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Effect of Intensive Rehabilitation Programs on Motor and Cognitive Functions in Children with Cerebral Palsy

Year 2025, Volume: 11 Issue: 1, 10 - 17, 21.03.2025
https://doi.org/10.30934/kusbed.1532081

Abstract

Objective: This study aimed to investigate the impact of intensive rehabilitation programs (IRPs) on the motor and cognitive functions of children diagnosed with cerebral palsy (CP) who have undergone multi-level Botulinum toxin-A (BoNT-A) injections, aligning with their individualized treatment goals and clinical characteristics.

Methods: In this prospective controlled clinical study, a cohort of 50 children aged 4-18 years diagnosed with CP and classified as level I-IV on the Gross Motor Function Classification System (GMFCS) participated. After multi-level BoNT-A injections, participants in the study group underwent a comprehensive IRP lasting for 3 weeks, with sessions conducted 5 days a week, either half or full day, tailored to the unique needs of each child. The evaluation of outcomes encompassed the Gross Motor Function Measure-66 (GMFM-66), Observational Gait Scale (OGS), and Goal Attainment Scale (GAS) for assessing motor functions, whereas cognitive functions were measured using the Stroop Test and Auditory Verbal Learning Test (AVLT).

Results: The analysis revealed statistically significant enhancements in various parameters for both groups, including OGS, GMFM-66 total score, total goal achievement, and scores in the C, D, and E dimensions. Notably, the study group exhibited significantly greater improvements in OGS, GAS, and GMFM-66 total score, total goal achievement, and D, E dimensions' scores compared to the control group by the fourth week of intervention. Furthermore, significant improvements were observed in Stroop test S5T and S5C scores, and AVLT scores across all parameters in the study group.

Conclusion: The results of this study showed that intensive rehabilitation practices had positive effects on motor and cognitive functions in children with CP who underwent multi-level BoNT-Aapplication to spastic muscles.

References

  • Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109(suppl 109):8-14.
  • Shevell M, Dagenais L, Oskoui M. The epidemiology of cerebral palsy: new perspectives from a Canadian registry. Semin Pediatr Neurol. 2013;20(2):60-64.
  • Shevell MI. Current understandings and challenges in the management of cerebral palsy. Minerva Pediatr. 2009;61(4):399-413.
  • Pruitt DW, Tsai T. Common medical comorbidities associated with cerebral palsy. Phys Med Rehabil Clin N Am. 2009;20(3):453-467.
  • Rosenbaum P. Stewart D. The World Health Organization International Classification of Functioning, Disability, and Health: a model to guide clinical thinking, practice and research in the field of cerebral palsy. Semin Pediatr Neurol. 2004;11(1):5-10.
  • Song, CS. Relationships between physical and cognitive functioning and activities of daily living in children with cerebral palsy. J Phys Ther Sci. 2013;25(5):619-622.
  • Cornec G, Brochard S, Drewnowski G, Desguerre I, Toullet P, Fontaine A, et al. The use and outcomes of motor rehabilitation services among people with cerebral palsy change across the lifespan. Front Neurol. 2022;12:e771348.
  • Patel DR, Neelakantan M, Pandher K, Merrick J. Cerebral palsy in children: a clinical overview. Transl Pediatr. 2020;9(Suppl 1), S125-S135.
  • Mc Mahon M, Adams J. Cerebral Palsy. In: Alexander M, ed. Pediatric Rehabilitation Principles and Practice. 4th ed. Bang Printing; 2010:165–98.
  • Tur B. (2014). Özürlü Çocuklar. Delisa’nın Fiziksel Tıp ve Rehabilitasyon İlkeler ve Uygulamalar. Ankara: Güneş Tıp Kitabevi. 2014:1475–1502.
  • Damiano DL. Activity, activity, activity: rethinking our physical therapy approach to cerebral palsy. Phys Ther. 2006;86(11):1534-1540.
  • Dursun N, Akyuz M, Gokbel T, Akarsu M, Yilmaz E, Karacan C, et al. GMFCS level improvement in children with cerebral palsy treated with repeat botulinum toxin injections and intensive rehabilitation: A retrospective study. J Pediatr Rehabil Med. 2022;15(1):107-112.
  • Rahlin M, Duncan B, Howe CL, Pottinger HL. How does the intensity of physical therapy affect the Gross Motor Function Measure (GMFM-66) total score in children with cerebral palsy? A systematic review protocol. BMJ Open. 2020;10(7): e036630.
  • Arpino C, Vescio MF, De Luca A, Curatolo P. Efficacy of intensive versus nonintensive physiotherapy in children with cerebral palsy: a meta-analysis. Int J Rehabil Res. 2010;33(2):165-171.
  • Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, et al. State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep. 2020;20(2):3.
  • Carvalho I, Pinto SM, das Virgens Chagas D, Dos Santos JLP, de Sousa Oliveira T, Batista LA. Robotic gait training for individuals with cerebral palsy: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2017;98(11):2332-2344.
  • Størvold GV, Jahnsen RB, Evensen KAI, Romild UK, Bratberg GH. Factors associated with enhanced gross motor progress in children with cerebral palsy: a register-based study. Phys Occup Ther Pediatr. 2018;38(5):548-561.
  • Novak I, Mcintyre S, Morgan C, Campbell L, Dark L, Morton N, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013;55(10):885-910.
  • Löwing K, Bexelius A, Carlberg EB. Goal-directed functional therapy: a longitudinal study on gross motor function in children with cerebral palsy. Disabil Rehabil. 2010;32(11):908-916.

