The Impact of Dosage Parameters on Motor Function in Children with Cerebral Palsy: A Systematic Review.

Special Interest Report
Population: Pediatric

Samantha Mohn-Johnsen, PT, DPT, OCS, PCS, Assistant Professor of Physical Therapy, The College of St. Scholastica

Steven Cope, ScD, OT/L, Professor and Chair, Department of Occupational Therapy, The College of St. Scholastica

Keywords: Plasticity, Cerebral palsy, Dosage, Frequency

Purpose: The aim of this study is to provide an updated review of the literature regarding treatment dosage for children with cerebral palsy (CP) using the parameters that are consistent with the definition of dosage derived during the Research Summit III. The focused research questions for this review examine the manipulation of dosage through the variables of time, frequency, and intensity.

Description: A systematic review of the literature was performed using predefined inclusion and exclusion criteria. During a search of ten electronic databases with key search terms of cerebral palsy, children, intermittent, intes*, rehabilitation, effort, and dosage, 276 titles were found with thirty articles meeting the inclusion criteria for full review. Two authors independently extracted data from each selected article, and methodological quality of each article was assessed using a modification of Steultjens et al. (2004). Controlled trials were assessed as having high or low quality based on meeting criteria thresholds in three rating categories: internal validity, descriptive criteria, and statistics. Similarly, other designs were assessed as having sufficient or insufficient quality based on meeting relevant criteria thresholds within the same rating categories. Ultimately, 16 articles were included in the full review capturing results of 412 subjects ranging from GMFCS Level I to V and ages four months to sixteen years. Thirteen of the articles were considered to have high or sufficient levels of evidence.

Summary of Use: Of the dosage variables considered in this systematic review, time was the variable most often manipulated (ten studies), frequency was manipulated in three studies, and both time and frequency were manipulated in three studies. No studies investigated the variable of intensity. The overall findings suggest that manipulating time and/or frequency may result in better motor function for those children who received higher total dosing of therapy time and/or frequency; however, these benefits were not consistent across all studies and relatively few showed clinically significant improvements.

Importance to Members: This review provides the most current evidence regarding the effect of dosage on motor function for children with CP. The mixed results from this review suggest there is insufficient evidence to support the implementation of high versus low dosage of therapy. Additionally, this review highlights the need for studies which investigate the effects of intensity of effort. In summary, further research is needed to clarify the relationship between the dosage variables of time, frequency, and intensity on motor function for children with CP.

Mohn-Johnsen, Samantha , PT, DPT, OCS, PCS; Cope, Steven , ScD, OT/L. The Impact of Dosage Parameters on Motor Function in Children with Cerebral Palsy: A Systematic Review.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online.