Impact of Intensive Upper Limb Therapy on School Readiness Skills in Preschool Children With Unilateral Cerebral Palsy

Abstract

Date Presented 03/23/24

Engagement in high-intensity, motor-based therapeutic activity is associated with improvements in school readiness for preschool-age children with unilateral cerebral palsy with or without the inclusion of cognitive development skill training.

Primary Author and Speaker: Angela Shierk

Additional Authors and Speakers: Heather Roberts

Contributing Authors: Fabiola Reyes, Nancy Clegg, Mauricio R. Delgado, Emily Kirby, Lindsay Miles, Rebecca Dharamraj, Ariel Alexander, Joe De La Torre

PURPOSE: Preschool-aged children with unilateral cerebral palsy (UCP) encounter challenges using their hands, which can contribute to a gap in school readiness skills. This study compared the impact of a motor-only version of Therapy Together (TTM), an 8-week, group-based pediatric constraint-induced movement therapy program combined with caregiver coaching and in-home training, to a motor plus cognition (TTMC) version of the program on school readiness.

DESIGN: A prospective quasi-experimental study. Participants were recruited from a tertiary center using volunteer sampling. The study included preschool-aged children with UCP who demonstrated an interest in objects and attempted to reach/grasp objects with the impaired upper extremity. The study excluded children with uncontrolled epilepsy, a significant visual impairment, or severe behavioral problems.

METHOD: The primary outcome measure was the Developmental Assessment of Young Children (DAYC-2) measured pre-intervention and post-intervention. DAYC-2 scores were analyzed using a multivariate analysis for effects within each group and group comparison.

RESULTS: 14 children with UCP (9 right hemiplegia, MACS level II n=11, level III n=3) participated (11 males) age range of 14-55 months (median age 37 mo). Both interventions caused statistically significant growth in cognition (F(1,14)=9.518, p=.008), communication (F(1,14)=10.133, p=.007), physical development (F(1,14)=22.00, p< .001), and adaptive behavior (F(1,14)=5.928, p=.029). Statistically significant growth was not observed in the social-emotional domain for either group (F(1,14)=.679, p=.424), and a statistically significant difference between the TTM and TTMC groups was not found in any of the DAYC-2 domains.

CONCLUSIONS: Overall, engagement in high-intensity, motor-based therapeutic activity is associated with improvements in school readiness for preschool-aged children with UCP regardless of the inclusion of cognitive development skill training.

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