Effect of Intensive Rehabilitation Programs on Motor and Cognitive Functions in Children with Cerebral Palsy

Year 2025, Volume: 11 Issue: 1, 10 - 17, 21.03.2025
https://doi.org/10.30934/kusbed.1532081

Abstract

Objective: This study aimed to investigate the impact of intensive rehabilitation programs (IRPs) on the motor and cognitive functions of children diagnosed with cerebral palsy (CP) who have undergone multi-level Botulinum toxin-A (BoNT-A) injections, aligning with their individualized treatment goals and clinical characteristics.

Methods: In this prospective controlled clinical study, a cohort of 50 children aged 4-18 years diagnosed with CP and classified as level I-IV on the Gross Motor Function Classification System (GMFCS) participated. After multi-level BoNT-A injections, participants in the study group underwent a comprehensive IRP lasting for 3 weeks, with sessions conducted 5 days a week, either half or full day, tailored to the unique needs of each child. The evaluation of outcomes encompassed the Gross Motor Function Measure-66 (GMFM-66), Observational Gait Scale (OGS), and Goal Attainment Scale (GAS) for assessing motor functions, whereas cognitive functions were measured using the Stroop Test and Auditory Verbal Learning Test (AVLT).

Results: The analysis revealed statistically significant enhancements in various parameters for both groups, including OGS, GMFM-66 total score, total goal achievement, and scores in the C, D, and E dimensions. Notably, the study group exhibited significantly greater improvements in OGS, GAS, and GMFM-66 total score, total goal achievement, and D, E dimensions' scores compared to the control group by the fourth week of intervention. Furthermore, significant improvements were observed in Stroop test S5T and S5C scores, and AVLT scores across all parameters in the study group.

Conclusion: The results of this study showed that intensive rehabilitation practices had positive effects on motor and cognitive functions in children with CP who underwent multi-level BoNT-Aapplication to spastic muscles.

References

  • Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109(suppl 109):8-14.
  • Shevell M, Dagenais L, Oskoui M. The epidemiology of cerebral palsy: new perspectives from a Canadian registry. Semin Pediatr Neurol. 2013;20(2):60-64.
  • Shevell MI. Current understandings and challenges in the management of cerebral palsy. Minerva Pediatr. 2009;61(4):399-413.
  • Pruitt DW, Tsai T. Common medical comorbidities associated with cerebral palsy. Phys Med Rehabil Clin N Am. 2009;20(3):453-467.
  • Rosenbaum P. Stewart D. The World Health Organization International Classification of Functioning, Disability, and Health: a model to guide clinical thinking, practice and research in the field of cerebral palsy. Semin Pediatr Neurol. 2004;11(1):5-10.
  • Song, CS. Relationships between physical and cognitive functioning and activities of daily living in children with cerebral palsy. J Phys Ther Sci. 2013;25(5):619-622.
  • Cornec G, Brochard S, Drewnowski G, Desguerre I, Toullet P, Fontaine A, et al. The use and outcomes of motor rehabilitation services among people with cerebral palsy change across the lifespan. Front Neurol. 2022;12:e771348.
  • Patel DR, Neelakantan M, Pandher K, Merrick J. Cerebral palsy in children: a clinical overview. Transl Pediatr. 2020;9(Suppl 1), S125-S135.
  • Mc Mahon M, Adams J. Cerebral Palsy. In: Alexander M, ed. Pediatric Rehabilitation Principles and Practice. 4th ed. Bang Printing; 2010:165–98.
  • Tur B. (2014). Özürlü Çocuklar. Delisa’nın Fiziksel Tıp ve Rehabilitasyon İlkeler ve Uygulamalar. Ankara: Güneş Tıp Kitabevi. 2014:1475–1502.
  • Damiano DL. Activity, activity, activity: rethinking our physical therapy approach to cerebral palsy. Phys Ther. 2006;86(11):1534-1540.
  • Dursun N, Akyuz M, Gokbel T, Akarsu M, Yilmaz E, Karacan C, et al. GMFCS level improvement in children with cerebral palsy treated with repeat botulinum toxin injections and intensive rehabilitation: A retrospective study. J Pediatr Rehabil Med. 2022;15(1):107-112.
  • Rahlin M, Duncan B, Howe CL, Pottinger HL. How does the intensity of physical therapy affect the Gross Motor Function Measure (GMFM-66) total score in children with cerebral palsy? A systematic review protocol. BMJ Open. 2020;10(7): e036630.
  • Arpino C, Vescio MF, De Luca A, Curatolo P. Efficacy of intensive versus nonintensive physiotherapy in children with cerebral palsy: a meta-analysis. Int J Rehabil Res. 2010;33(2):165-171.
  • Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, et al. State of the evidence traffic lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep. 2020;20(2):3.
  • Carvalho I, Pinto SM, das Virgens Chagas D, Dos Santos JLP, de Sousa Oliveira T, Batista LA. Robotic gait training for individuals with cerebral palsy: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2017;98(11):2332-2344.
  • Størvold GV, Jahnsen RB, Evensen KAI, Romild UK, Bratberg GH. Factors associated with enhanced gross motor progress in children with cerebral palsy: a register-based study. Phys Occup Ther Pediatr. 2018;38(5):548-561.
  • Novak I, Mcintyre S, Morgan C, Campbell L, Dark L, Morton N, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013;55(10):885-910.
  • Löwing K, Bexelius A, Carlberg EB. Goal-directed functional therapy: a longitudinal study on gross motor function in children with cerebral palsy. Disabil Rehabil. 2010;32(11):908-916.
There are 19 citations in total.

