine motor function using standard instruments or tests that assessed changes both objectively and subjectively six times over the course of the study.  Each of the objective outcome evaluations were recorded on DVDs and then sent to the U.S. where they were scored by physical therapists who did not know which of the two groups the children were in nor did they know the sequence of the evaluations they were scoring.  The results seen in both groups of children were very impressive.  The gains in function were greater than gains made by children subjected to any intervention evaluated and published in any western medical journal.  However, that is China and this is the United States.  Before this approach could even be considered for adoption here the study must be repeated and determined if it will be accepted by parents of children with cerebral palsy in this country.  That question constitutes the basis of this proposal.

For more information, please contact:
Dr. Burris "Duke" Duncan
brduncan@email.arizona.edu