Details

Primary Language English
Subjects Rehabilitation, Allied Health and Rehabilitation Science (Other)
Journal Section Original Article / Medical Sciences
Authors

Güler Gözpınar 0000-0002-3167-5057

Tugba Gokbel 0000-0003-2673-9092

Begüm Çapa Tayyare 0000-0003-3813-8331

Melike Akarsu 0000-0002-1834-312X

Nigar Dursun 0000-0002-6552-7204

Publication Date March 21, 2025
Submission Date August 14, 2024
Acceptance Date February 27, 2025
Published in Issue Year 2025 Volume: 11 Issue: 1

Cite

APA Gözpınar, G., Gokbel, T., Çapa Tayyare, B., Akarsu, M., et al. (2025). Effect of Intensive Rehabilitation Programs on Motor and Cognitive Functions in Children with Cerebral Palsy. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, 11(1), 10-17. https://doi.org/10.30934/kusbed.1532081
AMA Gözpınar G, Gokbel T, Çapa Tayyare B, Akarsu M, Dursun N. Effect of Intensive Rehabilitation Programs on Motor and Cognitive Functions in Children with Cerebral Palsy. KOU Sag Bil Derg. March 2025;11(1):10-17. doi:10.30934/kusbed.1532081
Chicago Gözpınar, Güler, Tugba Gokbel, Begüm Çapa Tayyare, Melike Akarsu, and Nigar Dursun. “Effect of Intensive Rehabilitation Programs on Motor and Cognitive Functions in Children With Cerebral Palsy”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 11, no. 1 (March 2025): 10-17. https://doi.org/10.30934/kusbed.1532081.
EndNote Gözpınar G, Gokbel T, Çapa Tayyare B, Akarsu M, Dursun N (March 1, 2025) Effect of Intensive Rehabilitation Programs on Motor and Cognitive Functions in Children with Cerebral Palsy. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 11 1 10–17.
IEEE G. Gözpınar, T. Gokbel, B. Çapa Tayyare, M. Akarsu, and N. Dursun, “Effect of Intensive Rehabilitation Programs on Motor and Cognitive Functions in Children with Cerebral Palsy”, KOU Sag Bil Derg, vol. 11, no. 1, pp. 10–17, 2025, doi: 10.30934/kusbed.1532081.
ISNAD Gözpınar, Güler et al. “Effect of Intensive Rehabilitation Programs on Motor and Cognitive Functions in Children With Cerebral Palsy”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi 11/1 (March 2025), 10-17. https://doi.org/10.30934/kusbed.1532081.
JAMA Gözpınar G, Gokbel T, Çapa Tayyare B, Akarsu M, Dursun N. Effect of Intensive Rehabilitation Programs on Motor and Cognitive Functions in Children with Cerebral Palsy. KOU Sag Bil Derg. 2025;11:10–17.
MLA Gözpınar, Güler et al. “Effect of Intensive Rehabilitation Programs on Motor and Cognitive Functions in Children With Cerebral Palsy”. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, vol. 11, no. 1, 2025, pp. 10-17, doi:10.30934/kusbed.1532081.
Vancouver Gözpınar G, Gokbel T, Çapa Tayyare B, Akarsu M, Dursun N. Effect of Intensive Rehabilitation Programs on Motor and Cognitive Functions in Children with Cerebral Palsy. KOU Sag Bil Derg. 2025;11(1):10-7.